Health Insurance Marketplace in Michigan
If you live in Michigan, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as January 1, 2014.
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Michigan will expand its Medicaid program as of April 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in Michigan 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
Community Bridges Management, Inc. provides expert IPA services including medical network management, claims processing oversight, provider relations, medical care service, patient relations and services. Funds will be used to provide both training and resources to make the process of enrolling in a health plan easier and more understandable through one-on-one contact. Community Bridges will also conduct widespread outreach and education activities.
ACCESS is non-profit service agency that advocates for, empowers and enables individuals, families, and the Arab, Chaldean, and Bangladeshi American communities in metropolitan Detroit to achieve optimal health and wellness. Funds will be used to proactively reach out to
and engage under/uninsured community members through local, multicultural electronic and print media, public access television and radio, and monthly ACCESS and community partner events, like weekly health “Expos” at the three County Public Health Offices.
American Indian Health and Family Services is a non-profit health organization serving a large number of the uninsured or under insured. Funds will be used to host educational forums, publications, provide self-service kiosks and expert personnel able to assist consumers to enroll in health plans.
The Michigan Consumers for Healthcare (MCH) network includes statewide organizations and local affiliates with deep experience in conducting Medicaid and CHIP outreach and enrollment and health insurance counseling for uninsured and vulnerable individuals and families. The project will provide services in 10 Michigan Regions and Tribal Health Centers. These organizations reach low-income, vulnerable populations in every region and county in the state, guaranteeing that the project will serve Michigan residents regardless of where they live.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Consumer Operated and Oriented Plan Program
Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets. CO-OP’s in Michigan:
Accountable Care Organizations in Michigan
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- TransforMED MI – Health Care Innovation Award
- Altarum Institute MI – Health Care Innovation Award
- Henry Ford Health System MI – Health Care Innovation Award
- Michigan Public Health Institute MI – Health Care Innovation Award
- Trustees Of Dartmouth College MI – Health Care Innovation Award
- Institute For Clinical Systems Improvement MI – Health Care Innovation Award
- Feinstein Institute For Medical Research MI – Health Care Innovation Award
- University Of North Texas Health Science Center MI – Health Care Innovation Award
Models Run at State Level
Health care facilities where Innovation Models are being tested
- Detroit Receiving Hospital Detroit, MI – BPCI Initiative: Model 2
- Borgess Medical Center Kalamazoo, MI – BPCI Initiative: Model 2
- Henry Ford West Bloomfield Hospital West Bloomfield, MI – BPCI Initiative: Model 2
- Henry Ford Wyandotte Hospital Wyandotte, MI – BPCI Initiative: Model 2
- DMC Surgery Hospital Madison Heights, MI – BPCI Initiative: Model 2
- Huron Valley Sinai Hospital Commerce Twp., MI – BPCI Initiative: Model 2
- Sinai Grace Hospital Detroit, MI – BPCI Initiative: Model 2
- Henry Ford Macomb Hospital Clinton Township, MI – BPCI Initiative: Modl 2
- Marvin & Betty Danto Family Health Care Center W. Bloomfield, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Dearborn Heights Dearborn Heights, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Georgian Bloomfield Bloomfield Hills, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Ann Arbor Ann Arbor, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Briarwood Flint, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Canton Canton, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Dorvin Livonia, M – BCPI Initiative: Model 3
- Heartland Health Care Center-Fostrian Flushing, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Georgian East Grosse Pointe, MIA – BCPI Initiative: Model 3
- Heartland Health Care Center-Jackson Jackson, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Allen Park Allen Park, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Oakland Troy, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-Plymouth Court Plymouth, MI – BCPI Initiative: Model 3
- Heartland Health Care Center-University Livonia, MI – BCPI Initiative: Model 3
- Heartland-West Bloomfield W Bloomfield, MI – BCPI Initiative: Model 3
- Bronson Methodist Hospital Kalamazoo, MI – BCPI Initiative: Model 4
- Sparrow Hospital Lansing, MI – BCPI Initiative: Model 4
- Michigan Area Agency on Aging 1-B MI – Community-based Care Transition Program
- Tri-County Aging Consortium Lansing, MI – Community-based Care Transition Program
- Valley Area Agency on Aging Flint, MI – Community-based Care Transition Program
- St. John Providence Health System MI – Community-based Care Transition Program
- The Senior Alliance, Area Agency on Aging 1-C MI – Community-based Care Transition Program
- Baldwin Family Health Care, Inc. – Grant Grant, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Bellaire Family Health Center Bellaire, MIA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- County of Ingham – Sparrow Health Center of Ingham County Lansing, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- County of Ingham – St. Lawrence Community Health Center Lansing, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Downriver Community Services: Algonac Medical Center Algonac, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- East Jordan Family Health Center East Jordan, MI- Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Downriver Community Services-New Haven Medical Center New Haven, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Family Medical Center of Michigan Temperance, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Hackley Community Care Center Muskegon, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- InterCare Community Health Network – Bangor Bangor, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- InterCare Community Health Network – Holland Holland, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- InterCare Community Health Network – Pullman Pullman, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Lakeland Immediate Care Center dba Cassopolis Family Clinic Cassopolis, MI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- MidMichigan Medical Offices – Roscommon Roscommon, MI- Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Visiting Physicians Association, P.C Flint, MI – Independence at Home Demonstration
