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. Beginning January 1, 2019, the tax penalty is $0.
Those who were uninsured for more than two months in 2018 may pay a federal tax penalty of $695, plus any inflation adjustment to be determined, or 2.5% of their household income.
You may be exempt from paying the penalty for not having coverage if you were uninsured for only one or two months, experienced a financial hardship, religious or moral objection, belong to a Health Care Sharing Ministry, or if it would cost more than 8.05% of your income in 2018 to purchase coverage. The Health Insurance Marketplace (Marketplace) provides more information about the exemptions from the requirement to have health insurance.
Open Enrollment for Individual Coverage
For coverage in 2019, the open enrollment period is November 1, 2018 to December 15, 2018. Plans purchased during open enrollment will become effective January 1, 2019. During open enrollment, individuals can shop for coverage in the Marketplace or outside in the overall market. To access the Marketplace or to learn more, visit:
- DIFS’ Health Insurance Marketplace page, or
- Contact the Marketplace Call Center at 800-318-2596
Ways You Can Buy a Plan
- Through the Health Insurance Marketplace. Visit www.healthcare.gov or call 800-318-2596.
- Directly from a health insurer. DIFS provides a list of Authorized Major Medical Companies.
- With the help of a licensed agent. To find licensed health insurance agents in your area and to verify their licensure in Michigan, please use DIFS' Insurance Licensee Locator. Please note that not all agents listed here have registered to sell on the Marketplace.
- 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. For more information about finding a navigator or certified application counselor near you, please visit DIFS’ In-Person Consumer Assistance with the Marketplace page.
Some insurance companies and agents can sell you plans through the Marketplace. All of them must sign agreements with the Marketplace to sell Marketplace health 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 Marketplace or in the overall market.
Things to Consider When Shopping for Coverage
Before shopping, you may wish to visit DIFS’ Health Coverage Basics page to learn more about different types of policies available to consumers, and certain minimum coverage requirements required under the Michigan Insurance Code. There is also a Glossary of Health Coverage Terms.
- Do your best to balance the cost (monthly premium) of a policy with the protection it provides. 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, such as deductible, coinsurance, and copayment, 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 a Glossary of Health Coverage Terms. If you buy a plan for your family, determine if the deductible amount is per person or a combined family total. 2019 individual plans limit out-of-pocket costs to $7,900 for an individual and $15,800 for a family.
- Determine what benefits are covered without having to meet the deductible in advance. Under the ACA, all 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 copayments 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 insurer!
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
Moody's Investor Service
Standard & Poor's
Phone: 877-772-5436, option 4
Links to health insurer complaint information:
Links to health insurer financial information: