1. Health Coverage Enrollment in Michigan

2. Coverage options
Qualified Health Plans through the Health Insurance Marketplace
Open enrollment and renewal is November 1, January 31st, 2017
Medicaid programs
Includes Healthy Michigan Plan (HMP) and CHIP
Consumers can enroll in Medicaid and Healthy Michigan Plan any time
Individual Market
Employer Coverage

3. Healthy Michigan Plan

4. Healthy Michigan Plan Eligibility Criteria
Age years old
Income at or below 133% of the federal poverty level (FPL) under the Modified Adjusted Gross Income methodology
Do not qualify for or are not enrolled in Medicare
Do not qualify for or are not enrolled in other Medicaid programs
Are not pregnant at the time of application
Meet other standards including residency and citizenship
MSA 14-11

5. Healthy Michigan Plan Benefits
The Healthy Michigan Plan will have a comprehensive range of benefits including:
All 10 Essential Health Benefits
Dental
Vision
Hearing
Home Health
Non-Emergency Medical Transportation
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs (at least one per therapeutic category)
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
MSA 14-11

6. Healthy Michigan Plan Service Delivery System
The vast majority of Healthy Michigan Plan beneficiaries will enroll into the one of the current Medicaid Health Plans
Beneficiaries enrolled in a plan will also receive their dental services through that plan
Beneficiaries not enrolled in a health plan will utilize the FFS Medicaid dental network
HMP utilizes the Michigan’s current carve out system for severe mental health conditions and substance abuse
MSA 14-11

7. Healthy Michigan Plan Costs
Healthy Michigan uses standard Medicaid copayments paid into a MI Health account
Healthy Michigan has enrollee payment responsibilities for individuals from % FPL
Quarterly statements will show cost of services and amount of contribution in account
No co-pays for preventive services
Healthy Michigan has enrollee payment responsibilities for individuals from % FPL
2% of annual income after the first 6 months paid monthly
There’s a 5% of annual income “cap” on enrollee payments

8. Healthy Michigan Plan Costs Continued…
In addition to copays, beneficiaries with incomes from % FPL will also be required to pay a monthly contribution into their MI Health Account
The total contribution is based on 2% of a beneficiary’s annual income
Similar to copays, the contribution requirement starts after being enrolled in a health plan for six months
Beneficiaries will not pay more than 2% of their annual income in cost-sharing (contributions and copays combined)
A Health Risk Assessment is used to identify health goals and can lower the cost-sharing contribution
Quarterly statements from a beneficiary’s MI Health Account will show cost of services and the amount owed etc.
MSA 14-11

9. Healthy Michigan Plan Application
Receive an instant eligibility determination online
Apply over the phone
or enrollmichigan.com Locate organizations offering free enrollment help

10. Health Insurance Marketplace

11. Health Insurance Marketplace Benefits
Health insurance plans will be required to cover ten essential health benefits
The essential health benefits were designed to mimic a “typical employer plan”
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs (at least one per therapeutic category)
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

12. Health Insurance Marketplace Eligibility Criteria
To be eligible for Marketplace coverage, you must:
Live in its state, or service area, and
Be a U.S. citizen or national, or
Be a non-citizen who is lawfully present in the U.S. for the entire period for which enrollment is sought
Not be incarcerated
Can apply for Marketplace coverage if pending disposition of charges
Can apply for Medicaid/CHIP at any time

13. Health Insurance Marketplace Plan Categories
Bronze
Lowest monthly premium
Higher costs for services
“A good option if you expect to use a low amount of health services”
Silver
Medium monthly premium
Medium costs for services
Gold
Higher monthly premium
Low costs for services
Majority of large employer plans are closest to Gold plan designs
Platinum
Highest monthly premium
Lowest cost for services
“A good option if you expect to use a lot of health services”

14. Health Insurance Marketplace Costs
Financial help is available for eligible families and individuals, including
Tax credits that may be used to lower monthly premiums
Premium tax credits claimed when filing taxes
Advance payment of premium tax credits
Reduced cost sharing to lower out-of-pocket spending for health care costs
% FPL
% FPL
Premium Tax Credit
Cost-Sharing Reduction

15. Health Insurance Marketplace Application
Apply online at healthcare.gov
Apply by phone
Call (TTY ). A Call Center Representative will assist consumers with completing an application and choosing a plan
Apply by mail
Consumer can download a paper application online and return it by mail
Find local help
Consumers can visit the Find Local Help page on healthcare.gov to search for Certified Application Counselors and Navigators in their area or Enrollmichigan.com
Paper applications:
Find local help page

16. Questions?