Resources for Michigan beneficiaries
State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.
In Michigan you can reach SHIP at 1-800-803-7174 or online here.
Snapshot of Medicare in Michigan
- Total Medicare enrollment in Michigan
- Michigan’s Medigap subsidy program
- Guaranteed access to Medigap for under-65 enrollees
- Eligibility: Age versus disability
- Medicare spending per beneficiary and statewide
- Medicare Advantage in Michigan
- Medicare Part D in Michigan
- Health insurance for Michigan residents under age 65
Total Medicare enrollment in Michigan
As of September 2018, there were 2,022,406 Medicare beneficiaries in Michigan, which is 20 percent of its total population. That compares with about 18 percent of the United States population enrolled in Medicare.
In raw numbers, Alaska has the fewest Medicare beneficiaries at 96,641 and California (which has about an eighth of the country’s population within its borders) has the most at 6.1 million (15 percent of its population). This doesn’t count the US Territories, which mostly have low total enrollment in Medicare (Northern Mariana Islands had just 2,358 Medicare enrollees in September 2018).
Michigan’s Medigap subsidy program
Michigan’s Medigap subsidy program helps eligible enrollees pay their Medigap premiums. Enrollees with household income up to 225 percent of the poverty level are eligible for assistance (for a single person, that’s a little over $27,000 in income; for a household of two, it’s about $37,000).
The subsidy program pays $40 or $65 per month towards the enrollee’s premiums, depending on their age (this is changing to at $35 or $56 per month subsidy as of April 2019). Disabled Medigap enrollees under age 65 are generally charged much higher premiums for their Medigap coverage, so the subsidy is larger, at $125 per month (it will be $110/month as of April 2019). The enrollee is responsible for the remainder of the Medigap premium after the subsidy is applied.
Medigap access for people under the age of 65
Federal law protects enrollees’ access to Medigap coverage, but only in the six months after they turn 65 and are enrolled in Medicare A and B (and in limited circumtances that trigger a special enrollment period with guaranteed issue rights). There’s no federal rule protecting access to Medigap for Medicare enrollees who are under age 65 and enrolled in Medicare due to a disability
But Michigan requires “a limited number” of insurer to offer Medigap Plans A and C to enrollees under age 65. Although the plans are required to be guaranteed-issue, the premiums can be higher than the insurers would charge for an enrollee who is eligible for Medicare due to turning 65.
Breakdown of the aged vs. disabled
Individuals who qualify by virtue of their age alone make up 82 percent of Michigan Medicare recipients. The balance — 18 percent — are on Medicare as the result of a disability.
Kentucky has the highest percent of Medicare recipients listed as disabled (24 percent), followed by Alabama, Mississippi, and Arkansas at 23 percent, and West Virginia at 22 percent. Hawaii has the smallest percentage at 10 percent, followed by New Jersey at 13 percent, and North and South Dakota at 12 percent each.
Medicare spending per recipient
As of 2015, Medicare paid about $9,690 annually per enrollee in Michigan. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas). The report only considers spending in Original Medicare, as opposed to Medicare Advantage.
Medicare spending overall
In total Medicare spending on Medicare, Michigan ranked #8 in 2014, with $20.9 billion. With the largest and smallest numbers of recipients, itʼs no surprise that California accounted for $64.8 billion of overall Medicare spending, while Medicare spending in Alaska was just $741 million in 2014. Total Medicare spending for all states and the District of Columbia was $581 billion in 2014.
Medicare Advantage in Michigan
Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but they are controversial due to the profits generated by private insurers that offer the plans. And it’s important to understand that Medicare Advantage plans tend to have limited local provider networks, as opposed to the vast nationwide access the Original Medicare members have. There are pros and cons to both options.
Medicare Advantage plans have premiums that average $28/month in 2019, in addition to the cost of Part B ($135.50/month for most enrollees in 2019), although some Medicare Advantage plans have no premiums at all, and members only pay their Part B premiums. But in addition to the narrower provider networks for Medicare Advantage plans, total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap.
As of September 2018, 40 percent of Michigan’s Medicare recipients chose a Medicare Advantage plan. That’s slightly higher than the nationwide average of 36 percent.
Minnesota is the only state where more than half (58 percent) of Medicare eligibles enrolled in a Medicare Advantage plan (or other private plan; in Minnesota in particular, that includes Medicare Cost plans). Alaska, with only 1,417 Advantage enrollees, has the nation’s lowest percentage enrollment in Medicare Advantage. Only one other state ( Wyoming with 4 percent) has Medicare Advantage enrollment (as a percentage of the state’s Medicare enrollees) in the single digits.
Stand-alone Medicare Prescription Drug plans
Michigan had 1,114,910 Medicare beneficiaries – about 55 percent of the state’s total – enrolled in stand-alone prescription drug plans as of September 2018. The state has 29 plans with premiums ranging from about $15 to $89 per month.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers. But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries, including those who have Part D coverage as part of their Medicare Advantage plan).