Health Insurance in Michigan

Health Insurance In Michigan

According to the United Health foundation’s 2008 Health Rankings, Michigan is the 27th healthiest state to live in. The state climbed four spots from its 31st position in 2007 in spite of weak public health funding, high crime rate and high prevalence of binge drinking. The state of Michigan, having the population of more than nine million people, boasts of both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced health coverage to the uninsurable residents of Michigan who meet specific eligibility requirements such as age, income, etc.

The Michigan Office of Financial and Insurance Regulation is in charge for regulating all types of insurance sold in the state of Michigan including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 11% of the population remains uninsured, which is the biggest health issue for the state lawmakers. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 34% uninsured Michigan residents come under the above 200% FPL category.

Choosing a health plan is not as easy as it used to be before. Therefore, it is advisable to consult with a licensed health insurance agent/broker to avail the appropriate health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Michigan. These regulations apply to all insurance companies offering individual or family health insurance in Michigan:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
12 months
Look Back Period
6 months
Look Back Standard
Objective
Mandatory Benefits
Cancer screening for women including breast cancer screening, reconstructive surgery after mastectomy, direct access to OB/GYNs, maternity care
Market Rate Restrictions
None
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Michigan. These regulations apply to all insurance companies offering small group health insurance in Michigan:

Small Group Size
2-50
Employee Qualifications
Two employees must work for at least 6 months out of the year, and work 20 hours per week
Guaranteed Issue
Yes
Premium Rating Factors
Rate bands
Rate Adjustment Factors
45%
Look-Back Period
0
Pre-existing condition exclusionary period
0
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Michigan. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
No
Eligible Group Sizes
NA
Extension of Benefits Period – Standard
NA
Extension of Benefits Period – Disabled
NA
Maximum Premium Increase
NA
State Legislation Reference
NA
Additional Notes
NA
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Michigan to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Michigan does not offer health insurance coverage through state high risk pool program for individuals who are medically-uninsurable.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Michigan provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
MIChild
Website
https://www.michigan.gov/mdhhs/0,5885,7-339-71547_2943_4845_4931—,00.html
Phone Number
888-988-6300
Apply Online
Yes
Age Limits
Under 19
Insurance Carrier
Varies by community
Length of Coverage
12 months
Residency Requirements
Michigan residents and U.S. citizens, some legal immigrants qualify
Other Eligibility Requirements
The child must have no health insurance and must meet income requirements
Pre-Existing Condition Exclusions
None
Cost
$10 monthly premium per family and no co-pays or deductibles
Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Michigan:

Governing Agency
Michigan Department of Community Health
Website
https://michigan.gov/mdch/0,1607,7-132-2943_4860—,00.html
Phone Number
517-373-3740
Residency Requirements
Michigan residents
Federal Poverty Line Income Limits
Pregnant women and infants up to 185% FPL; if income is too high, apply for MOMS
Children 1-19 income at or below 150%
Non-Working Parents: 35% FPL
Working Parents: 59% FPL
Medically Needy Individual: 57% FPL
Medically Needy Couple: 56% FPL
SSI Recipients: 74% FPL
Additional Resources

Michigan Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Michigan’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Michigan: At-A-Glance
Provides exclusive health data of the Michigan state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.

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