With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike.
Most Michigan residents are requested to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based health insurance marketplace and federally facilitated exchanges.
Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the health insurance marketplace in Michigan, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Michigan
Michigan ranked 34th in United Health Foundation’s 2014 America’s Health Rankings. Its strengths included a low incidence of Salmonella infections, a low percentage of uninsured, and a small disparity in health status by educational attainment, while challenges included a high prevalence of smoking and binge drinking, a high prevalence of obesity, and a high violent crime rate. 1
The U.S. Department of Health and Human Services reported that 272,539 individuals in Michigan selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Michigan enrolled in a marketplace plan increased to 541,080 during the open enrollment period.3
Michigan individual and family health insurance
When the Obamacare health insurance exchanges opened for 2014 enrollment, Michigan defaulted to the federal health insurance marketplace. Individuals and families living in Michigan may purchase health insurance coverage through the state’s federally facilitated exchange and in the private marketplace.
Those who join ACA health insurance may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans.
- Michigan’s department of insurance: Michigan Department of Insurance and Financial Services
Michigan small group health insurance plans
In Michigan, small businesses with 50 or fewer employees may purchase small group health insurance plans through the federally facilitated Small Business Health Options Program, SHOP Marketplace and in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees should apply for an individual health insurance plan.
Michigan State COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Michigan’s small group COBRA continuation variations are as follows:4
|Eligible group sizes||N/A|
|Maximum continuation period – standard||N/A|
|Maximum continuation period – disability||N/A|
|Maximum premium increase||N/A|
|State legislation reference||N/A|
Those who work for employers with fewer than 20 employees and do not qualify for federal COBRA continuation coverage may either convert to an individual policy with the same insurer that provided group health insurance coverage or purchase individual health insurance coverage from healthcare.gov or in the private marketplace.
Michigan high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPS and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level.6
Michigan elected to expand its Medicaid program, effective April 1, 2014.7
The information below is specific to Michigan’s Medicaid program:
|Medicaid expansion||Yes – Healthy Michigan Plan|
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Michigan Department of Community Health|
|Where to apply||mibridges.michigan.gov/access/|
|Residency requirements||Michigan resident, U.S. citizen, qualified non-citizens|
|Eligibility||Michigan resident, U.S. citizen or qualified non-citizen; income and resource requirements vary by program.The Healthy Michigan Plan expands health insurance coverage to adults who are 19 to 64 years old, have an income at or below 133 percent of the federal poverty level, do not qualify or are not enrolled in Medicare or Medicaid, and are not pregnant at the time of application.8|
|More information||Michigan Medicaid State Plan:michigan.gov/mdch|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Michigan’s health insurance program for low-income children:
|Where to apply||https://healthcare4mi.com|
|Eligibility||Pregnant women, babies and children under age 199|
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1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Michigan Department of Insurance and Financial Services. “Switching from One Health Plan to Another. Retrieved from https://www.michigan.gov/difs/0,5269,7-303-12902_35510-263905–,00.html
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/
7 Centers for Medicare & Medicaid Services. “Michigan.” Medicaid.gov. N.D. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/michigan.html
8 State of Michigan. “Healthy Michigan Plan – Who is Eligible?” Michigan.gov. N.D. Retrieved fromhttp://www.michigan.gov/healthymiplan/0,5668,7-326-67874—,00.html
9 State of Michigan. Department of Community Health. “Healthy Kids.” Michigan.gov. N.D. Retrieved from http://www.michigan.gov/mdch/0,4612,7-132-2943_4845-17752–,00.html