Changes to healthcare: You have questions, we have answers.
Effective Jan. 1, 2014, as part of the federal Patient Protection and Affordable Care Act, all states are required to have a healthcare exchange in place where individuals and small groups can compare health insurance plans, shop and apply for coverage.
The Michigan Health Insurance Marketplace, commonly referred to as the Exchange, is administered by the federal government and opened for enrollment on Oct. 1, 2013, to help provide an estimated 1.4 million uninsured or underinsured Michiganders access to health care coverage.
There are many public resources for more information on purchasing health insurance on the Exchange, and we’ve gathered some of the more frequently asked questions and answers here:
Q: How does the Affordable Care Act affect people like me? A: If you need coverage, you can use the Exchange. If you have coverage, you gain new protections in the form of covered preventative care and other basic services. If you don’t obtain coverage, you may face a federal income tax penalty.
Q: Where do I go to purchase insurance on the Exchange? A: Michigan and 17 other states are using an exchange run by the federal government. To talk to an expert, research and compare plans, and apply for coverage, visit www.healthcare.gov or call 1.800.318.2596. Open enrollment starts Oct. 1, 2013, and runs through March 31, 2014. Coverage starts Jan. 1, 2014.
Q: I hear there are problems with the website that have prevented people from enrolling to purchase health insurance on the Exchange?A: Yes.The federally run site, healthcare.gov, which Michigan residents use to purchase healthcare on the Exchange, has experienced difficulties since its launch on Oct. 1. While many individuals have been successful, many others have encountered technical difficulties during the enrollment process.
The federal government has made repairing the site a priority and fixes are being implemented daily. You may continue to run into difficulties, however, for a few more weeks.
Those wishing to pursue coverage can still do so by calling 1.800.318.2596 or by meeting with a Health Insurance Exchange Navigator in person to complete your enrollment paperwork. You can find a local Navigator by visiting LocalHelp.HealthCare.gov and entering your ZIP code.
Q: What types of insurance will be offered on the Exchange? Is this government-run healthcare? A: While the Exchange is being run by the federal government, the health insurance offered on the Exchange is provided by local, regional, and national health insurance companies which must meet a minimum set of criteria laid out in the Affordable Care Act.
Plans will be presented in four categories – bronze, silver, gold, and platinum – to make comparing them easier. Those plans with lower premiums offer less coverage on health care costs, whereas those with higher premiums cover a larger portion of your health care bills.
- Bronze – Lowest premiums but covers only about 60 percent of costs
- Silver – Approximate 70 percent coverage
- Gold – Approximate 80 percent coverage
- Platinum – Highest premiums, but covers approximately 90 percent of costs
- Catastrophic – Available only to healthy individuals under the age of 30
Q: Which plans on the Exchange will allow me to seek care at Sparrow?
A: You can receive care at Sparrow with any of these plans, however whether it is considered in-network or out-of-network will vary, which can affect your costs.
Sparrow is participating with the following Michigan Exchange plans and services are covered at “in-network” levels for treatment at Sparrow:
- Blue Care Network of Michigan
- Blue Cross Blue Shield of Michigan
- McLaren Health Plan Rewards Plan – Directly Contracted Network level coverage (10-40% coinsurance depending on plan level)
Sparrow is not participating with the following Michigan Exchange plans and services are covered at “out-of-network” levels for treatment at Sparrow. Please consult your plan provider for your “out-of-network” coverage as it may vary.
- Alliance Health and Life Insurance Company
- Consumers Mutual Insurance of Michigan (CO-OP)
- Health Alliance Plan
- Humana Medical Plan of Michigan, Inc.
- Meridian Health Plan of Michigan, Inc.
- Molina Healthcare of Michigan
- Priority Health
- Priority Health Insurance Company
- Total Health Care USA
- United Healthcare Life Insurance Company
Q: How do I know if I qualify for Medicaid or should look for insurance on the Exchange?
A: When you visit healthcare.gov and go through the process to enroll, the program will automatically assess and inform you of your eligibility for Medicaid before allowing you to purchase coverage.
Q: I don’t have insurance because I can’t afford it. How will I be able to afford insurance on the Exchange? A: Federal tax credits are available toward health care insurance purchased on the Exchange. The amount of federal tax credit you may quality for will vary, and is based upon a graduated scale for those making up to four times the 2014 federal poverty level (currently $46,680 for individuals and $95,400 for a family of four). Additionally, those making up to 2.5 times the poverty level (currently $29,175 for individuals and $59,625 for a family of four) are also eligible for reduced co-pays and deductibles.
Q: Where can I go for more information? A: There are many public resources for more information on purchasing health insurance on the Exchange. Here are a few of the top places to learn more:
- Healthcare.gov / 1.800.318.2596 - This is where Michigan residents will compare plans, apply for coverage and enroll. It also provides extensive information for consumers on the ACA and Health Insurance Marketplaces. You can call 24 hours a day, 7 days a week. TTY users should call 1.855.889.4325. Online chat is also available 24/7, just look for the blue box on the lower right hand corner on most pages of the site. You’ll be connected to a customer service representative who can answer your questions in an online conversation.
- LocalHelp.HealthCare.gov - To find help in your area. You can search by city and state or ZIP code to see a list of local organizations with contact information, office hours, and the types of help they offer.
- phphealthanswers.com - The site provides much needed information through question and answer sections specific to individuals, employers, healthcare providers and insurance agents.
- michigan.gov/difs - Offers Michigan specific information regarding health insurance, ACA, state-based and marketplace insurance information.
- hhs.gov/healthcare - Offers state-by-state information on how the Affordable Care Act is providing better options, better value, better health and a stronger Medicare program to the people of Michigan.
- Kff.org/health-reform - This site, operated by the Kaiser Family Foundation, offers in-depth information on key health policy issues and interactive tools to determine how healthcare reform will impact you.
- Email us at ExchangeAnswers@sparrow.org