Health Coverage Enrollment in Michigan

Coverage options Qualified Health Plans through the Health Insurance Marketplace Open enrollment and renewal is November 1, 2017- December 15, 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

Healthy Michigan Plan

Healthy Michigan Plan Eligibility Criteria Age 19-64 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

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

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

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 100-133% 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 100-133% FPL 2% of annual income after the first 6 months paid monthly There’s a 5% of annual income “cap” on enrollee payments

Healthy Michigan Plan Costs Continued… In addition to copays, beneficiaries with incomes from 100-133% 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

Healthy Michigan Plan Application www.michigan.gov/mibridges Receive an instant eligibility determination online 855-789-5610 Apply over the phone www.mibenefitsaccess.org or enrollmichigan.com Locate organizations offering free enrollment help

Health Insurance Marketplace

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

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

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”

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 100-250% FPL 250-400% FPL Premium Tax Credit Cost-Sharing Reduction

Health Insurance Marketplace Application Apply online at healthcare.gov Apply by phone Call 1-800-318-2596 (TTY 1-855-889-4325). 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: http://marketplace.cms.gov/applications-and-forms/marketplace-application-for-family.pdf Find local help page

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