TABLE OF CONTENTS
Michigan residents have many options to choose from when selecting medical insurance. You’re able to enroll in coverage from your employer’s offered health benefits, enroll in a marketplace plan, apply for Medicare or Medicaid, or shop for insurance directly from an insurance company.
Consult this guide to understand your coverage options and connect with resources for further assistance.
Enrolling in coverage on the Health Insurance Marketplace is simple. Michigan doesn’t have its own exchange, so you need to use the federal exchange by visiting HealthCare.gov.
Once you set up your account, you can start your application for health coverage. The site checks automatically to see if you qualify for Medicaid and financial assistance based on the information you provide. You need to provide the full names, birth dates, and Social Security numbers of every person you’d like to insure. The marketplace will inform you if you qualify for the Advanced Premium Tax Credit when you complete the application.
The application requires you to answer the following questions to help determine whether you qualify for financial assistance or the tax credit:
The next step is to review insurance plans offered on the marketplace. You can use a tool on the site to compare up to three plans side-by-side. Healthcare.gov provides information about each plan, including monthly premiums, annual deductibles, and your coinsurance. Once you find the plan that you like best, you can enroll for coverage.
Several insurance companies offer individual coverage in Michigan:
The enrollment process is the same whether you choose an individual policy or insurance for your entire family. Before you decide what type of policy you’d like to shop for, consider:
The type of coverage you look for depends on whether you’re healthy, have any preexisting conditions, and how much freedom you need to see the doctors and specialists you prefer.
One way to save money is to select a plan with a high annual deductible, but keep in mind that you’re required to pay your deductible each year before your insurance covers any of your medical expenses. Consider a balance with an affordable premium and a deductible you can meet in the event of a catastrophic medical occurrence.
There are three types of insurance plans that you can select.
While you may be in good health, your spouse or a child might have a condition that requires ongoing care. You want to find a plan that reduces the total out-of-pocket cost of your health care each year rather than focusing on the monthly premium.
When you shop for insurance on the federal exchange, you can choose between four types of plans: Bronze, Silver, Gold, and Platinum. Insurance plans receive these designations based on premiums, coverage level, and annual deductibles. Consider both the cost of the insurance plan and your out-of-pocket expenses when you’re choosing a plan:
|Average premium in Michigan||2020||2021||2022||2023|
|Most affordable Bronze plan||$380||$358||$343||$266|
|Most affordable Silver plan||$506||$470||$445||$354|
|Most affordable Gold plan||$510||$464||$435||$395|
Michigan provides Medicaid coverage to low-income residents. It also offers benefits to children and pregnant women through its Healthy Kids Program. These programs are joint efforts between the state and federal governments to provide health coverage for those who cannot afford it.
To be eligible for Michigan Medicaid, you must be a resident of the state of Michigan, a United States national, citizen, permanent resident, or legal alien, in need of health care or insurance assistance, and have low or very low income. You must also be one of the following:
The Medicaid program covers routine care, emergency services, physical rehabilitation, and medical procedures that a doctor can prove are medically necessary.
To receive benefits, your household income must remain under the maximum threshold for your household’s size. This is $18,075 per year for a single person, but if you live with three additional household members, the limit would be $36,908. These limits represent the maximum combined income allowed for your household to qualify for Medicaid.
To learn more about Michigan Medicaid, you can visit the state website for assistance and enrollment.
The Healthy Kids program offers state-sponsored health coverage to Michigan residents who are 19 years old or younger, as well as pregnant women. If your family cannot afford health coverage for your minor children, you can apply for the Healthy Kids program by visiting the portal on the Michigan state website. Children and pregnant women enrolled in the program are covered for:
Michigan residents have access to Medicare, which provides coverage if you’re 65 or older, living with a qualifying disability, or caring for someone who is disabled.
Medicare Supplement Insurance plans cover out-of-pocket expenses that your Medicare plan won’t, such as your coinsurance for procedures or medical equipment. These plans are advised if you’re concerned about your ability to afford your medical care.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
For assistance with Medicare or Medicaid enrollment, you can contact the Michigan Department of Health & Human Services at (800) 975-7630.
Michigan has strict rules governing short-term health insurance policies. A short-term insurance plan is often used to cover a coverage gap. You might wish to purchase a short-term health insurance plan if you want cheap health insurance, just moved, got a new job, or are waiting to be able to enroll in a health plan by another means, such as through Medicare or the marketplace.
Short-term plans aren’t Affordable Care Act (ACA)-compliant and don’t have to provide minimum essential coverage. Your rates may be increased based on your health history, medical conditions that run in your family, age, and preexisting conditions. An insurance company can also deny you coverage or refuse to cover your preexisting conditions.
There are no laws in Michigan mandating health insurance coverage for state residents. The Affordable Care Act does include a mandate, but that mandate can’t be enforced since the U.S. Congress passed a measure in 2019 to repeal the tax penalty for not having insurance.
You’re not required to use the Health Insurance Marketplace, but there are certain advantages to doing so. The most significant benefit is access to the Advanced Premium Tax Credit. You’re only able to get this tax benefit if you enroll in an insurance plan through the federal exchange. Eligibility for the tax credit depends on your income level.
The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t conform to ACA standards and don’t cover pre-existing conditions, mental health care, or pregnancy.
Michigan doesn’t have a state exchange or website that you can use to enroll in coverage through the ACA. You need to visit HealthCare.gov instead, which is the federal exchange.
Nine insurance companies provide coverage through the marketplace, but your location may determine which companies you have access to. Most residents will have access to at least four insurers.
A health savings account (HSA) or flexible savings account (FSA) can help you plan for sudden medical expenses, but these plans aren’t sufficient to cover most of your medical expenses. Health insurance can reduce the cost of your care while an HSA or FSA helps with the out-of-pocket expenses not covered by insurance.
Short-term disability coverage is a good supplement to health coverage because it can cover the cost of your groceries, utilities, and mortgage while you recover from an injury or illness. It’s not a replacement for health insurance because it offers household rather than medical benefits.
Long-term disability insurance is similar to short-term disability coverage and provides the same benefits. If you’re disabled and require ongoing medical care while being unable to work, health insurance will cover your required medical care. Long-term disability coverage can help you with the rest of your expenses.
The Healthy Kids program provides coverage for routine medical examinations, immunizations, medications, therapy, and prenatal care. You can also sign up for dental and vision coverage that includes routine teeth cleaning and prescription eyewear.