What is the marketplace?
Essential Health Benefits Coverage
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Preventive care
Hospitals
Physicians
Prescription drugs
Mental health
Rehabilitation
Habilitation services
Substance abuse
Dental and vision for children
Maternity care
Levels of Coverage
Security and Control
• Insurance companies won’t be able to turn people down because of pre-existing
conditions, including pregnancy and disability.
• This took effect in 2010 for children and on Jan. 1, 2014 for everyone.
• You can get lower costs on coverage: The Marketplace application will tell you if
you’re eligible for a new way to get lower costs on your monthly premiums or out-ofpocket costs for private insurance. You’ll also learn if you can get free or low-cost
coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
• You can get help in your area: Navigators are available to give you personalized
assistance with the process.
Financial Protections
• No annual or lifetime limits
• Spending caps will limit the amount
consumers pay out of pocket each year.
• Insurance companies have to spend at least
80-85% of premiums on medical care.
• Eligible for tax credits
• Insurers must justify premium
increases
Can I keep my own doctor?
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Depending on the plan you choose in the
Marketplace, you may be able to keep your
current doctor.
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Most health insurance plans offered in the
Marketplace have networks of hospitals, doctors,
specialists, pharmacies, and other healthcare
providers.
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When comparing plans in the Marketplace, you will
see a link to a list of providers in each plan’s
network.
Moderate-Income Families
• Families and individuals will receive tax credits to help pay for health insurance,
depending upon income.
• Tax credits are available to everyone between 400% and 133% of the Federal
Poverty Limit to make purchasing insurance more affordable. (Everyone below
133% FPL will be part of the Healthy Michigan program that begins April 1 st.)
• Tax credits are designed to keep premium costs between 2%-8% of income, on a
sliding scale.
Cost-Sharing Assistance
What about Medicaid?
• State health insurance programs under
Medicaid will cover all families and
individuals with incomes up to 133% of the
Federal Poverty Level ($15,282 for an
individual, $31,322 for a family of four)
• In Michigan, the expanded Medicaid
program will not begin until April 1, 2014
• Even if you were told you didn't qualify for
Medicaid in the past, you may qualify under
the new rules. Eligibility remains the same
for women and children
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Job-Based Insurance
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If you have job-based
insurance, you’re
considered covered.
You may be able to change
to Marketplace coverage
Your income will determine
your eligibility for lower
cost premiums
By 2014, you must...
What about the fees?
What about small business?
• No mandate on small
businesses
• Rewards good actors with
subsidies
• Small businesses and non-profits
qualify
• Credits carry over up to 20 years
• Maximum
subsidy is 50% for
smaller businesses
How does the marketplace work?
Navigators are here to help
What documents do I need?
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Social Security Numbers (or document
numbers for legal immigrants)
Employer and income information for
every member of your household who
needs coverage (for example, from
pay stubs or W-2 forms—Wage and
Tax Statements)
Policy numbers for any current health
insurance plans covering members of
your household
Stay Connected
Join our MCH’s email list
Follow Us on Twitter @Enroll Michigan
Like Us on Facebook @EnrollMichigan
Use the Legislative Action Center at
http://www.consumersforhealthcare.org
Navigators and Community Events are
available at
http://www.enrollmichigan.com
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