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••••••••••
Preventive care
Hospitals
Physicians
Prescription drugs
Mental health
Rehabilitation
Habilitation services
Substance abuse
Dental and vision for children
Maternity care
Essential Health Benefits Coverage
• Insurance companies won’t be able to turn people down because of pre-existing conditions, including pregnancy and disability.
• This took effect in 2010 for children and on Jan. 1, 2014 for everyone.
• You can get lower costs on coverage: The Marketplace application will tell you if you’re eligible for a new way to get lower costs on your monthly premiums or out-of-pocket costs for private insurance. You’ll also learn if you can get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
• You can get help in your area: Navigators are available to give you personalized assistance with the process.
Security and Control
Financial Protections
• No annual or lifetime limits
• Spending caps will limit the amount consumers pay out of pocket each year.
• Insurance companies have to spend at least 80-85% of premiums on medical care.
• Eligible for tax credits
• Insurers must justify premium increases
• Depending on the plan you choose in the Marketplace, you may be able to keep your current doctor.
• Most health insurance plans offered in the Marketplace have networks of hospitals, doctors, specialists, pharmacies, and other healthcare providers.
• When comparing plans in the Marketplace, you will see a link to a list of providers in each plan’s network.
Can I keep my own doctor?
Moderate-Income Families
• Families and individuals will receive tax credits to help pay for health insurance, depending upon income.
• Tax credits are available to everyone between 400% and 133% of the Federal Poverty Limit to make purchasing insurance more affordable. (Everyone below 133% FPL will be part of the Healthy Michigan program that begins April 1st.)
• Tax credits are designed to keep premium costs between 2%-8% of income, on a sliding scale.
What about Medicaid?• State health insurance programs under
Medicaid will cover all families and individuals with incomes up to 133% of the Federal Poverty Level ($15,282 for an individual, $31,322 for a family of four)
• In Michigan, the expanded Medicaid program will not begin until April 1, 2014
• Even if you were told you didn't qualify for Medicaid in the past, you may qualify under the new rules. Eligibility remains the same for women and children
10
Job-Based Insurance
• If you have job-based insurance, you’re considered covered.
• You may be able to change to Marketplace coverage
• Your income will determine your eligibility for lower
cost premiums
What about small business?
• No mandate on small
businesses
• Rewards good actors with subsidies
• Small businesses and non-profits qualify
• Credits carry over up to 20 years
• Maximum subsidy is 50% for smaller businesses
What documents do I need?
• Social Security Numbers (or document numbers for legal immigrants)
• Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements)
• Policy numbers for any current health insurance plans covering members of your household
Stay Connected
Join our MCH’s email list
Follow Us on Twitter @Enroll Michigan
Like Us on Facebook @EnrollMichigan
Use the Legislative Action Center athttp://www.consumersforhealthcare.org
Navigators and Community Events are available at
http://www.enrollmichigan.comOPEN
ENROLLMENT ENDS