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Health Insurance Marketplace

The Health Insurance Marketplace is a new federally operated insurance marketplace (or “exchange”) where individuals and small businesses will be able to shop for and compare health coverage. The Marketplace is primarily accessed as a website: www.healthcare.gov. However, a paper application and consumer assistance is available at the Health Insurance Marketplace Call Center: 800-318-2596.

Purchasing Coverage in the Health Insurance Marketplace:
Any individual or family may buy coverage in the Marketplace. (Illegal or undocumented immigrants and incarcerated people cannot purchase coverage in the Marketplace.) For those who do not want to purchase in the Marketplace, coverage will continue to be sold outside of the Marketplace. However, new federal tax credits will be available to help with the cost of coverage only for plans sold within the Marketplace.

If you currently have health coverage through an employer, the Healthy Michigan Plan, Medicare or Medicaid, you don’t need to do anything with the Marketplace. However, if you are uninsured, purchase individual coverage or believe your coverage is inadequate or unaffordable, you may wish to apply to the Health Insurance Marketplace to find out if you qualify for tax credits to help with the cost of coverage.

Health Coverage Requirement:
In 2014 and beyond, 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. If you currently have coverage from the Healthy Michigan Plan, Medicare, Medicaid or an employer, you are considered covered and will not pay a tax penalty.

Those who do not have or do not obtain coverage will pay a federal tax penalty. The amount of the penalty for an individual is phasing in as follows:

  • In 2014 - the greater of $95 per adult or 1% of taxable income
  • In 2015 - the greater of $325 per adult or 2% of taxable income
  • In 2016 - the greater of $695 per adult or 2.5% of taxable income

You may be exempt from paying the penalty for not having coverage if you have a financial hardship, religious objection, belong to a Health Care Sharing Ministry, or if it would cost more than 8% of your income to purchase coverage. For more information on the Health Coverage Requirement, click here.

Open Enrollment for the Health Insurance Marketplace:
Open enrollment for coverage in 2014 was October 1, 2013 through March 31, 2014. Open enrollment for coverage in 2015 is November 15, 2014 through February 15, 2015.

Cost of Coverage in the Health Insurance Marketplace:
To officially apply for coverage and tax credits and to view the plans sold in the Marketplace go to www.healthcare.gov. To get an estimate of what your premiums might be, please visit “Premium Estimator”. However, the premium estimates do not represent an offer of coverage on the Marketplace.

Help with the Cost of Coverage in the Health Insurance Marketplace:
In 2014, federal tax credits to assist with the cost of health coverage in the Health Insurance Marketplace may be available for those with income between 100 percent and 400 percent of the federal poverty level who are not eligible for other affordable coverage. (The federal poverty level is adjusted annually. In 2013, 400 percent of the poverty level for Michigan residents was about $45,960 for an individual or $94,200 for a family of four.) For more information on federal tax credits, click here.

Healthy Michigan Plan:
Some Michigan residents may be eligible for the Healthy Michigan Plan, a new health coverage program that began on April 1, 2014. To be eligible for the Healthy Michigan plan, you must be:

  • Ages 19-64
  • Not currently eligible for Medicaid
  • Not eligible for or enrolled in Medicare
  • Not pregnant when applying for the Healthy Michigan Plan
  • Earning up to 133% of the federal poverty level (The federal poverty level is adjusted annually. In 2013, 133% of the poverty level for an individual was $14,856 or $30,657 for a family of four)
  • A resident of Michigan

For more information, visit www.HealthyMichiganPlan.org or call 855-789-5610.

Types of Plans Available in the Marketplace:
Four tiers of coverage is available through the Marketplace:

  • Bronze Level - These plans must cover 60% of expected health care costs.
  • Silver Level - These plans must cover 70% of expected health care costs.
  • Gold Level - These plans must cover 80% of expected health care costs.
  • Platinum Level - These plans must cover 90% of expected health care costs.

One additional level of coverage is available in the Marketplace: a catastrophic plan. Catastrophic plans are available only to people under age 30 and to people who have received certain “hardship exemptions.” Catastrophic plans generally have lower premiums and higher deductibles. Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost. People with catastrophic plans are not eligible for federal tax credits to lower their monthly premiums.

Plans for Sale in the Marketplace:
To get a listing of plans sold in the Marketplace by geographic area and sample prices, visit “Company Premiums by Metal Level/Age.”

Cost for Coverage for People with Pre-Existing Conditions:
Beginning in 2014, new plans cannot deny you coverage, charge you more, or impose a waiting period on your coverage because of a pre-existing medical condition.

Rating Factors:
Individual health insurance premiums (both on and off the Marketplace) can only vary based on: whether the policy to be sold will be for an individual person or for a whole family; the geographic area that you live in; your age; and tobacco use.

Help Signing up for Coverage:
Assistance will be available from “navigators” and “certified application counselors.” Health insurance agents may be able to assist you as well. More information on who will be providing this assistance may be accessed here.

Michigan’s role in the Health Insurance Marketplace:
The federal government operates Michigan’s Health Insurance Marketplace. Michigan reviewed the rates and forms for carriers that sell products in the Marketplace.