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Michigan Health Insurance

Michigan Medical Insurance Overview

The state of overall health in Michigan has seen a steady decline since the year 2011, dropping in rank from 28th place to 35th as of 2015.  This downward spiral has caused a lot of problems for the state with regard to the maintenance of a healthy population of its residents.  With the introduction of healthcare reform, it is hoped that Michigan’s health status will improve and its residents will be covered under medical benefits.  It is estimated that with the implementation of the Affordable Care Act in 2010, its changes will still gradually come into effect until the year 2020.  In addition, studies show that nationwide, 30 million more U.S. residents will be able to enjoy health insurance as a result.

Michigan’s Health Care Issues
As of the year 2015, Michigan is ranked in 35th place when compared to the rest of the states in the country regarding the healthiness of its citizens.

With regard to the strengths of the state, it has a high immunization percentage against MCV4, a low population of residents without insurance and a small disparity in health status by level of education.  Its weaknesses include its high prevalence of smokers in the state, its low immunization among children overall and its low rate of immunizations for adolescents against TDAP.

Understanding Michigan’s Uninsured Population
Of the residents living in the state of Michigan, the Kaiser Family Foundation reports that only 7% are without insurance coverage.  This number has dropped from 13% in recent years, but it still leaves nearly 700,000 uninsured residents living in the state.  A study reported by the Michigan Department of Community Health revealed that African American and Hispanics residing in Michigan were less likely to have insurance coverage when compared to Caucasians living in the state.

Listed below are some statistics with regard to the state’s uninsured population:

  • Poor adults earning 139% or less than the Federal Poverty Level make up the largest portion of uninsured people in Michigan.
  • Eight percent of children who are poor and eight percent of children in low income situations are lacking insurance coverage in the state of Michigan.
  • Five percent of the children in Michigan do not have insurance of any kind, which is half of the percentage of uninsured children nationwide.

Group Health Plans
The percentage of companies that offer insurance benefits to their workers is at 52% overall.  This means that under half of the companies operating in the state of Michigan offer no benefits to their workers whatsoever.  Bigger corporations are more likely to offer benefits when compared to smaller companies and half of the population of Michigan is covered under an employer-funded benefits package.  If you are a self-employed individual living in Michigan, you can look to a trade union in order to receive coverage under a group policy.

Private insurance companies are regulated by the Department of Labor & Economic Growth in the state of Michigan.

Signing Up
Most companies in Michigan have enrollment periods for their workers to join their group health insurance plan.  Consult your Human Resources department first to ensure that you have the appropriate information regarding its open enrollment period so you can apply for coverage.  Be sure to explore all of your options prior to signing up for insurance coverage through your workplace so that you can select the plan that is best for you and your family members.  Group plans are more beneficial to people than individual policies, but doing a lot of research ahead of time can help you pick the best policy for your situation.  Selecting your insurance plan is a big choice because of the monetary commitment involved on a monthly basis.

Before opting for a plan under your group coverage, consider the following information:

  • What your group health plan includes and excludes.
  • What exclusion and affiliation periods apply.
  • How many options there are for coverage under your employer’s plan.
  • Your other options for the best coverage that is affordable to you and your family members.

Pre-Existing Condition Exclusion Periods
In the state of Michigan, you cannot be subject to an exclusion period because of the presence of a pre-existing condition.

Affiliation or Waiting Periods
Affiliation periods are times that you have to wait following your enrollment for coverage to begin.  In Michigan, affiliation periods usually last only two months, but for late enrollees, it can be as long as three months.

Individual Health Plans
If you are self-employed, unemployed or are working for a company that doesn’t provide benefits to its workers, you might be able to get coverage under an individual policy.  In Michigan, six percent of people are covered under this plan type.  These numbers are low because of the freedom for the insurance company to do extensive underwriting on the policies.

While new enrollees cannot be subject to an exclusion period under the terms of a group insurance contract, individual contracts allow for you to wait out a period of 12 months before your benefits become active.

It is believed that a healthy young person in the state of Michigan can obtain individual insurance coverage for around $50 every month, but will be subject to a high deductible amount and low amounts of coverage.

Continuation Coverage
If you have lost your insurance coverage because of a change or loss of job, divorce or through any other means, you can get temporary insurance coverage through COBRA.  This coverage can last for up to 18 months and eligibility is dependent on how many employees the original company who offered the group coverage has.

