Skip to main content

Plan First

Plan First Limited Medicaid Benefit

Plan First is a limited health coverage program administered by the Michigan Department of Health and Human Services. The Plan First is a limited Medicaid benefit that covers family planning services such as contraceptive services and supplies, sexually transmitted infection (STI) testing and treatment, vaccines, and other preconception health services.

There are no gender or age requirements to be eligible for Plan First.

Individuals on Plan First do not have full Medicaid coverage. Plan First is not minimum essential coverage and you are eligible to apply for coverage on the Health Care Marketplace.

Eligibility

Plan First family planning coverage is available to individuals who:

  • Are of any age or gender
  • Are not pregnant at the time of application
  • Are a U.S. citizen or a qualified immigrant
  • Are a Michigan resident
  • Are not covered under another Medicaid benefit
  • Meet income eligibility requirements (income at or below 195% of the Federal Poverty Level)

Covered Services

The Plan First program benefit is limited to family planning services only. The Plan First family planning program covers a broad range of family planning services which includes U.S. Food and Drug Administration (FDA)-approved contraceptive products and natural family planning methods for individuals who want to prevent pregnancy and to space births. It also includes pregnancy testing and counseling, sexually transmitted infection (STI) services, vaccines and other preconception health services.

  • Office Visits for family planning related services
  • Birth control medication and supplies
  • Some lab tests
  • Some cancer screenings
  • Testing and treatment for sexually transmitted infections
  • Voluntary sterilization procedures and follow-up care

*Coverage for abortions, Hepatitis, HIV and infertility are not covered under this program.

All Plan First enrollees have free choice of family planning providers and may obtain covered family planning services from any qualified Medicaid-enrolled providers. Qualified family planning providers working within their state licensure and scope of practice include, but are not limited to, Title X family planning clinics, Local Health Departments, Federally Qualified Health Centers, Tribal Health Centers, and primary care or obstetrical providers such as physicians, physician assistants, Certified Nurse-Midwives, Nurse Practitioners, and Clinical Nurse Specialists.  Decisions about family planning methods, including sterilization procedures, are to be made only with the full and informed consent of the individual, either alone or with support, and free from coercion.

Frequently Asked Questions

  • The Plan First program includes the following covered services:

    • Office Visits:
      • Family planning services, including preconception counseling, contraceptive counseling, and physical exams.
      • Preventive services, including annual wellness exams, preventive screening, counseling, and vaccines, including Human Papilloma Virus (HPV) and Hepatitis B.
      • Diagnostic procedures, counseling, and follow-up visits to diagnose and/or treat an STI or STI-related condition identified or diagnosed at a family planning visit.
      • Counseling for the prevention, screening, and diagnosis of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and hepatitis.
      • Treatment of pre-cancerous conditions which commonly originate from an STI.
      • Basic diagnostic infertility services, including infertility counseling.
      • Treatment of major complications related to family planning services and family planning-related procedures.

         

    • Laboratory Services:
      • Pregnancy testing.
      • Screening for cervical cancer.
      • Screening and counseling for STIs, HIV/AIDS, and hepatitis.

         

    • Pharmaceutical Services:
      • All FDA approved methods of contraception supplies and devices to prevent or delay pregnancy.
      • Over-the-counter contraceptives and supplies, such as condoms, spermicides, and sponges.
      • Pharmaceuticals to treat an STI or STI related condition identified or diagnosed at a family planning visit (other than HIV/AIDS or hepatitis).

         

    • Sterilization Procedure Services:
      • Voluntary sterilization surgical procedures and follow-up care provided in accordance with Medicaid program coverage.

     

    Noncovered Services

    The Plan First program does not cover the following:

    • Abortions
    • Treatment of infertility, such as drugs or artificial insemination
    • Reversal of voluntary sterilization
    • Hysterectomies for sterilization
    • Treatment, including pharmaceuticals, for conditions not related to family planning, such as cancer, HIV/AIDS, or hepatitis.
    • Inpatient hospital services
    • Other health care services not related to family planning
  • Individuals eligible for Plan First include those:

    • Who have income at or below 195% of the Federal Poverty Level (FPL) under the Modified Adjusted Gross Income (MAGI) methodology.
    • Of any age or gender.
    • Who are not pregnant at the time of application; and
    • Who are a resident of the state of Michigan and are a U.S. citizen or a qualified immigrant.

