Home to the car capital of the world, Motown, the University of Michigan – the first state university, and the Kellogg’s company, Michigan is full of lakes and industry. With more shoreline than any other state, except Alaska, Michigan has over 11,000 lakes and 36,000 miles of streams. The residents of Michigan have several great health insurance companies to choose from when using East Coast Health Insurance, including Aetna, Blue Cross Blue Shield of Michigan, Humana and UnitedHealth Care. To get a quote and compare rates between these insurers, enter your zip code below. If you need some additional help sorting through plan types and finding one to fit you best, consult one of our licensed brokers at 888.803.5917.
Michigan’s overall health has declined over the past two years, due to various factors. The adult population is proving a lack of concern with health, as the number of diabetics has grown over the past year, now affecting 761,000 people. Obesity is another issue, with an increase in the past five years from 26.2% to 31.7% of all adult residents of Michigan. Poverty among children is also an area of concern, now affecting 20% of children under 18. A positive note is that smoking is becoming less frequent in Michigan residents over age 19, though 1.4 million adults are still smoking. There is also a fairly high level of excessive drinking in the state.
There is a high level of immunization coverage and frequent use of early prenatal care, so there is a relative level of concern for health when it comes to disease prevention and pregnancy in Michigan. There is a great amount of work to be done when it comes to the health of Michigan residents, which can be helped by getting a good health insurance plan to fit your health care needs and taking necessary measures to live a healthy lifestyle. If you cannot afford a health insurance plan from a private company or have a condition that requires extra help and treatment, utilize the state-funded health care programs (see Public Health Options below) related to your illness or need.
Health Insurance Plans
- PPO plans from Aetna in Michigan come in two types. Value PPO plans have deductible options of $3,000, $5,000 and $10,000, and PPO plans have $1,500, $2,500, $3,500 and $5,000 deductibles to choose from. With any of these plans, you have the freedom to use in-network of out-of-network services, though when using Aetna’s preferred network, you will receive greater savings. Depending on the plan you choose, your amount of cost sharing will vary after deductible. These plans include coverage on hospital admission, urgent care, primary care and specialist visits for a copay, and other major medical services. Preventive care is covered at 100% with in-network providers.
- PPO High Deductible plans are available with a deductible of $3,500 or $5,500 for individuals, and twice as much for families. These plans offer a comprehensive level of care, including doctor’s office visits, hospital care, emergency room services, lab work and skilled nursing for either 10% coinsurance or no cost after deductible. The out-of-pocket maximum for high deductible plans is $2,450 or $5,500 for individuals in-network. As soon as your plan begins, you can see an in-network provider for preventive care at no cost.
- Preventive & Hospital Care plans have a low level of coverage for individuals who want the basics and also have a safety in case of emergency. Once your plan starts, you can receive preventive care for no cost with a provider from Aetna’s preferred network. After you have met your deductible, a select number of medical services including outpatient surgery, inpatient hospitalization, skilled nursing and home health care are available for 20% coinsurance. There is one choice of annual deductible, which is $2,750 for individuals and $6,000 for families.
Blue Cross Blue Shield of Michigan
- PPO plans come in four types in Michigan: Keep Fit, Young Adult Blue Max, Individual Care Blue Plus and Flexible Blue II. These plans are simple to use and provide a light level of coverage, for those who do not expect to use many medical services but want to stay healthy. With these plans, you can choose to use in-network or out-of-network providers for your care, though using the large BCBSM network will cost significantly less. These plans have low monthly premiums, and deductibles ranging from $1,000 to $10,000 for individuals and $10,000 to $20,000 for families. Preventive care is covered in full as soon as your plan becomes effective, including annual physicals, GYN exams, mammograms and immunizations. Individual Care Blue Plus provides comprehensive coverage for a low deductible, and has great maternity benefits. Flexible Blue II plans are HSA-compatible, so you have the option of opening a tax-advantaged health savings account.
- HMO plans from BCBSM give an equal amount of quality care, but less freedom to choose providers. The HMO network is still very large, so you have a choice of great providers within the HMO. Your primary care doctor will facilitate your care, giving referrals to specialists and other providers as needed. Preventive care is covered at 100% as soon as your plan starts, and HMO plans also cover maternity, dental and prescriptions. These are available in two different options: OneBlue and Smart Select. Coinsurance is either 20, 25 or 50%, depending on the service covered.
- Copay plans from HumanaOne come in three types: Copay 70, Copay 80 and Enhanced Copay 80, which means once your deductible is met you will receive 70 or 80% coverage on qualified medical services. Office visits to a primary care doctor are available for $35 in-network, as well as $60 copay for a specialist and urgent care. Once you have met your deductible, you can use your plan to receive inpatient and outpatient hospital care, emergency room services, surgery, diagnostic testing and more. Preventive care is covered immediately when your plan begins at 100% with in-network doctors.
- 100% After Deductible plans cover a variety of medical costs after you have met the deductible. These plans are come in Value, Enhanced HSA and HSA types, with several choices of high deductibles meet your financial needs. Once you have reached your deductible, you can receive most kinds of health care at 100% coverage. This includes specialist and non-specialist office visits outside of preventive care, inpatient and outpatient care, lab and X-ray, and emergency room visits. 100% After Deductible plans have add-on benefits such as dental, term life and supplemental accident, as well as incentive plans that give you rewards for participating in health lifestyle programs.
