Guide to the Michigan Health Insurance Exchange
Michigan’s health insurance marketplace is operated mostly by the federal government, but the state opted for a partnership exchange model and runs a portion of the organization itself. For consumers, that means coverage is available through local Michigan health insurance companies and agents, or the federal website, HealthCare.gov, rather than a state-specific URL. Exchange plans carved a new niche in the individual and small group insurance markets, making subsidized coverage available to uninsured Americans and small business owners.
The marketplace serves as a source of health insurance plans that meet Obamacare criteria and can be reduced in cost by tax credits. Private health insurers in Michigan whose plans have received federal approval sell qualified health plans on the marketplace to comply with the Affordable Care Act in offering uninsured residents with low-to-moderate income more options than simply Medicaid or individual health plans.
These plans are especially geared towards those who don’t have access to employer-sponsored insurance, or whose company health plan doesn’t cover enough medical expenses. The marketplace is also a great resource for those with pre-existing conditions who need to ensure they are able to pay for the care they need.
The Michigan exchange helps residents satisfy the requirement to get insured under Obamacare. So that residents can afford to meet the law’s requirements and not be penalized, subsidies are available to those earning between 138 and 400 percent of poverty.
It’s an excellent resource for those who couldn’t afford coverage previously and want to take charge of their health. To enroll or find out more about your options on the Michigan Marketplace, call a licensed health agent at 888.803.5917.
The Michigan health insurance exchange makes finding a plan easier by categorizing coverage levels into four tiers: bronze, silver, gold and platinum. Each level is assigned a different actuarial value, which doesn’t change even if you look at a gold plan from three separate insurers. These levels range from 60 to 90 percent coverage, which refers to the entirety of covered medical cost sharing, including deductibles, coinsurance and copayments.
Tax credits are available to lower the cost of health insurance for many eligible Michiganders shopping on the marketplace. These credits cannot apply to plans purchased off the exchange. If your income is on the lower end, you might qualify for a subsidy to help pay for premiums and cost sharing. Even those earning a more stable living can benefit from tax credits, as it covers individuals earning up to 400 percent of the federal poverty level.
To view the current FPL as annual income in dollars, click here.
Cost Sharing and Premium Tax Credit Eligibility: 138-250% FPL
Premium Tax Credit Only: 250-400% FPL
If you qualify for a subsidy, it will help pay for a portion of your premium depending on your income. Your premium share cannot exceed a certain amount for your income group, as seen below, and the government will contribute the remainder of the cost. Subsidies are calculated by the premium cost of the second-least expensive silver (mid-level) plan in your region. Your subsidy can be applied to any level plan, but will adjust based on the policy you choose.
Michigan offers a variety of health insurers to choose from when applying for coverage on the state exchange. National carriers and local HMOs participate equally so you can find the best plan in your zip code from the company of your choice. Keep in mind that networks have been modified to create cost-effective plans, so always check if your doctor is part of that particular plan’s provider network on the marketplace before you enroll, if that’s a priority.
Like the traditional individual health plan market, benefits vary across policies and carriers on the exchange. However, each plan must include certain categories of covered services, essential health benefits, according to federal law. Insurers may cover numerous services within each category, or have their own rules regarding EHBs. Always check your outline of benefits for specific coverage details, exclusions or policy limitations, even related to essential health benefit categories. The law has created a broad definition of what can be covered, but some services are still considered too costly or complex.
Regardless, for most Americans the EHB requirement is a major win. Pregnant women of all incomes can finally enroll in a health plan without needing lower wages to sign up for temporary Medicaid or CHIP. Prescription drugs are also covered, which is another variable to double-check between plans before you commit.
Essential Health Benefit Categories
- Preventive, wellness, and chronic disease management
- Prescription drugs
- Office visits
- Emergency care
- Laboratory tests
- Maternity and newborn care
- Pediatric care, including dental and vision
- Mental health and substance abuse services, including behavioral health care
- Rehabilitative and habilitative services and devices
How to Apply
To sign up for coverage on the health insurance marketplace, you can attempt to use HealthCare.gov, the federal portal for Obamacare plans, and there are other ways to apply, as well. Call the marketplace to request a paper application to fax or send by mail at 800-318-2596, but expect a longer processing time.
To receive professional assistance selecting the best plan for your needs, use a licensed local insurance agent. Verify that a broker is certified to sell plans on the marketplace before you East Coast Health Insurance is licensed in Michigan and certified to sell plans on the exchange. Our agents can be reached for help with marketplace plans and subsidies at 888.803.5917.
Compare Michigan Marketplace Plans
Featured below is a cost comparison tool providing estimates of plans and coverage costs in your county. You can also receive an estimate of your potential subsidy based on the average premium rates provided by insurers. The tool does not include the option of purchasing coverage, though it’s helpful to visualize what your subsidized coverage could cost. If you’re interested in buying one of these plans, please contact us and we’ll help connect you to coverage.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.