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

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

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

The Health Insurance Marketplace Making Things Affordable 100-250% of the Federal Poverty Level (FPL) Premium Tax Credit Cost-Sharing Reduction 250-400% FPL

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

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”

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!

The Health Insurance Marketplace Application: apply over the phone Complete application over the phone: 800-318-2596 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!

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

Basic Eligibility Criteria Healthy Michigan Plan Basic Eligibility Criteria Age 19-64 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

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

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 100-138% 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 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 1-855-789-5610 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!

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 888-367-6557 or; Online: healthcare4mi.com Call within 60 days to schedule your first appointment You don’t need to wait to use your new coverage!

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

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!

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

Need Help? Certified Application Counselors and Navigators provide free assistance For one-on-one assistance contact [Name of Health Center] Phone: Email: 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

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!

Questions?