- Health Savings Account plans in Michigan are available in two types: HSA 100 and Enhanced HSA 100. HSA plans give you a range of deductibles to fit your budget, and the option of opening a health savings account for better management of your medical costs. A comprehensive level of coverage is available with both of these plans, as they require no cost after you have met your deductible on major medical services. Enhanced HSA 100 plans include prescription drugs coverage, while HSA 100 does not. Both plans cover non-preventive doctor’s office visits, hospitalization, surgery, emergency care and more after meeting the deductible. From the day your plan starts, you can seek in-network preventive care services for no cost. HSA plans are practical, great choices for those who want to set aside funds specifically for medical use and get tax breaks in return.
- Copay plans simplify paying for health care, with fixed rates for primary care visits, specialist visits, prescription medications and several other services. Premiums are higher with Copay plans compared to other UnitedHealthOne options, but once you meet the deductible, your plans covers most medical care at 100%. Covered services include emergency care, inpatient hospital stays, outpatient surgery, lab work, X-rays and tests, mental health care and physical therapy. Preventive services with an in-network provider are free of charge at any time before meeting your deductible.
- High Deductible plans provide a comprehensive level of coverage, with a high deductible to allow room for any type of emergency, illness or injury. These plans are available in three different plan types, including Plan 100, Plan 80 and Saver 80. Plan 100 covers the entirety of your medical expenses after deductible, including but not limited to emergency room care, diagnostic lab testing and X-ray, inpatient hospital care and outpatient services. Plan 80 and Saver 80 require you pay 20% coinsurance on the same services once your deductible has been met.
- Health Savings Account plans have a range of high deductibles and are qualified for use with a health savings account for optimum control over health care costs. These plans have coinsurance options of 100% or 70/30 coverage after meeting the deductible, applied to a large number of health care services. Some of the covered benefits are doctor’s office visits, prescription drugs, inpatient hospital stays, outpatient care, surgery, testing and management of major conditions. Preventive care is available immediately, covered at 100% when using a network doctor. Deductibles start at $1,250 for individuals and $2,500 for families with HSA 70 plans, and $2,500 for individuals and $5,000 for families with HSA 100 plans.
Public Health Options
The State of Michigan provides funding for several health care programs to help residents who cannot afford a health plan or have medical needs that require a high level of care that surpass the limits of typical health insurance coverage. Medical Assistance/Medicaid programs have the largest enrollment, and provide health care coverage to qualifying Michigan families, children, elderly, pregnant women, disabled individuals and more. For a full list of Medicaid criteria, read our Medicaid Eligibility by State article.
Other services for specific illnesses and conditions, as well as prevention programs are available through the state to encourage better health and give everyone access to immunizations, family planning, and nutrition education. For a full list of services, visit the Michigan Department of Human Services or the Michigan Department of Community Health.
- Medicaid: coverage for medical services for low-income families, children, and other individuals living in Michigan.
- MIChild: a program for children without health insurance in Michigan.
- Plan First: birth control and family planning services for residents of Michigan with a low income.
- Breast and Cervical Cancer Control Program (BCCCP): cancer screening program for uninsured or underinsured women between ages 40 -64.
- MiRx: a prescription drug discount program for Michigan residents without prescription coverage.
Health Insurance Laws
Health insurance laws in Michigan are in place for the protection of the insurance company as well as the policy-holder. While some regulations may seem more in favor of one or the other, it is fairly well balanced, and at the time there are many new laws arriving to affect how health insurance operates. Through the Affordable Care Act, adults with pre-existing conditions will not be allowed to get rejected for a plan by a private health insurance company as of 2014. Also, every state will be running a state health exchange in order to compete with the private market and offer affordable plans through state and federal funding.
Current legislation in Michigan allows for insurance companies to still deny an individual or increase their premiums, based on health status. Pre-existing conditions are defined by the objective standard in this state, meaning a condition that someone has actually received care for in the past. Once accepted for a plan, a Michigan health insurer can decide to not pay for care related to the pre-existing condition for up to twelve months. After this exclusion period, they will be required to cover all types of care. Exclusion periods are not permitted in the state of Michigan, which is highly beneficial to those with such conditions.
Individuals who have been assigned the pre-existing condition label have the option of using the Pre-Existing Condition Insurance Plan. In Michigan, PCIPs are state-run, and provide health coverage similar to a private plan with monthly premium payments on doctor’s office visits and hospital care. These plans will expire at the end of 2013, as all adults will be able to purchase a plan through a state exchange or a health insurance company in 2014.
For insured individuals in Michigan, you have the protection of HIPAA to keep you insured, regardless of becoming ill. Once you have purchased your health plan, an insurer is not permitted to terminate your benefits on the grounds of illness, according to the guaranteed renewability provision. This provision also makes sure that the health insurance company you use offers to renew your plan when your term has ended. If you have paid your premiums and claims, and have not done anything to violate the terms of your plan, you are eligible for guaranteed renewal.