1. Health Coverage Enrollment in Michigan
What do I Need to Know?
Understanding the Health Insurance Marketplace and Healthy Michigan Plan

2. Coverage Options
Qualified Health Plans through the Health Insurance Marketplace
Medicaid
Children’s Health Insurance Program (CHIP)
Healthy Michigan Plan (HMP)
Marketplace Option
Other Medicaid
Individual Market
Employer Coverage

3. The Health Insurance Marketplace
Open Enrollment: November 1 – December 15, 2017
Apply for financial assistance
Shop for and compare health insurance plans
Coverage begins January 1, 2018
“Apples to apples” comparisons on the basis of price, benefits, quality, provider network etc.
That “break” comes in the form of a tax credit paid in advance and cost-sharing reductions for some people
Special Enrollment Periods are available for those experiencing major life changes

4. The Health Insurance Marketplace Making Things Affordable
% of the Federal Poverty Level (FPL)
Premium Tax Credit
Cost-Sharing Reduction
% FPL

5. The Health Insurance Marketplace
The 10 Essential Health Benefits
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including
behavioral health treatment
6. Prescription drugs (at least one per therapeutic category)
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

6. The 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”

7. The Health Insurance Marketplace
Application: apply online at Healthcare.gov
Create an account
Complete online application
Receive an eligibility decision (with tax credit amount)
Choose a plan
Pay your first month’s premium
The Marketplace will let you know you or your family members may be eligible for Medicaid coverage (including the Healthy Michigan Plan). You will not be eligible for tax credits and cost sharing reductions if you are eligible for Medicaid.
Congratulations, you’re enrolled!

8. The Health Insurance Marketplace
Application: apply over the phone
Complete application over the phone:
Receive an eligibility decision (with tax credit amount)
Create an account on Healthcare.gov
Use your application ID number to view and choose a health plan online
Pay your first month’s premium
Congratulations, you’re enrolled!

9. The Healthy Michigan Plan (HMP)
Extends coverage to Michiganders earning up to 138% of the FPL
$16,643 for individuals
$22,411 for a household of 2
Consumers will be enrolled in a health plan
Consumers will have a “health savings” style MI Health account

10. Basic Eligibility Criteria
Healthy Michigan Plan
Basic Eligibility Criteria
Age years old
Income at or below 138% of the federal poverty level under the Modified Adjusted Gross Income (MAGI) methodology
Do not qualify for or enrolled in Medicare
Do not qualify for or enrolled in other Medicaid programs
Are not pregnant at the time of application
Are residents of the State of Michigan

11. Healthy Michigan Plan Benefits The 10 Essential Health Benefits Dental
Vision
Hearing
Home Health

12. 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

13. Healthy Michigan Plan Congratulations, you’re enrolled!
Application: apply online
MiBridges.gov
Apply for health care coverage only or for multiple benefits
Receive an eligibility decision
Approved
Denied
Pending
Application: apply by phone
Complete the application
Receive eligibility decision by mail
The MI Bridges application will screen for all types of Medicaid eligibility – coverage for children, adults, and seniors.
Congratulations, you’re enrolled!

14. You don’t need to wait to use
Healthy Michigan Plan
Application Approved
Enroll in a health plan and choose a doctor
By phone: call MI Enrolls at or;
Online: healthcare4mi.com
Call within 60 days to schedule your first appointment
You don’t need to wait to use
your new coverage!

15. Healthy Michigan Plan Marketplace Option Begins April 1, 2018
Population
Over 100% of FPL
In HMP for 12 months or more
Over 21 years old
Not pregnant or Native American
Not medically frail
Transition
February 2018
You will receive a letter from MDHHS
April 2018
MI Enrolls will send an enrollment packet
Select a plan or have one auto-selected for you
Enrollment
Ongoing eligibility
Enrolled until next open enrollment period

16. Want to stay on the Healthy Michigan Plan (HMP)?
Complete the Health Risk Assessment
Commit to a healthy behavior
When you receive the letter from MDHHS indicating you are part of the Marketplace Option, you have 30 days!

17. Incentives Healthy Michigan Plan HMP Completes healthy behavior
50% reduction in copays after 2% contribution
50% reduction in required contributions
If no required contribution, you will receive a gift card
Marketplace Option
Reduce premiums by 50%
Income falls at or below 100% of FPL
Premiums suspended
Becomes pregnant
All cost sharing suspended
Or go to Medicaid
Becomes medically frail
Goes to HMP

18. Need Help?
Certified Application Counselors and Navigators provide free assistance
For one-on-one assistance contact [Name of Health Center]
Phone:
I am a Certified Application Counselor, so contact me if you would like to talk more!
Or, to find a CAC/Navigator near you, visit enrollmichigan.com

19. for information on accessing and using your coverage
Need more information?
Visit
MiCoverage.org
for information on accessing and using your coverage
I am a Certified Application Counselor, so contact me if you would like to talk more!

20. Questions?