Jeffrey Wade
Michigan offers its residents a range of health insurance options, including ACA Marketplace plans, Medicare, Medicaid, and employer-sponsored coverage. The state's ACA Marketplace, accessible through HealthCare.gov, provides a selection of health insurance products from multiple private insurers. Michigan has expanded Medicaid under the ACA, making it more accessible to low-income adults and children. Additionally, short-term health plans and special programs like MI Health Link and the Healthy Michigan Plan offer alternative coverage options. The state also facilitates small businesses with 1-50 full-time employees to offer insurance through the Small Business Health Options Program (SHOP).
| Characteristics | Values |
|---|---|
| Health Insurance Options | ACA Marketplace (Obamacare) plans, Medicare, Medicaid, short-term health insurance, employer-sponsored health insurance |
| Health Insurance Providers | Ten private insurers for 2025, including one newcomer |
| Eligibility | Michigan residents, lawfully present in the U.S., not incarcerated, not on Medicare coverage |
| Enrollment Period | Open enrollment for 2025: November 1, 2024 - January 15, 2025 |
| Financial Assistance | Advance premium tax credits (APTC), cost-sharing reductions (CSR), tax credits for employers with fewer than 25 employees and average salaries below $50,000 per year |
| Additional Programs | MI Health Link, Healthy Michigan Plan, MIChild, Family Independence Program |
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What You'll Learn
ACA Marketplace plans
The Affordable Care Act (ACA) has led to private health insurance companies offering new plans for individuals, families, and small businesses in Michigan, with fewer restrictions than before. ACA Marketplace plans are available to individuals, families, and small businesses.
ACA plans are divided into five metal levels: platinum, gold, silver, bronze, and expanded bronze. Each level represents how the cost of healthcare services is split between the individual and the health plan. Platinum plans, for example, must cover 90% of expected healthcare costs, leaving the individual financially responsible for the remaining 10%. Insurers are not required to offer plans in every metal category or in all counties.
Catastrophic health plans are also available on the Marketplace, but these are only accessible to those under 30 or of any age who have received certain hardship exemptions. Catastrophic plans generally have lower premiums and higher deductibles, and they cover three annual primary care visits before the deductible is met.
The Health Insurance Marketplace is a federally operated insurance marketplace where individuals and families can purchase and compare health plans. It can be accessed at www.healthcare.gov or by telephone. An individual health plan can be purchased during the annual open enrollment period with the Marketplace. A federal tax credit, or APTC, can be used to lower the monthly cost of a Marketplace health plan. Eligibility for an APTC is available for those with a household income between 100% and 400% of the federal poverty level. If you use an APTC, you will have to "reconcile" the credit when you file your federal taxes.
If you missed the deadline for enrollment and still need health insurance, you may qualify for a Special Enrollment Period if you experience a qualifying life event, such as a birth, job loss, or divorce.
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Medicaid and CHIP
Michigan residents can apply for Medicaid and the Children's Health Insurance Program (CHIP) at any time of the year. Medicaid and CHIP provide free or low-cost health coverage to low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Medicaid programs must follow federal guidelines, but coverage and costs vary from state to state. Some programs pay for care directly, while others use private insurance companies to provide coverage. In all states, CHIP provides low-cost health coverage to children in families that earn too much to qualify for Medicaid. In some states, CHIP also covers pregnant people. Each state has its own eligibility requirements for Medicaid and CHIP. In Michigan, residents can visit Healthcare.gov/lower-costs to review their eligibility for these programs.
Medicaid eligibility generally depends on income level and state of residence. Even if someone does not qualify for Medicaid based on income, they may qualify for their state's program, especially if they have children, are pregnant, or have a disability. If an individual has limited Medicaid coverage, they can apply for full-benefit coverage through the Marketplace and may qualify for savings based on their income. Most people whose incomes are just above the level to qualify for Medicaid can pay very low premiums and out-of-pocket costs for private health insurance through the Marketplace. However, if an individual qualifies for Medicaid, they are not eligible for savings on a Marketplace plan.
