Congress passed the Affordable Care Act (ACA), which is sometimes referred to as Obamacare, in March 2010. This law paved the way for uninsured Americans to apply for health insurance without fear of being denied. It also mandated that all Americans have health insurance. If you do not, you must pay a penalty fine each year that you’re without coverage or obtain an exemption.
Michigan is one of 31 states that rely on the federally run healthcare exchange marketplace. Through the marketplace, Michiganders can apply for insurance from private healthcare companies. In addition, small business owners can apply for group coverage for their employees. During the application process, individuals can find out if they’re eligible for subsidies, tax credits, or low-income health insurance plans, such as Medicaid.
In June 2014, 18 companies applied to the federally run Michigan Health Insurance Marketplace for 2015.
These companies include:
- Alliance Health and Life Insurance Company
- Blue Care Network of Michigan
- Blue Cross Blue Shield of Michigan
- Consumers Mutual Insurance of Michigan (CO-OP)
- Grand Valley Health Plan
- Harbor Health
- Health Alliance Plan
- Humana Medical Plan of Michigan, Inc.
- McLaren Health Plan
- Meridian Health Plan of Michigan, Inc.
- Molina Healthcare of Michigan
- Physicians Health Plan
- Priority Health Insurance Company
- Time Insurance Company
- Total Health Care USA
- United Healthcare Community Plan
- United Healthcare Life Insurance Company
By law, all health insurance plans offered through a federal- or state-run exchange must cover the following 10 essential services:
- check-ups or in-office doctors’ visits
- chronic disease management
- emergency care
- in-patient hospital services
- laboratory services
- maternity and newborn care
- mental healthcare
- outpatient services
- pediatric care, including vision and dental coverage for children
- rehabilitative services
While in the marketplace, adults can also purchase additional plans that cover vision and dental needs. These plans are not included with the 10 essential services for adults, but children’s health insurance plans do cover them.
People who purchase their health insurance through the federal exchange may have the chance to buy one of five insurance plan types. Each type, also called a metal level, offers a different financial structure. The percentages of payments change from metal level to metal level.
For example, a platinum plan, which is the top metal level, covers more than the bottom metal level plan, or bronze plan. A platinum plan also costs more than a bronze plan. That’s why it’s important for you to weigh your costs with your needs to find a level that is best for you and your family.
The levels of health insurance are:
- Platinum: Your plan covers 90 percent; you pay 10 percent.
- Gold: Your plan covers 80 percent; you pay 20 percent.
- Silver: Your plan covers 70 percent; you pay 30 percent.
- Bronze: Your plan covers 60 percent; you pay 40 percent.
There is also catastrophic insurance coverage. Congress designed this type of plan to be used only in the event of an emergency. These plans are sold only to people under the age of 30 who do not have chronic health problems. A catastrophic health plan pays less than 60 percent of your costs each time you use your insurance.
Health insurance rates in the federal marketplace are based on your geography, your history of tobacco use, and your age. People who smoke or use tobacco products often pay more than people who do not. In addition, many states are divided into geographical regions. Insurance prices may vary from region to region.
According to the Kaiser Foundation’s Health Insurance Marketplace Calculator, a 30-year-old, non-tobacco user who lives in Michigan can expect to pay an average of $216 per month. This price does not include any possible cost-saving opportunities you may be eligible for through the exchange.
You can also use the Premium Estimator provided by the Michigan Department of Insurance and Financial Services. The Premium Estimator says a 30-year-old, non-tobacco user from Michigan can expect to pay between $240.49 and $338.39. These estimates don’t include any possible cost-saving opportunities.
When you apply for insurance, you may find out that you qualify for financial aid. This assistance can help you offset the cost of buying and paying for health insurance.
This aid may include:
- Medicaid coverage, which is a plan for low-income individuals.
- Healthy Michigan Plan, which is a health insurance option for low-income individuals who make too much to qualify for Medicaid, but also fall at or below a particular threshold of the federal poverty level.
- Lower premiums or reduced monthly bills for your plan.
- Lower out-of-pocket maximum or a lower cap on what you will pay out of pocket before your insurance company begins paying 100 percent of your bills.
You may qualify for lower premiums if your annual income falls within a certain range. These ranges, which are established by the federal marketplace, include:
- $11,670 to $46,680 for 1 person
- $15,730 to $62,920 for 2 people
- $19,790 to $79,160 for 3 people
- $23,850 to $95,400 for 4 people
- $27,910 to $111,640 for 5 people
- $31,970 to $127,880 for 6 people
You may qualify for lower premiums and lower out-of-pocket costs if your annual income falls within a certain range. These ranges include:
- $11,670 to $29,175 for 1 person
- $15,730 to $39,325 for 2 people
- $19,790 to $49,475 for 3 people
- $23,850 to $59,625 for 4 people
- $27,910 to $69,775 for 5 people
- $31,970 to $79,925 for 6 people
Learn more about purchasing health insurance in Michigan by visiting the Michigan Department of Health and Human Services. There, you can find information on how the exchange works and what you can do to be prepared to apply.
Once you’re ready to apply visit healthcare.gov. The step-by-step guide navigates you through the application process. If at any point you become confused or unsure, you can reach out to agents who are equipped to help you through the process.
If you do not currently have insurance but want it, you have two options:
- You can wait for the 2016 annual open enrollment period (which starts November 1, 2015).
- You can see if you’re eligible for a special enrollment period. These special enrollments are decided on a case-by-case basis.
You may be feeling overwhelmed by your options, choices, and decisions. But you’ve made the right decision to get health insurance. Knowing that you have coverage if and when the unthinkable happens will help you avoid financial worries, difficulties, and problems. Apply during the open enrollment period to be sure you start coverage as soon as you’re eligible.