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Premium Assistance (PA) Program

Premium Assistance (PA) Program

Premium Assistance (PA) Program

The Premium Assistance (PA) Program helps Michigan Drug Assistance Program (MIDAP) members cover costs associated with their health insurance policy, including copayments, deductibles, coinsurance and/or premiums and maintain health insurance coverage.

For the 2025 year, MIDAP-eligible members will be able to select any Metal Level Plan (Platinum, Gold, Silver, Bronze) from the Health Insurance Marketplace. MIDAP will cover the copay/coinsurance for medications on the MIDAP Formulary. MIDAP does not cover costs for medical expenses.

Below is a summary of the cost-sharing breakdown of medical expenses for each metal level.

  • Platinum plans will cover 90 percent of covered medical expenses; clients must cover the remaining 10 percent of expenses.
  • Gold plans will cover 80 percent of covered medical expenses; clients must cover the remaining 20 percent of expenses.
  • Silver plans will cover 70 percent of covered medical expenses; clients must cover the remaining 30 percent of expenses.
  • Bronze plans will cover 60 percent of covered medical expenses; clients must cover the remaining 40 percent of expenses.

MIDAP Marketplace Matrix (guide to provide information on availability and estimated costs of Marketplace insurance plans for Wayne, Macomb, Kent and Ingham County)

Who Qualifies?

To be eligible for Premium Assistance:

  • You must first be approved for MIDAP assistance. If you are not currently an active member, visit MIDAP to view the MIDAP qualifications and application.

Premium Assistance includes COBRA, Medicare Part C (Advantage Plan), Medicare Part D (Prescription Plan), or a Qualified Health Plan (QHP) through the Affordable Care Act (ACA) Health Insurance Marketplace.

  • Access the ACA Insurance Marketplace at HealthCare.gov.
    Marketplace Open Enrollment begins November 1, 2024 and ends January 15, 2025.

What Assistance is Available?

Three types of premium assistance are available. Please read each of the following descriptions carefully to determine which program may be appropriate for you.

  1. COBRA Premium Assistance

    This type of assistance is for members who have recently been terminated from employment and are eligible for COBRA benefits. Premium Assistance will pay for eligible COBRA benefits for up to 18 months. For assistance with these premiums, applicants must:

    • fully complete the Premium Assistance Application and submit it with their COBRA election paperwork; and
    • have already elected for COBRA benefits through the COBRA Administrator.

    Please note:
    A) If you have already signed up for COBRA, the Premium Assistance program will only assist with medical premiums.
    B) The Premium Assistance program is the payer of last resort. If you have not yet signed up for COBRA coverage, please contact us at 888-826-6565 (toll-free) for instructions.

     

  2. Medicare Part C (Advantage Plan) and Medicare Part D (Prescription Plan)

    This type of assistance is for members who are Medicare eligible and enrolled in either a Medicare Part C (Advantage Plan) or Medicare Part D (Prescription Plan). For assistance with these premiums, applicants must:

    • fully complete the Premium assistance Application and submit it with their most recent insurance billing statement;
    • note any existing overdue balance on their application; and
    • For Medicare Part D applicants, if your income falls between 100%-150% of the Federal Poverty Level you must enroll in Low-Income Subsidy (LIS) Extra Help. MIDAP must be notified of enrollment status and subsidy provided.

     

  3. Qualified Health Plan Assistance

    This type of assistance is for members who have already applied for insurance through the ACA Marketplace, have applied for tax credit subsidies and cost sharing, and have been approved. For assistance with these premiums, applicants must:

Premium Assistance Program Application, Forms, and Instructions

Important Notes

  • You must complete the application in its entirety.

  • All three types of assistance require different information on the application. When applying, please be careful to submit the correct information for that type of assistance. Submitting partial or incorrect information may delay the processing of your application.

  • Please submit your application 30 days prior to the premium due date. Payments of premiums by the due date cannot be guaranteed if the application is received less than 30 days prior to the due date and may result in a delay or loss of insurance coverage.

  • Once your request for premium assistance has been approved, MIDAP will notify you by mail. Monthly billing statements will continue to be sent to you by your insurance company or COBRA Administrator. It is your responsibility to ensure payments are being received and credited to your account.

  • If you do not meet the eligibility requirements for the programs listed above, you may still qualify for the Insurance Assistance Program (IAP) through the Michigan Department of Health and Human Services. Please call 877-342-2437 or 517-335-9134 to discuss eligibility requirements.

  • Any changes to your premiums, overdue balances, or credits to your account must be immediately reported to the MIDAP office at 1-888-826-6565. You will be instructed to fill out a Premium Payment Adjustment Form. Failure to do this may result in loss of insurance coverage.