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Healthcare Advisor

Dr. Noor Ali is a licensed medical doctor and surgeon with an established national health insurance consulting practice serving clients in 34+ states.

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.

What to know about insurance in Michigan

  • Purchasing insurance coverage: In Michigan, you’re allowed to purchase a health care plan from any insurer you’d like. You’re also allowed to purchase additional coverage if you feel your employer coverage isn’t adequate.
  • Open Enrollment: Michigan residents using the Health Insurance Marketplace must enroll in an insurance plan during Open Enrollment. This period typically runs from November 1 to December 15 but was extended to August 15th for 2021 due to the COVID pandemic. If you miss open enrollment, you either need to wait until the next open enrollment period or a special enrollment period (typically granted due to a change in family or where you live) to be able to enroll.
  • Subsidized premiums: Michigan residents can enroll for coverage through the federal Health Insurance Marketplace to take advantage of the Advanced Premium Tax Credit. The only way to qualify for this credit is to purchase a plan through the exchange.
  • Off-exchange plans: You’re not required to use the federal exchange. If you don’t qualify for the Advanced Premium Tax Credit or don’t want it, you can obtain a plan from any off-exchange insurer.
  • Coverage types: In Michigan, just under 51% of residents receive insurance coverage through an employer. An additional 5.2% are enrolled in private plans, while just under 16% of residents receive coverage through Medicare. Nearly a quarter (7%) of the state is enrolled in Medicaid, and 5.8% are uninsured.

How do I enroll in Michigan’s health insurance marketplace?

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 automatically checks 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:

  • Are you single or married?
  • How many people did you declare as dependents on your last tax return?
  • What is your total household income?
  • Would you like to apply for financial assistance?

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.

Nine insurance companies offer individual coverage in Michigan:

  • Ambetter
  • Blue Cross Blue Shield of Michigan
  • Blue Care Network (HMO only)
  • McLaren Health Plan
  • Molina
  • Oscar Health
  • Physicians Health Plan
  • Priority Health (Offers HMO and POS plans)
  • Total Health Care USA

How do I enroll in Michigan individual and families insurance?

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 needs of everyone you’d like to cover
  • What type of plan you’d prefer
  • Your monthly premium
  • Your deductible
  • Your total cost of health care

Insurance for individuals in Michigan

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.

  • Health Maintenance Organization (HMO) plans offer a network of doctors that you can visit. You will need to get a referral whenever you need to see a specialist.
  • Preferred Provider Organization (PPO) plans provide much more freedom to see any doctor or specialist you want, but you’re required to pay higher premiums for this freedom.
  • Point-of-Service (POS) plans rest in the middle because they offer a network of doctors you can receive care from at a discount, but you’re able to see doctors outside of the network as long as you pay a higher copayment.

Insurance for families in Michigan

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.

  • Consider your family deductible, your copayment budget, and your monthly premium. Find a balance between the cost of your coverage and the benefit. Also, decide whether you can live within the network provided if you’re looking at an HMO network plan. If the network doesn’t provide access to the specialists a family member needs to see, consider a PPO or POS plan.

How much does health insurance cost in Michigan?

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 premiums in Michigan 2018 2019 2020 2021
Most affordable bronze Plan $249 $255 $251 $255
Most affordable silver Plan $358 $367 $348 $340
Most affordable gold Plan $393 $400 $382 $370

  • Bronze plans provide the least amount of coverage while offering the lowest monthly premiums. You can expect a high deductible and a copayment of 40% whenever you receive medical treatment. If you’re looking for individual coverage and are healthy, this could be a good option for you. Most people who enroll in bronze plans want to reduce their financial risk exposure to a sudden injury or illness. The most affordable bronze plan offered in Michigan in 2021 costs $255 per month.
  • Silver plans provide more coverage with lower deductibles and copayments. These plans cost more each month, but if one of your family members requires frequent doctor’s visits, the lower copayment can reduce your out-of-pocket expenses and justify the higher premium. If you’re eligible for a cost-sharing reduction, you might be able to enroll in a silver plan for less than a bronze plan would cost. The most affordable silver plan for Michigan residents in 2021 costs $340.
  • Gold and platinum plans are the most expensive insurance plans available on the marketplace and provide the most comprehensive coverage. These plans are best for families dealing with chronic health conditions requiring advanced treatments and routine access to specialists. Your copayment requirement with a gold plan is 20%, while you’re only required to pay 10% of the cost of your medical care under a platinum plan. The most affordable gold plan in Michigan during 2021 costs $370 per month.

