Shopping for Health Coverage
Health Coverage Requirement
The “individual mandate” provision of the Patient Protection and Affordable Care Act (ACA) requires that people obtain health insurance or pay a federal tax penalty. For more information on the tax penalty or exemptions to the penalty, click here: Internal Revenue Service.
Open Enrollment for Individual Coverage
For coverage in 2015, the open enrollment period is November 15, 2014 to February 15, 2015. For coverage in 2016, the open enrollment period is November 1, 2015 to January 31, 2016. Individuals can shop for coverage in the Health Insurance Marketplace or outside in the overall market. The Health Insurance marketplace is a new marketplace where individuals and small businesses may choose to shop for and compare health coverage. To access the Marketplace or to learn more, visit: www.healthcare.gov, DIFS’ Health Insurance Marketplace page or call the Marketplace at 800-318-2596. To find out what options may be available outside of open enrollment, call DIFS 877-999-6442.
Ways You Can Buy a Plan
- Through the Health Insurance Marketplace. Visit: www.healthcare.gov or call 800-318-2596.
- Directly from an insurance company. The following link would be useful for shopping for coverage from an HMO: HMO open enrollment periods.The following is a list with contact information for all health insurance companies that are actively writing health coverage in Michigan: Authorized Major Medical Companies.
- With the help of a licensed agent. The following is a link where you can type in your zip code and get a list of insurance agents in your area that may be able to provide you with health coverage quotes: Search Criteria for Insurance Agencies.
- With the help of a federally trained navigator or certified application counselor.
Navigators and certified Application Counselors can help you sign up for a Marketplace plan.
- From an online health insurance seller.
Some insurance companies, agents, and online insurance sellers can sell you plans through the Marketplace. All of them must sign agreements with the Marketplace in order to sell Marketplace plans. In order to receive a tax credit to help with the cost of coverage, you must apply through the Marketplace.
Special Enrollment Periods outside of Open Enrollment Period
Certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other job-based health coverage would entitle one to a special enrollment period (outside of the standard open enrollment period) in the Health Insurance Marketplace or in the overall market.
Things to Consider When Shopping for Coverage
Before shopping, you may wish to visit the link Health Coverage Basics for Michigan, to learn more about different types of policies available to consumers, certain minimum coverage requirements and explanations of many key terms.
- Do your best to balance the cost (monthly premium) of a policy with the protection it offers. It is important to understand that what you pay as a monthly premium alone does not indicate the total cost you pay for your health care. Generally speaking the lower your monthly premium, the greater your portion of health care costs will be when you seek medical treatment.
- Determine what you will have to pay for covered services in a deductible, coinsurance, copayments, and out-of-pocket limit. To see a definition and explanation of those terms, visit the Glossary of Health Coverage and Medical Terms. If you buy a plan for your family, determine if the deductible amount is per person or a combined family total. All new individual plans limit out-of-pocket costs to $6,350 for an individual and $12,700 for a family.
- Determine what benefits are covered without having to meet the deductible in advance. All new plans must cover certain preventive care services free of charge and without having to pay a portion towards the deductible. In addition, some plans may exempt a certain number of physician visits or prescription drugs from the deductible. Some plans may not exempt any services from the deductible other than the required preventive services. You may also want to determine what co-payments are required before and after a deductible is met.
- Determine the access to care. You may want to find out if you would need to designate a primary care physician, if you would need a referral to see a specialist and what providers would require a prior approval. If you have a doctor or hospital that you prefer, you may want to pick a plan that participates with that provider.
Optional Method to Compare Insurance Companies
Note: The Department of Insurance and Financial Services does not rate or recommend health carriers!
Private Rating Firms
Several private firms specialize in evaluating the finances and services of insurance companies or health maintenance organizations. Each of these agencies has its own methods and standards and gives grades to the companies based on their judgment of how well the company is doing.
Contact information for some of the most popular rating firms is listed below. There may be a charge for some reports. Several of these rating firms publish books with their ratings, so you may also be able to find what you need at your local library. Before you rely on any report, make sure you understand the rating system because each firm has its own grading system. For example, one firm may use "A+" as its top grade, while another may go all the way up to "A+++."
A.M. Best Company
Web site: www.ambest.com
Web site: www.fitchratings.com
Moody's Investor Service
Web site: www.moodys.com
Standard & Poor's
Web site: www.standardandpoors.com
Links to health carrier complaint information:
Health Insurance companies and Blue Cross Blue Shield of Michigan
Links to health carrier financial information:
Health Insurance Companies Financial Information
HMO Financial Information