- Visiting Physicians Association, P.C Okemos, MI – Independence at Home Demonstration
- Stevi Riel Muskegon, MI – Innovation Advisors Program
- Erin Conklin MPA Grand Blanc, MI – Innovation Advisors Program
- Michigan Pioneer ACO Southfield, MI – Pioneer ACO
- Genesys PHO Flint, MI – Pioneer ACO
- Allegiance Health Jackson, MI – Strong Start for Mothers and Newborns Initiative
- Providence Hospital Southfield, MI – Strong Start for Mothers and Newborns Initiative
- St. John Hospital and Medical Center Detroit, MI – Strong Start for Mothers and Newborns Initiative
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Michigan
While Governor Rick Snyder (R) supports the creation of MI Health Marketplace, a nonprofit to oversee the state’s health insurance exchange, he acknowledged on November 16, 2012, that without authorizing legislation, he would plan for a state-federal partnership exchange.1 The state began moving in the direction of a partnership in August 2012 due to legislative opposition that left the state unable to meet the federal timetable for implementation.2,3 Michigan will perform plan management and consumer assistance functions and defer other exchange management functionality to the federal government.4
The Governor’s initial recommendation for a state-based exchange was largely informed by the work of the Exchange Steering Committee, which includes representatives from the Department of Community Health, the Office of Financial and Insurance Regulation, and the Department of Technology, Management, and Budget. The Department of Community Health, with the assistance of subcontractors, organized five stakeholder workgroups on Governance; Finance, Reporting, and Evaluation; Technology; Business Operations; and Regulatory and Policy Action, which met between February and April 2011 to plan various aspects of the exchange.5 The Department of Technology, Management and Budget, with the assistance of subcontractors, developed plans for new technology to establish a MI Health Marketplace portal which would allow for the integration of the exchange with new Medicaid eligibility requirements mandated in the Affordable Care Act (ACA).
Essential Health Benefits (EHB): The ACA requires that all individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. Governor Snyder’s administration solicited public comment on the issue and in September 2012, the Governor received preliminary EHB recommendations from the Office of Financial and Insurance Regulation. Recommendations included using Priority Health HMO plan as the benchmark plan and supplementing with the state’s Children’s Health Insurance Program (CHIP) dental plan and the Federal Employees Dental and Vision Insurance Program (FEDVIP) for pediatric vision services.6
Michigan’s Department of Community Health was awarded a federal Exchange Planning grant of $1 million. In November 2011, Michigan’s Department of Licensing and Regulatory Affairs was awarded a $9.8 million federal Level One Establishment grant to conduct further insurance market analysis and technology planning; however, the Legislature has yet to approve spending the funds. In January 2013, Michigan received a second Level One grant of $30.7 million to support creation of a consumer assistance partnership program, establishment of an IT system that coordinates with federal partners, and the plan management functions that Michigan will carry out.7
Michigan, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance exchanges, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.8
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Michigan is participating in Medicaid expansion.
On March 5, 2013, Michigan received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a partnership exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time; complying with future regulations; establishing a memorandum of understanding (MOU) between the Michigan Department of Licensing and Regulatory Affairs (LARA) and the state’s Medicaid agency that defines each agency’s role and responsibilities; and obtaining legal and spending authority for Exchange activities.9
1. Governor Snyder. “Michigan moves toward state-federal partnership health exchange, leaves door open for MI Health Marketplace.” November 16, 2012.
2. Livengood, Chad. “Snyder gives up on plan for state-run health exchange.” August 23, 2012. Detroit News.http://www.detroitnews.com/article/20120823/POLITICS02/208230380/1409/metro/Snyder-gives-up-plan-state-run-health-exchange
3. A Special Message from Governor Rick Snyder: Health and Wellness. Office of the Governor. September 14, 2011. http://www.michigan.gov/snyder/0,4668,7-277–262254–,00.html
4. Letter from Governor Snyder to Secretary Sebelius. January 22, 2013. Available athttp://cciio.cms.gov/Archive/Technical-Implementation-Letters/mi-marketplace-letter.pdf
5. Michigan Department of Community Health. Health Insurance Exchange Planning Workgroup solicitation letter. January 25, 2011. http://www.mahu.org/images/Michigan_Health_Insurance_Exchange_Planning.doc
6. Michigan’s Essential Health Benefits Benchmark Plan: Executive Report. September 25, 2012. Office of Financial and Insurance Regulation. http://www.statereforum.org/sites/default/files/ehb_report_09_05_12-final_397063_7.pdf
7. Michigan Affordable Insurance Exchange Grants Awards List. http://cciio.cms.gov/archive/grants/states-exchanges/mi.html
8. Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011. http://www.rwjf.org/coverage/product.jsp?id=72289
9. Letter from Secretary Sebelius to Governor Snyder. March 5, 2013. Available athttp://cciio.cms.gov/resources/files/mi-blueprint-letter-3-5-2013.pdf
Also of interest
Provided by the Henry J. Kaiser Family Foundation