What Is Plan First?

For those who do not qualify for full Medicaid, the Plan First program is available to all ages and genders and is a limited Medicaid benefit that covers family planning services such as birth control and STI testing and treatment.

What Is Covered Under Plan First?

Services included under Plan First:

• Office visits for family planning.
• All FDA-approved contraception supplies and devices to prevent or delay pregnancy.
• OTC contraceptives and supplies such as condoms, spermicides and sponges.
• Testing and treatment for STIs, including pharmaceuticals.
• Cervical cancer screening.
• HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP).

Eligibility Requirements

• There are no gender or age requirements to be eligible for Plan First.
• Individuals qualify by meeting the income requirement of being at or below 195% of the Federal Poverty Line.
• Be a Michigan resident and US citizen or qualified immigrant.

How do I Apply?

An individual needs to complete a Medicaid application, which is available on the MI Bridges portal or via a paper form that can be downloaded here.

You can apply to Plan First at any time – there is no open-enrollment period.

How Much Does Plan First Cost?

People with Plan First health care coverage generally will not have to pay for family planning services including copays.

What If I Need More Comprehensive Health Insurance?

Individuals in Plan First do not qualify for full Medicaid coverage and are eligible to apply for additional coverage on the Health Insurance Marketplace.

What If I Would Like More Information?

Additional information about Plan First, including FAQs are available at Michigan.gov/PlanFirst.

A brochure about Plan First is available here. (Spanish | Arabic)

What Is Medicaid?

Medicaid is the nation’s largest public health insurance program for people with low income. It is a health care program jointly financed by states and the federal government. States have flexibility to design and administer their Medicaid programs within federal guidelines.

What Is Covered Under Medicaid?

Medicaid covers a broad spectrum of family planning care that includes contraceptive service, such as diagnostic evaluation, drugs and supplies for voluntarily preventing or delaying pregnancy. The services covered enable beneficiaries to voluntarily choose to prevent initial pregnancy or to limit the number of and spacing of their children.

In addition to family planning services, Medicaid also covers the full spectrum of medical, dental and behavioral health benefits. 

Medicaid Eligibility Requirements

• MDHHS reviews the beneficiary's financial and nonfinancial (e.g., disability, age) factors to determine what types of assistance the beneficiary is eligible for. If an individual qualifies for Medicaid, they are placed in the most beneficial category for which they qualify.
  • For example, the Healthy Michigan Plan, for individuals who are 19 to 64 years old, has an income threshold up to 133% of the Federal Poverty Line.
• A Michigan resident and US citizen or qualified immigrant.

How do I Apply?

To apply for Medicaid, an individual needs to complete a Medicaid application, which is available on the MI Bridges portal or via a paper form which can be downloaded here.

You can apply to Medicaid at any time – there is no open-enrollment period.

How Much Does Medicaid Cost?

People with Medicaid coverage generally will not have to pay for family planning services including co-pays.

What If I Need More Comprehensive Health Insurance?

Most individuals enrolled in Medicaid have comprehensive health insurance and therefore do not need to apply for supplemental insurance on the Health Insurance Marketplace.

What If I Would Like More Information?

Additional information about Medicaid is available at MIchigan.gov/Medicaid.

Who This Applies To

Anyone enrolled in a health insurance plan that is generally regulated by the federal government or states. These plans also have certain family planning requirements that they must also abide by. These health plans are:

• Individual, small and large group plans.
• Self-insured plans.
• Federal employee plans.

What Is Covered?

These health insurers are required to provide at least one form of each of the contraceptive methods currently approved by the Food and Drug Administration (FDA), including:

• Barrier methods, like diaphragms and sponges.
• Hormonal methods, like birth control pills and vaginal rings.
• Long-acting reversible contraception, like intrauterine devices (IUDs).
• Emergency contraception, like Plan B.
• Female sterilization procedures.
• Patient education and counseling.

Related health care services, such as an office visit for a contraceptive shot, must also be covered. Private health insurers also cover a wide range of other medical and some behavioral services. Coverage is specific to each plan. Visit the Michigan Department of Insurance and Financial Services (DIFS) for more information.

What Do These Services Cost?

There should be no out-of-pocket cost to consumers. However, if you prefer a type or brand of contraceptive that is not currently covered by your private health insurer, you may have a copay or other out-of-pocket costs for your treatment.

What If My Insurer Refuses to Cover My Family Planning or Contraceptive Care?

If you have questions, DIFS can help consumers with health insurance questions and complaints. For more information visit Michigan.gov/HealthInsurance or call 877-999-6442, Monday through Friday from 8 a.m. to 5 p.m.

Who This Applies To

Health insurance plans that can be purchased on the Health Insurance Marketplace through healthcare.gov.

What Is Covered?

FDA-approved contraceptive methods prescribed by a woman’s doctor are covered, including:

• Barrier methods, like diaphragms and sponges.
• Hormonal methods, like birth control pills and vaginal rings.
• Implanted devices, like intrauterine devices (IUDs).
• Emergency contraception, like Plan B® and ella®.
• Sterilization procedures.
• Patient education and counseling.

Health insurance plans in the Marketplace also cover a range of other medical services including preventative health care services and 10 essential health benefits that are required by law.

Visit Healthcare.gov for more information about what is covered.

What Do These Services Cost?

Health insurance plans must cover contraceptive services without charging a copay or coinsurance when provided by an in-network provider — even if you haven’t met your deductible.

How do I Apply?

Open enrollment in the Marketplace is Nov. 1, 2024 through Jan. 15, 2025.

• Enroll by December 15 for coverage starting Jan. 1, 2025.
• Enroll by January 15 for coverage starting Feb. 1, 2025.

The Marketplace is available to individuals who do not have health insurance through their job, Medicaid, Medicare, or other qualifying health coverage. To be eligible to enroll in Marketplace health coverage, you must live in the United States, be a U.S. citizen or national (or be lawfully present), and not be incarcerated.

Outside of open enrollment, you can only get coverage in the Marketplace if you:

• Have a life change or income that qualifies for a Special Enrollment Period.
• Qualify for Medicaid. You can enroll any time of year and coverage can start immediately.

What If I Need More Information?

If you need more information, please visit healthcare.gov.

If you need assistance determining what is the most appropriate insurance option for you, local assistors are available to support you. Trained and certified assistors can help you apply and enroll in a Marketplace health plan (with any eligible savings) or apply for Medicaid. Assistors are required to provide fair, impartial and accurate information.

Find local help at localhelp.healthcare.gov.