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Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA) commonly called the Affordable Care Act (ACA) or "Obamacare", is a federal statute signed into law by President Barack Obama on March 23, 2010. The law was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare. The law requires all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs to obtain an insurance policy or pay a penalty, unless the individual has a financial hardship. The law includes subsidies to help people with low incomes pay for the cost of the insurance policy.

The law requires all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs to obtain an insurance policy or pay a penalty, unless the individual has a financial hardship. The law includes subsidies to help people with low incomes pay for the cost of the insurance policy.

You may find the following links helpful:

To apply for coverage:

Healthcare.gov

To find application help in your area:

localhelp.healthcare.gov

enrollmichigan.com/about-us

What is the Health Insurance Marketplace?

How do I apply for Marketplace coverage?

Frequently asked questions about the marketplace

Marketplace 101

Healthy Michigan Plan

The ACA provided states with the opportunity for an Expanded Medicaid program. On September 16, 2013, Governor Rick Snyder signed into law Michigan Public Act 107 of 2013, which directs the creation of the Healthy Michigan Plan. The Healthy Michigan Plan in set to begin around April 1, 2014.

The Healthy Michigan Plan provides health care coverage for individuals who:

  • Are age 19-64 years

  • Have income at or below 133% of the federal poverty level under the modified adjusted gross income methodology

  • Do not qualify for or are enrolled in Medicare

  • Do not qualify for or are enrolled in other Medicaid programs

  • Are not pregnant at the time of application

  • Are residents of the State of Michigan

The Healthy Michigan Plan provided coverage for the 10 Essential Health Benefits including:

  • Ambulatory patient services

  • Emergency services

  • Hospitalization

  • Maternity and newborn care

  • Mental health and substance use disorder treatment services, including behavioral health treatment

  • Prescription drugs

  • Rehabilitative and habilitative services and devices

  • Laboratory services

  • Preventive and wellness services and chronic disease management

  • Pediatric services, including oral and vision care

The Healthy Michigan Plan will cover other medically necessary services as appropriate.

Healthy Michigan Plan participants may be subject to cost-sharing obligations.

You may find the following links helpful:

Healthy Michigan Frequently Asked Questions

Healthy Michigan Handbook

ATTENTION Plan A Members (Adult Benefits Waiver Beneficiaries):

On April 1, 2014, the Adult Benefits Waiver, also known as Adult Medical Program or AMP, will change to the Healthy Michigan Plan. MDCH is in the process of notifying Adult Benefits Waiver beneficiaries of this change, with instructions on choosing a Medicaid health plan (if applicable).

County Health Plans and ACA/Health Michigan

With the passage of ACA, the implementation of the Marketplace, and the opening of the new expanded Medicaid program (Healthy Michigan), many of the current uninsured residents in Michigan will now have access to comprehensive, cost effective health care options. County Health Plan members with incomes above 138% FPL may now qualify government subsidized insurance through the Marketplace and members with incomes below 138% may qualify for the Healthy Michigan Plan.

After much consideration of the impending impact of these programs on plan membership, many of the County Health Plans will be terminating programs. Most of the termination dates coincide with the start of the Healthy Michigan Plan:

  Plan A Termination Date Plan B Termination Date
Barry Eaton Health Plan 3/31/2014 3/31/2014
Berrien Health Plan 3/31/2014 4/30/2014
Branch Hillsdale St Joseph 3/31/2014 3/31/2014
Coalition Health Access Program 3/31/2014 3/31/2014 Medical and 4/30/2014 pharmacy
Calhoun Health Plan 3/31/2014 4/30/2014
Ingham Health Plan 3/31/2014 Plan continues with limited membership
Ionia Health Plan 3/31/2014 4/30/2014
Jackson Health Plan 3/31/2014 3/31/2014
Kalamazoo Health Plan 3/31/2014 Plan continues with limited membership
Lenawee Health Plan 3/31/2014 No Plan B or V program
Livingston Health Plan 3/31/2014 Plan continues with limited membership until 12/31/2014
Mid-Michigan Health Plan 3/31/2014 Plan continues with limited membership until 12/31/2014
Monroe County Health Plan 3/31/2014 6/30/2014
Washtenaw Health Plan 3/31/2014 Plan continues with limited membership

* Plan B termination dates are tentative for some plans and may be lengthened depending on Healthy Michigan enrollment availability.

Plan A members will be automatically transferred to the Healthy Michigan Plan effective April 1, 2014. Plan B members will either need to apply for a Marketplace product by March 31, 2014 or apply for Healthy Michigan once enrollment opens sometime after April 1.

The Ingham, Kalamazoo, Livingston, Mid-Michigan and Washtenaw County Health Plans will continue to operate their Plan B programs with limited membership available to those who do not qualify for Healthy Michigan or those who qualify for a marketplace exemption. Members should refer to the local enrollment office for eligibility specifics.

Payments for covered services will only be made on dates of service prior to the members’ termination date. Previously issued authorizations are valid only if the member is covered on the date of service. Providers must submit claims or appeals within twelve months of the plan’s closure to be considered for payment. Claims should continue to be submitted by paper to Po Box 30125, Lansing, MI 48909 or electronically to payer ID 63719.

You may find the following links helpful:

2014 Federal Poverty Level Guidelines

Contact Customer Service at 1-866-291-8691 (toll free)