State Marketplace Profiles: Michigan
Updated as of November 26, 2013
Establishing the Marketplace
While Governor Rick Snyder (R) supports the creation of a State-based Marketplace, he acknowledged on November 16, 2012, that without authorizing legislation, he would plan for a State-federal Partnership Marketplace.1 The state began moving in the direction of a partnership in August 2012 due to legislative opposition that left the state unable to meet the federal timetable for implementation.2 Michigan will perform plan management functions and defer other Marketplace management functionality to the federal government.3
Contracting with Plans: The Department of Insurance and Financial Services (DIFS) performs plan management functions for health insurance products offered through the Marketplace, as well as plans sold outside the Marketplace. Eleven carriers are certified to participate in the Michigan Marketplace; ten offer Qualified Health Plans (QHPS) in the Individual Marketplace and eight offer small group coverage. Insurers may rate by age, tobacco use, and geography. There are 16 geographic rating areas in the state.4 Plans are offered on the Platinum, Gold, Silver, and Bronze metal level tiers, and catastrophic plans are available to those who are eligible. A tool that estimates premiums in Michigan’s individual Marketplace is available on the DIFS website. Information on plans and rates available to individuals and small businesses can be found on HealthCare.gov.
Dental and Vision Benefits: Dental coverage may be embedded in a QHP or offered as a stand-alone product. Eight dental carriers offer a total of 108 stand-alone dental plans through the Marketplace for 2014.5 Information on dental plans for individuals and small businesses is available on HealthCare.gov.
Consumer Assistance and Outreach: Since Michigan is not engaging in a consumer assistance partnership, the state does not operate an In-Person Assister (IPA) program and relies on the federally-run Navigator program to provide in-person assistance. In August 2013, the Department of Health and Human Services (HHS) selected four organizations in Michigan to serve as Navigators and awarded the grantees a total of over $2.5 million to perform education activities and enrollment assistance for individuals and small businesses. One Navigator organization will provide in-person services on a state-wide basis while the others will focus on smaller county-based service areas.6 All individual Navigators must complete an online training module and pass a test designed and administered by HHS. A bill (HB 4576) that would impose state licensing and certification requirements on Navigators is currently pending.7 In July 2013, 31 community health centers in Michigan received a total of $3.8 million in funding from the Health and Resources Services Administration (HRSA) to hire 69 additional workers to facilitate enrollment.8 Other organizations interested in assisting consumers applying for Marketplace coverage may apply to become volunteer Certified Application Counselors (CACs). Licensed agents and brokers that register and complete a federal training course may sell health insurance coverage through the Marketplace. The DIFS website provides further details about how consumers may locate and contact a Navigator, CAC, or agent for in-person assistance.
The DIFS is hosting a series of community events across the state to educate consumers on the implications of the Affordable Care Act. The DIFS has also produced a set of brochures explaining how the law impacts various populations, such as young adults, families, and small businesses.9
Small Business Health Options Program (SHOP) Marketplace: Issuers must maintain separate risk pools for the small group and individual Marketplaces. Employers with up to 50 employees are eligible to participate on the SHOP in 2014 and 2015.4 Employers must select a single QHP to offer employees in 2014; employers will have the option to offer their employees a choice of QHPs in 2015. 70% of employees eligible for health coverage must enroll in the SHOP in order for the employer to participate.10
Essential Health Benefits (EHB): The ACA requires that all individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. In September 2012, Governor Snyder informed HHS that Priority Health’s HMO plan had been selected as the state’s benchmark EHB plan for plan years 2014 and 2015. The MIChild dental program serves as the pediatric dental supplement, and the FEDVIP Blue Vision High plan is the pediatric vision supplement.11 Actuarial equivalent substitutions of benefits are not allowed in Michigan.10
Michigan’s Department of Community Health was awarded a federal Exchange Planning grant of $1 million. In November 2011, Michigan’s Department of Licensing and Regulatory Affairs was awarded a $9.8 million federal Level One Establishment grant to conduct further insurance market analysis and technology planning; however, the Legislature has yet to approve spending the funds. In January 2013, Michigan received a second Level One grant of $30.7 million to support creation of a consumer assistance partnership program, establishment of an IT system that coordinates with federal partners, and the plan management functions that Michigan will carry out. However, the Senate failed to vote on HB 4111, which would authorize the state to spend the funds.12
Michigan, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance Marketplaces, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.13
On March 5, 2013, Michigan received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-federal Partnership Marketplace.14 Enrollment into Marketplace coverage began on October 1, 2013. The federal government is operating the online eligibility and enrollment system, and consumers must use the federal portal to apply for coverage online.
Governor Snyder. “Michigan moves toward state-federal partnership health exchange, leaves door open for MI Health Marketplace.” November 16, 2012.
A Special Message from Governor Rick Snyder: Health and Wellness. Office of the Governor. September 14, 2011.
Letter from Governor Snyder to Secretary Sebelius. January 22, 2013.
State of Michigan Department of Insurance and Financial Services. Bulletin 2013-07-INS.
State of Michigan Department of Insurance and Financial Services. Dental Plans.
Michigan Legislature. House Bill 4576. 2013.
Michigan: Health Center Outreach & Enrollment Assistance. HRSA. July 2013.
Department of Insurance and Financial Services. Health Coverage Consumer Brochures.
Department of Insurance and Financial Services. Essential Health Benefits and Plan Management FAQs.
Letter from Governor Snyder to Secretary Sebelius. September 28, 2012.
Michigan Affordable Insurance Exchange Grants Awards List.
Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011.
Letter from Secretary Sebelius to Governor Snyder. March 5, 2013.
also of interest
- Analysis of 2016 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces
- Adult Behavioral Health Benefits in Medicaid and the Marketplace
- The ACA and Medicaid Expansion Waivers
- Analysis of 2015 Premium Changes in the Affordable Care Act's Health Insurance Marketplaces