Medicare in Michigan
Key Takeaways
- Medicare in Michigan is available to legal U.S. citizens 65 or older.
- When you are eligible for Medicare in MI, you can sign up during the Annual Enrollment Period or a Special Enrollment PeriodA Special Enrollment Period is an opportunity outside of a standard enrollment period in which your specific circumstances allow you an opportunity to make changes to your Medicare-related coverage. .
- The cost of Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). in Michigan depends on several factors, including your income and how long you’ve worked.
From farmland to urban areas to lake life, Michigan has something for everyone. And if you’re a U.S. citizen who’s 65 or older, that includes Medicare.
Before you enroll in Medicare in Michigan, there are some details you’ll want to understand to get the most out of your coverage. How does Medicare in MI work? Are there different plans? How much does Medicare cost? Whether you’re in the Upper Peninsula or down in Detroit, here is information to help you enroll in Medicare in Michigan.
What Medicare coverage is right for my specific situation?
Who Qualifies for Medicare in Michigan?
To be eligible for Medicare in Michigan, you must be:
- 65 or older
- A legal United States citizen
What Does Medicare Cover in Michigan?
Medicare covers medically necessary and preventive services, as well as stays at hospitals, nursing homes, and skilled nursing facilities. These essential benefits include:
1. Outpatient care
2. Emergency service
3. Maternity and newborn care
4. Prescription drugs
5. Pediatric services
6. Laboratory services
7. Rehabilitation and habilitation services
8. Mental health and substance abuse
9. Preventive or wellness services
10. Hospitalization
Find the Medicare Plan that works for you.
What Does Medicare in Michigan Not Cover?
Medicare doesn’t cover everything. You have the option to enroll in Part D for prescription drug coverage and Medicare Supplement insurance for services like eye exams, dentures and most dental care, long-term care, cosmetic surgery, acupuncture, some footcare and hearing aids.
If you want a single plan to bundle Parts A and B with Part D and other services, consider Medicare Advantage.
Looking for dental, vision and hearing coverage?
What Is the Best Medicare Plan in Michigan?
Each person’s healthcare needs are unique. To determine the Medicare plan in Michigan that will fit your needs, here are some things to consider:
- Assess your needs. Check out our Enrollment Checklist page.
- Medicare Star Ratings. This is also known as the Star Rating System.
- Consider each plan’s pros and cons. Make sure you understand what each offers.
- Learn little-known tips. Our Pro Tips page will help Medicare in Michigan make sense.
- Contact GoHealth: If you are ready to enroll in Medicare in MI, start with GoHealth. Our licensed insurance agents discuss your needs and shop for plans in your area that fit what you’re looking for.
How Do I Apply for Medicare in Michigan?
To apply for Medicare in Michigan, you can do one of the following:
- Apply online at with Social Security
- Visit a local Social Security office in Michigan
- Enroll over the phone at 1-800-772-1213 (TTY: 1-800-325-0778).
- Did you work for a railroad? You may be able to enroll through the Railroad Retirement Board. To find out, contact the RRB at 1-877-772-5772.
Enrolling in Medicare in MI?
When it’s time for you to enroll in Medicare, whether you’re turning 65 or enrolling again, it’s important to know the enrollment periods.
Turning 65 and New to Medicare?
The Initial Enrollment Period (IEP) is when new enrollees sign up for Medicare the year they turn 65. IEP generally starts three months before you turn 65 and remains open for another three months after your birth month.
Already Enrolled in Medicare in MI?
The Medicare Open Enrollment Period, also called the Annual Enrollment Period (AEP), allows you to change from Original Medicare to Medicare Advantage (or vice versa). You may also switch Medicare drug plans. AEP happens each year from Oct. 15 to Dec. 7.
Medicare General Enrollment Period (GEP) is useful If you did not enroll in Medicare when you were first eligible. You can sign up for Original Medicare in Michigan during the General Enrollment Period each year from Jan. 1 to Mar. 31.
Medicare Advantage Open Enrollment Period (OEP), held annually from Jan. 1 to Mar. 31, is the time to enroll in a different Medicare Advantage plan, or switch back to Original Medicare. You must already be enrolled in a Medicare Advantage plan on the 1st of January to qualify for this enrollment period.
How Much Is Medicare in Michigan?
While there are some standard costs to share, it really depends on several factors. If you have Original Medicare, here are the costs you can expect to pay for Medicare in Michigan in 2025:
Medicare Part A
Premium:
- Typically no-cost if you or your spouse worked 10 or more years
- You or your spouse worked between 7.5 and 10 years: $285 a month
- You or your spouse worked fewer than 7.5 years: $518 a month
Deductible:
- $1,676 each plan period
Copayments & coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare Part B
Premium:
- $185 monthly and up (income-based)
Deductible:
- $257 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare Part D
Premium:
- Income-based; varies by plan
Deductible:
- No more than $590 in 2025
Copayments & coinsurance:
- Plan- and drug-specific
What Are the Parts of Medicare?
The parts of Medicare work in different ways to provide services and care. Knowing the differences between Original Medicare and Medicare Advantage can give you the tools you need to make the right choice. The same is true of knowing about Medigap and Part D prescription drug plans. Here’s a rundown:
Original Medicare (Part A and Part B)
Original Medicare is a federal insurance program made up of Part A and Part B.
- Part A: Provides hospital coverage. This can include inpatient hospital stays, skilled nursing and nursing home stays, and hospice and home health care
- Part B: The portion of Original Medicare that covers medically necessary and preventive services.
Medicare Advantage (Part C)
Medicare Advantage (Part C) substitutes for Original Medicare (Part A & B), offering the same coverage. Along with Part A and B benefits, Medicare Part C plans usually bundle additional services like dental, hearing, vision, and prescription drug coverage.