     

    There are no gender or age requirements to be eligible for Plan First.

  • Plan First is a limited Medicaid benefit that covers a broad range of family planning services, including annual wellness exams, preventive screening, pregnancy testing and counseling, sexually transmitted infection (STI) testing and services, and certain pharmaceutical, diagnostic, and laboratory services.

    Plan First is a Medicaid group and is available to anyone who meets eligibility requirements, regardless of age or gender.

    Because Plan First does not qualify as minimum essential coverage, enrollees can still purchase health plan coverage through the Marketplace.

  • No, The Plan First program is healthcare coverage for family planning services. Plan First also covers preventive health services, testing and treatment of sexually transmitted infections (STIs) and education. Plan First is not comprehensive Medicaid coverage.

    Because Plan First does not qualify as minimum essential coverage, enrollees can still purchase health plan coverage through the Marketplace.

  • MDHHS reviews the beneficiary's financial and nonfinancial (e.g., disability, age) factors and determines the types of assistance for which the beneficiary is eligible. If an individual qualifies for Medicaid, they are placed in the most beneficial category for which they qualify. The following income thresholds apply for different groups and programs: 

    Medicaid Chart by Income Limit

    Plan First is a Medicaid category with limited benefits.  An individual qualifies for Plan First because they are not eligible for a full coverage category like Healthy Michigan Plan or because they did not provide documentation necessary to establish coverage in a full benefit group for individuals who are Aged, Blind, or Disabled (usually information about assets).

    Example #1: You were previously enrolled in the Healthy Michigan Plan because your income as a single adult was 120% of the Federal Poverty Level.  However, 6 months ago you got a raise at your job.  When you submitted your Medicaid renewal paperwork in December, your income is now at 175% of the Federal Poverty Level.  Because your income went up, you are no longer eligible for the Healthy Michigan Plan, but you are eligible for Plan First coverage because it is the most beneficial Medicaid category available to you. 

    Example #2: You were previously eligible for full coverage Medicaid as an Aged, Blind, or Disabled individual (e.g., Ad-Care).  Coverage for Medicaid under this group has an income level of 100% of the Federal Poverty Level and it has an asset limit of $2,000 for an individual.  When you submitted your most recent Medicaid renewal, you reported assets higher than $2,000 and no longer qualify for coverage in an Aged, Blind, or Disabled group.  Because Plan First does not have an asset limit, you do qualify for Plan First and were moved to this coverage as it is the most beneficial category available to you.

    If you are confused because you do not believe your income or assets have changed, likely one of two things occurred: 1) There was actually a change in your income or assets (such as changes to a life insurance policy, accumulation of savings, etc.) that has now put you over the income or asset limit or 2) A Verification Checklist was mailed to you requesting additional details about your income and assets and when that was not returned, we were unable to determine that you were still eligible for Aged, Blind and Disabled full coverage Medicaid. Since you do qualify for Plan First, you were moved into the most beneficial category of Medicaid coverage available to you. The diagram below shows an example of these two situations:

    Beneficiary Renewal Paperwork Map

    Note: This diagram does not represent all the ways a beneficiary could be eligible and enrolled into Plan First. Because Plan First does not qualify as minimum essential coverage, enrollees can still purchase health plan coverage through the Marketplace.

  • MDHHS attempts to determine the most beneficial category of Medicaid coverage available to you based on the information you have provided on your application.  We attempt to alert you of this decision as soon as we have made it to allow you to begin using those services right away. If we believe you may also qualify for other categories of benefits based on the information available to us, but we still need to evaluate additional details of your income and assets to determine eligibility, a verification checklist may also be sent to you. If you receive an additional request for information, please respond within 10 days with the requested information (such as bank statements, etc.). If you qualify for additional Medicaid coverage, you will be moved into the most beneficial category of Medicaid coverage available to you.

  • People with Plan First healthcare coverage generally will not have to pay for family planning services including co-pays.

Additional Resources

To apply, go online at www.michigan.gov/mibridges or contact your local MDHHS office.

Plan First Brochure - MDHHS-2840

Click here for a list of covered drug classes.

Click here for diagnoses (ICD-10-CM) covered under Plan First.

Click here for procedures and services (HCPCS and CPTs) covered under Plan First.