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An Employer's Guide to Affordable Health Insurance in Michigan

CARRIE FARNUM
HNI Benefits Advisor

affordable health insurance in michiganThere's a new option for affordable health insurance in Michigan for people who don't qualify for Medicaid or Medicare. The plan, Healthy Michigan, offers health care benefits without busting the budgets of your employees.

It's important that employers understand all the benefits options out there for their talent. Even if your business doesn't offer benefits right now, your people still need coverage. Helping your workforce understand their health care options builds goodwill and ensures that your employees are in good health.

Following is a quick-and-dirty Q&A on affordable health insurance in Michigan, the Healthy Michigan Plan:

What is the Healthy Michigan Plan? What is it replacing?

The Healthy Michigan Plan is built on the belief that Michiganders shouldn't have to pick between paying bills and taking care of their health. In short, the plan makes health care benefits available at a low cost.

Healthy Michigan is for people who did not previously qualify for Medicaid. The program is not replacing Medicaid (which provides coverage for low-income people) or Medicare (which provides coverage for seniors and younger people with disabilities).

Let's get to the good stuff. What's covered under this plan? Are pre-existing conditions covered?

The Healthy Michigan Plan provides the essential health benefits as set by the federal government. The plan provides the following services:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity care
  • Mental health and substance use disorder treatment services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services for 19 and 20 year olds, including oral and vision care
  • Family planning services
  • Dental services

For the full spectrum of what's covered, check out The Healthy Michigan Plan Handbook (PDF).

And yes, pre-existing conditions are covered! The plan cannot deny coverage for pre-existing conditions.

Who's eligible for the Healthy Michigan Plan? How can I help employees discover their eligibility?

The state of Michigan has set the following eligibility rules. Applicants for the plan must:

  • Be between the ages of 19‐64
  • Not currently be eligible for or enrolled in Medicaid or Medicare
  • Not be pregnant when applying for Healthy Michigan Plan
  • Have an income up to 133 percent of the Federal Poverty Level
    • Up to $16,000 per individual
    • Up to $33,000 for a family of four 
  • Be a resident of Michigan

To help employees figure out whether they're candidates for the plan, we suggest sharing the eligibility rules as a checklist.

How does enrollment work? How can I help my employees enroll?

There are three ways to enroll in the Healthy Michigan Plan:

  1. Online: www.michigan.gov/mibridges
  2. By phone: 855-789-5610
  3. In person: Visit your local Department of Human Services (click here for county map of offices)

Each person applying for plan coverage needs to present four things:

  1. Birthdates of people who would be receiving coverage
  2. Income information (to determine standing against the Federal Poverty Level)
  3. Social Security numbers
  4. Citizenship or immigration status

Again, a checklist of required application materials can ensure smooth enrollment for your employees.

What's the price tag of the Healthy Michigan Plan?

Plan enrollees will have some cost-sharing responsibilities. People whose annual incomes are between 100 percent and 133 percent of the Federal Poverty Level will be required to pay 2 percent of their annual income.

Participants also will be responsible for co-pays that are consistent with current Medicaid standards.

The bottom line is that enrollees won't be required to pay more than 5 percent of their annual household income, including co-pays, for health care under the Healthy Michigan Plan. Cost-sharing expenses will come out of a health account called the MI Health Account.

The health plan will provide specific details about payment options after enrollment. Plan participants will have the opportunity to reduce their cost-sharing bill by completing an annual health risk assessment and by changing unhealthy activities.

When does the Healthy Michigan Plan get started?

The state started accepting plan applications April 1, 2014. As of Nov. 3, 2014, 439,975 Michiganders were receiving care through the plan. Enrollment is ongoing.

What happens after application?

Coverage is retroactive to the first day of the month in which an enrollee submitted an application. Plan participants will be mailed a health care card that shows status in the Healthy Michigan Plan.

Enrollees are encouraged to take the Healthy Michigan Plan health risk assessment (click here for the PDF version; click here for the Word version). Patients should share the results of the risk assessment with their doctor, and together they can work on care for any health issues.

I've still got some unanswered questions about affordable health insurance in Michigan. Where can I go for help?

The Healthy Michigan Plan is well-covered on the web! Check out:

What are some of your best practices for sharing this sort of information with employees? Affordable health insurance in Michigan (and other states) has changed the game for many employers; how have you been managing similar shifts? Please share in comments!

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