Part D and Medigap
If you’re enrolled in Medicare in Michigan, it’s important to know that there may be services you need that aren’t covered by Parts A and B alone. You may want to consider the other two forms of Medicare coverage:
Medicare Part D prescription drug plans are standalone plans that provide prescription drug coverage. Original Medicare enrollees need to add Part D separately if they want their prescriptions covered. However, Medicare Advantage Plans usually include Part D coverage.
Medicare Supplement Insurance, or Medigap policies are private insurance plans that help cover “gaps” in Original Medicare. These plans cover some of the out-of-pocket costs such as deductibles, coinsurance, and copays.
What Are the Parts of Medicare?
The parts of Medicare work in different ways to provide services and care. Knowing the differences between Original Medicare and Medicare Advantage can give you the tools you need to make the right choice. The same is true of knowing about Medigap and Part D prescription drug plans. Here’s a rundown:
Original Medicare (Part A and Part B)
Original Medicare is a federal insurance program made up of Part A and Part B.
- Part A: Provides hospital coverage. This can include inpatient hospital stays, skilled nursing and nursing home stays, and hospice and home health care
- Part B: The portion of Original Medicare that covers medically necessary and preventive services.
Medicare Advantage (Part C)
Medicare Advantage (Part C) substitutes for Original Medicare (Part A & B), offering the same coverage. Along with Part A and B benefits, Medicare Part C plans usually bundle additional services like dental, hearing, vision, and prescription drug coverage.
Part D and Medigap
If you’re enrolled in Medicare in Michigan, it’s important to know that there may be services you need that aren’t covered by Parts A and B alone. You may want to consider the other two forms of Medicare coverage:
Medicare Part D prescription drug plans are standalone plans that provide prescription drug coverage. Original Medicare enrollees need to add Part D separately if they want their prescriptions covered. However, Medicare Advantage Plans usually include Part D coverage.
Medicare Supplement Insurance, or Medigap policies are private insurance plans that help cover “gaps” in Original Medicare. These plans cover some of the out-of-pocket costs such as deductibles, coinsurance, and copays.
What Is the Best Medicare Advantage Plan in Michigan?
Finding the best Medicare Advantage in Michigan comes down to which plans provide the best fit for your personal needs. There are various MA plan types to choose from and plans offered can vary based on where you live.
- Health Maintenance Organization (HMO) plans use a network of doctors, hospitals and other providers to treat an insurance company’s customers.
- Preferred Provider Organization (PPO) plans allow you to see any doctor in your provider network without a referral from your primary care physician.
- Private Fee-for-Service (PFFS) plans pay healthcare providers separately for each service.
- Special Needs Plans (SNPs) are designed specifically for beneficiaries with specific conditions, diseases, or other characteristics. D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
Who Qualifies for Medicare Assistance Programs?
Need help paying for your Medicare? Whether you’re prepping for your Initial Enrollment Period or looking to lower your out-of-pocket costs, there are several low-income resources for Medicare plans in Michigan. Here are a few examples:
Medicare Savings Program
With a Medicare Savings Program (MSP), you may be able to lower the out-of-pocket costs associated with your Part B coverage. The Michigan MSP is based on your income and resources. If you qualify, a MSP may pay part or all of your premium, deductible, and coinsurance.
Medicare Extra Help
Also known as the Low Income Subsidy (LIS), Extra Help is financial assistance designed to help low-income Medicare enrollees afford their Part D coverage. If your income qualifies, you can get help paying for your premium, deductible, and prescription drug costs.
Programs for All-Inclusive Care for the Elderly (PACE)
PACE is designed to provide nursing home-level care to those that aren’t ready to move into a facility. If you qualify, you may be able to receive that care at home and in your community. In Michigan, eligibility starts at 55 and you must live within a PACE service area.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 2,037,871 people are enrolled in Medicare Part A and B in Michigan. The total number of beneficiaries enrolled in Medicare Advantage increased from 917,848 to 1,058,263 year over year. Medicare Advantage participation in Michigan went from 45.95% to 51.93% year over year. If you’d like to dive deeper into how Medicare in Michigan breaks down across the state, we provide a glance at who is using Medicare and how.
2,037,871 Beneficiaries with Part A & Part B
1,058,263 Medicare Advantage Beneficiaries
51.93% Medicare Advantage Participation Rate
54.90% Female
45.10% Male
83.13% Non-Hispanic White
10.25% African American
1.92% Hispanic
4.70% Other/Unknown
20.73% Eligible for Medicaid
1.06 Average HCC Score
$10,375.55 Actual Per Capita Costs
19.47% Hospital Readmission Rate
28.90% % of Beneficiaries with an Emergency Department Visit
917,848 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
45.95% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Michigan Department of Insurance and Financial Services (DIFS)
https://www.michigan.gov/difs/
What should I know about the Michigan Department of Insurance and Financial Services (DIFS)?
DIFS can help if you have questions or complaints about insurance companies and HMOs.
Michigan Department of Health and Human Services
COVID-19 questions: call 888-535-6136
https://www.michigan.gov/mdhhs
What should I know about the Michigan Department of Health and Human Services?
Visit MDHHS to sign up for Medicaid and find resources for caregivers and seniors in your community.
Michigan Department of Military & Veterans Affairs
Fax: 1-984-204-8343
https://www.michigan.gov/dmva/branches/state-operations
What should I know about the Michigan Department of Military & Veterans Affairs?
The MDMVA can help with housing assistance, employment resources, benefits, and claims.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in Michigan about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.gov.
- Special Needs Plans (SNP). Medicare.gov.
- Medicare Savings Programs. Michigan.gov.
- Program of All-Inclusive Care for the Elderly (PACE). Michigan.gov.
- Yearly deductible for drug plans. Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.