What kind of low-income health insurance is available in Michigan?

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.

Medicaid in Michigan

To be eligible for Michigan Medicaid, you must be a resident of the state of Michigan, a U.S. 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:

  • Pregnant
  • Be responsible for a child 17 years of age or younger
  • Have a disability or a household member with a disability

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 $17,131 per year for a single person, but if you live with three additional household members, the limit would be $35,245. 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.

Michigan Healthy Kids Program

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:

  • Prenatal care
  • Emergency care
  • Preventive care
  • Immunizations
  • Mental health services
  • Dental care
  • Vision
  • Prescription medications
  • Family planning services
  • Therapy for the hearing or speech impaired

What are Michigan’s Medicare options for seniors and people with disabilities?

Michigan residents have access to Medicare, which provides coverage if you are 65 or older, living with a qualifying disability, or caring for someone who is disabled.

  • Original Medicare consists of Medicare Part A and B. Part A covers inpatient care, including emergency treatment, hospital stays, nursing care, home health care, and hospice services. Part B covers preventative care, diagnostic testing, medical equipment and supplies, medical transportation, and outpatient procedures. If you need prescription drug coverage, you can access it through some Medicare Advantage plans or through Medicare Part D. Your premiums for Medicare Part D depend on the level of coverage you seek.
  • Medicare Advantage Plans provide Michigan residents with alternatives to traditional Medicare. An Advantage plan covers everything offered under Medicare Part A and B. You may also get prescription drug coverage, dental and vision coverage, and other perks under a Medicare Advantage Plan. The federal government subsidizes a portion of your premium.

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.

Eligibility and Enrollment
Eligibility To be enrolled in Medicare, you must be a United States citizen or permanent resident or have a qualifying disability, including end-stage renal disease.
Enrollment Your initial enrollment period for Medicare starts three months before your 65th birthday and ends 90 days after your birth date. If you miss your initial enrollment period, you can enroll during a special enrollment period if you qualify or during open enrollment. Open enrollment begins on October 15 of each year and ends on December 7.

Medicare Resources

For assistance with Medicare or Medicaid enrollment, you can contact the Michigan Department of Health & Human Services at 800-975-7630.

Are there short-term health insurance plan options in Michigan?

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 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.

Michigan insurance companies are only allowed to provide short-term plans that last under 186 days. While it’s possible to enroll in another short-term plan after your plan expires, it can’t be with the same insurance company.

Short-term plans are not ACA compliant and do not 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.

If you have any of the following conditions, you might be denied coverage under a short-term insurance policy:

  • Asthma
  • Autoimmune disorders such as lupus or scleroderma
  • Cancer
  • COPD
  • Epilepsy
  • Genetic disorders
  • Heart disease
  • Kidney disease or renal disease

You should seek a short-term health insurance policy as soon as you know you’re going to need it, so you don’t experience a lapse in coverage. For more information, you can call the Department of Insurance and Financial Services at 877-999-6442.

Michigan Insurance FAQs

Does Michigan require health insurance?

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 Congress passed a measure in 2019 to repeal the tax penalty for not having insurance.

Do I have to use the Health Insurance Marketplace in Michigan?

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.

What types of alternative health insurance plans (like cost-sharing plans) are available in Michigan?

Michigan residents are free to enroll in plans that pool members’ resources to cover medical bills. Sometimes, these plans can cost less than you’d pay if you obtained insurance from a regular provider. These plans may have a faith-based component but typically do not require you to be a part of a specific denomination. Keep in mind that these plans are not health insurance, so they are not obligated to pay out claims.

What type of marketplace does Michigan have?

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.

How many health insurance carriers offer insurance through the marketplace in Michigan?

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.

Do I need health insurance if I have FSA/HSA?

A health care savings account or flexible savings account 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.

Do I need short-term disability coverage in Michigan if I have health 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.

Do I need long-term disability coverage in Michigan if I have health insurance?

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.

What does Healthy Kids cover?

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.

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