There are also conversion plans for those who want to stay with the same insurance provider and convert their coverage to an individual policy.

Michigan Health Benefit Exchange
Michigan’s health benefits marketplace was initially going to be a state-run program as desired by Governor Rick Snyder.  It didn’t have the full support of republicans in the state and thus, the exchange was defaulted to be managed on the federal level.  In order to access the exchange, residents can go to healthcare.gov to compare their options and consider the selection of a health insurance policy that is suitable to their situation.

The governor opted to move forward with the state and federal partnership, but reportedly left the door open with regard to a completely state-run benefits marketplace in the future.

Michigan State Insurance Programs
People living in the state of Michigan who are not able to obtain insurance benefits through their workplace or don’t qualify for individual coverage can look to a state-funded program for health insurance coverage.  There are a wide variety of programs available to residents of Michigan, as listed in detail below.

Blue Cross/Blue Shield of Michigan (BCBSM)
This program is dedicated to people who have pre-existing or chronic medical conditions.  Plans provided through Blue Cross/Blue Shield of Michigan depend on the medical needs of the applicant and are available to those who are ineligible for COBRA or other state-funded programs.

Health Insurance Program for Michigan (HIP)
Additional coverage is provided under this program for people who suffer from pre-existing medical conditions.  Those who are given coverage under this program must have been without insurance coverage for six months time and must show proof of their denial for insurance because of a pre-existing condition.

Medicaid
This is a state and federally funded program that is geared toward providing low income individuals and families with medical benefits that are free or low cost.  Guaranteed coverage is offered to people earning 45% or less than the Federal Poverty Level.

MIChild & Healthy Kids
This program is for children in Michigan and offers services such as checkups, emergency services, prescription costs, costs associated with mental health, prenatal care and delivery.  To qualify, you must be between 150 and 200% of the Federal Poverty Level.

Children’s Special Health Care Services (CSHCS)
Children suffering from medical conditions like cystic fibrosis can apply for coverage under this program.  Coverage is offered that is directly related to the treatment of the patient’s condition.

Breast & Cervical Cancer Control Program (BCCCP)
This program offers cancer screening services to women living in Michigan who are in need of breast exams, pelvic exams or pap tests.  Those covered must earn at or under 250% of the Federal Poverty Level and be without insurance completely or underinsured.

Women, Infants, and Children (WIC)
The WIC program is available as a resource for women, infants and children up to age five to receive immunizations, breastfeeding information and supplemental food items based on need.

Plan First!
Plan First is a program dedicated to family planning in the state of Michigan.  Women covered under this program can receive physical exams, STD testing, contraceptives, counseling and more if their age is between 19 and 44 and they earn 185% or under the Federal Poverty Level.

Adult Benefits Waiver
For adults who have no dependents, the Adult Benefits Waiver offers medical services, equipment and supplies along with urgent care services, mental health services and more.  Those who are eligible for this coverage must earn 35% or less than the Federal Poverty Level and have no insurance coverage.

Medicare and the Medicare Prescription Drug Program
The Medicare program is available to seniors and disabled individuals along with people who are suffering from end-stage renal disease.  As long as you or your spouse has worked in a Medicare covered job for at least ten years and you are over the age of 65, you can qualify for Medicare benefits under one of the four associated Parts.  Each part offers varying levels of coverage to those who qualify.

Medicare/Medicaid Assistance Program (MMAP)
For people who qualify for Medicare, the MMAP is designed to offer advice regarding Medicare and Medicaid services.  This is a counseling service that offers you information on the services provided under each program listed.

VA Medical Benefits Package
The VA Medical Benefits Package is available for people who have served at least 24 months in a row in any branch of the United States military.  You are guaranteed health benefits under this program as long as you weren’t dishonorably discharged from the military.

Partnership for Prescription Assistance
The PPA is an assistance program that is designed to offer resources through 475 various programs for consumers to get help with prescription drug costs.

National Association of Mental Illness (NAMI) Helpline
The NAMI Helpline is a nationwide organization that offers counseling services to those individuals who are suffering from mental illness.  The helpline has volunteers who offer informational resources and guidance to people who call in for help.

The Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act grants protections to consumers by regulating private insurance companies.  Under HIPAA, consumers cannot be denied group health benefits because of the presence of a pre-existing condition.  The law also limits time allotted for exclusion and affiliation periods, covers continuation coverage through COBRA and afterward, and limits premium costs for consumers.

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