CHIP qualifications are also different in every state but typically depend on income. CHIP covers medical and dental care for uninsured children and teens up to age 19. If a child qualifies for CHIP, their information will be sent to their state agency, which will contact them about enrollment.
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Medicare and Medigap
Medicare is a federal insurance program for people over 65 or with specific disabilities. It is available across the United States, including Michigan, and is provided by private insurers. In Michigan, there are two parts to Medicare: Part A and Part B. Part A covers hospitalisation costs and Part B covers medical expenses.
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare and is provided by private insurers. It covers hospital and outpatient/physician services, and most plans include Medicare Part D prescription drug coverage. In Michigan, there is a robust Medicare Advantage market, with an average of 59 plans available to residents in 2025.
Medigap, or Medicare Supplement Insurance, is additional coverage for those on Original Medicare. It helps pay for some of the costs not covered by Original Medicare, like copayments, coinsurance, and deductibles. Medigap plans are sold by private insurers but are standardized under federal rules. In Michigan, there are 16 stand-alone Medicare Part D prescription drug plans available, and 26 insurers offer Medigap plans. However, only four of these insurers offer coverage to those under 65 years of age. The cost of Medigap plans in Michigan typically falls between \$90 and \$180 per month, with Plan G being the most popular.
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Short-term health insurance
When considering short-term health insurance in Michigan, it's crucial to understand the eligibility requirements and complete a health questionnaire from the insurance provider. This questionnaire assesses your medical history, including past diagnoses, treatments, and recent symptoms of specific illnesses. Some insurance companies will automatically disqualify individuals based on certain criteria, such as weight or specific prior diagnoses.
One example of a short-term health insurance plan in Michigan is the MyPriority Short-term plan, which offers benefits such as doctor visits, hospitalization, labs and X-rays, emergency care, and prescription drug coverage at discounted costs.
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Special Enrollment Periods
In Michigan, consumers can only enroll in a health plan during the open enrollment period, which runs from November 1 to January 15. After this period, they are locked into their health plan unless they experience a qualifying life event, such as the birth of a child, marriage, divorce, or losing their health coverage. This qualifying life event allows them to enroll in a new health plan during what is called a Special Enrollment Period (SEP).
During the SEP, consumers can change their health plan or apply for a new one outside of the open enrollment period. To qualify for an SEP, individuals must have experienced a significant life change or "qualifying life event." This could include losing health coverage, moving, getting married, having a baby, adopting a child, or if their household income falls below a certain threshold. Additionally, those who gain membership in a federally recognized tribe or become a US citizen may also qualify for an SEP.
For those who missed the open enrollment deadline and still need health insurance, they may qualify for an SEP if they experience a qualifying life event. They will need to submit proof of the qualifying life event with their application and apply within 60 days of the event. For assistance, consumers can visit LocalHelp.HealthCare.gov or call the Marketplace Call Center at 800-318-2596.
It is important to note that divorce or legal separation without losing health coverage does not qualify for an SEP. Additionally, moving solely for medical treatment or vacation does not qualify for an SEP.
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Frequently asked questions
Michigan has a state-run health insurance program called the Healthy Michigan Plan, which provides low-cost health care benefits to individuals. Michigan also expanded Medicaid under the ACA, making it easier for low-income adults and children to access comprehensive services.
To qualify for the Healthy Michigan Plan, you must be a resident of Michigan, be lawfully present in the US, and not have Medicare coverage or be incarcerated. You can apply for Medicaid at any time if you meet the eligibility requirements.
You can enroll in the Healthy Michigan Plan by visiting healthymichiganplan.org or calling 855-789-5610. For Medicaid, you can complete an application online at www.michigan.gov/mibridges or call 800-432-4121 if you have any questions about your eligibility or need help enrolling.
