LANSING - Physicians Health Plan, the administrator of the state's federally subsidized health care plan for uninsured people with pre-existing conditions, announced today the U.S. Department of Health and Human Services (HHS) has approved Michigan's request to reduce monthly premiums by 10 percent and ease the process to document a pre-existing condition, beginning Oct. 1.
"The approval by HHS allows HIP Michigan (Health Insurance Program for Michigan) to provide new lower premiums for most applicants and additional ways for them to demonstrate eligibility," said Scott Wilkerson, the president and CEO of PHP, a Sparrow affiliate. "These changes will make it easier for consumers to obtain the peace of mind and affordable health care that HIP Michigan delivers."
Michigan is among 27 states with a state-run pre-existing condition insurance plan (PCIP). The rest have federally run PCIP programs. The plans were developed after Congress approved the Affordable Care Act in 2010 and established health care exchanges to be fully implemented by 2014. Plans like HIP Michigan were designed as a bridge until 2014 to offer comprehensive coverage at market rates to people who have been denied health insurance due to pre-existing conditions such as cancer, heart disease and diabetes.
Applicants to HIP Michigan have a choice between three options to purchase their health care benefits, with rates determined by annual deductibles of $1,000, $2,500, and $3,500. Rates will continue to vary by age. Under the new premium rates that become available Oct. 1, for example, a 45-year-old could choose between paying a $191 monthly premium with a $3,500 annual deductible; a $227 monthly premium with a $2,500 annual deductible; or a $315 monthly premium with a $1,000 annual deductible. Monthly rates now will start as low as $103 for a 19-year-old enrollee.
To ease eligibility, HIP Michigan will accept applications with a certified provider documentation of a medical condition within the last 12 months. Also, there is no diagnosis list to limit an application. Applicants will still have to have been uninsured for six months prior to submitting their application to qualify. No applicant to HIP Michigan can be denied coverage or benefits simply because of health status, and the new changes approved by HHS will not impact benefits or coverage.
Benefits include preventative health care, medical office visits, prescription drug coverage, emergency services, inpatient and outpatient hospital services, pregnancy coverage, home healthcare, skilled nursing and hospice care, wellness services and behavioral health services. Co-pays are $20 for a primary care doctor's office visit, $30 for a specialist and $100 for emergency-room visits. Generic prescription co-pays are $10. Brand-name drug co-pays are $30 or $50.
A recent report by the U.S. Government Accountability Office (GAO) shows that Michigan ranks fourth out of seven Midwest states in terms of the number of people who had enrolled in the PCIPs as of March 31, 2011, though the report also shows Michigan had the latest launch date last year of all seven Midwest plans. The HIP Michigan plan kicked off Oct. 1, while the other programs became available on either Aug. 1 or Sept. 1. Illinois, Ohio and Wisconsin had more enrollees than Michigan on March 31, while Michigan enrolled more than Indiana, Iowa and Minnesota.
Applications to HIP Michigan have soared following a statewide public awareness campaign that included press conferences and paid media advertisements in Saginaw, Detroit, Lansing, Grand Rapids and Marquette. As a result, HIP Michigan's enrollments have more than doubled this summer, from 244 approved applicants on May 1 to 565 enrollees on Sept. 1. The HIP Michigan applicants are nearly evenly split between males and females and the majority of enrollees are age 45 and older, which mirrors national trends. Michigan hopes to provide coverage for up to 3,500 residents for a limited time, based on availability of federal funding.
"For a program that has been in operation for only 11 months, HIP Michigan has succeeded in offering vital insurance and life-saving care to Michigan citizens who could not find coverage for their conditions," Wilkerson said. "Given the new and unique nature of HIP Michigan, we anticipated that enrollment in the plan initially would be slow because that's been the experience of other states. We're confident that enrollment in HIP Michigan will continue to grow at a steady pace as awareness grows about the plan's quality and affordability."
Organizations that recommend Michigan's uninsured consider enrollment in HIP Michigan include the Michigan Department of Community Health (MDCH), Michigan Health & Hospital Association (MHA), AARP of Michigan, Michigan Pharmacists Association, Michigan Primary Care Association (MPCA), Michigan Association of Health Plans (MAHP), Michigan Osteopathic Association (MOA), Michigan State Medical Society (MSMS) and the Michigan Organization of Nurse Executives (MONE), among others.
HIP Michigan is funded entirely by subscriber premiums together with an estimated $141 million in federal subsidies. The state of Michigan Office of Financial and Insurance Regulation (OFIR) has regulatory oversight of HIP Michigan, including the approval of the contract, benefit design, premium rates, marketing materials and the ability to investigate consumer complaints.
People interested in detailed benefit, enrollment, cost and eligibility information, as well as application forms, can visit www.HIPMichigan.com. Applications are also available by calling HIP Michigan at 877-459-3113 from 9 a.m.-5 p.m. EST.