Residents of the Great Lake State have a few options when it comes to health care. According to a study by US News, Michigan has the 32nd best health care in the country. This study looks at access, quality, and good public health.
Health insurance options in Michigan
According to Michigan's Department of Insurance and Financial Services, residents can get health care coverage through several ways:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Michigan residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 51% | ||
| Individual or family | 5% | ||
| Medicaid | 22% | ||
| Medicare | 15% | ||
| Military | 1% | ||
| Uninsured | 5% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Around five percent of Michigan residents are uninsured. That's below the national average, which is good news for policyholders. The higher the rate of uninsured people, the more prices jump for insured people.
Michigan health insurance costs and rate factors
Michigan residents spend an average of $8,055 per year on health care expenditures. That's only ten dollars above the national average! What determines this price? Providers look at factors that vary person to person to determine your price tag:
Plan type
It’s a simple equation: the more coverage you want, the more you'll have to pay. Health care marketplace plans come in metal tiers: bronze, silver, gold, and platinum.
These are the average prices for health care for a 40-year-old Michigan resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $251 | $348 | $382 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
These numbers show that it costs about 52 percent more for a gold plan than a bronze plan. The price tag increases because gold plans cover 80 percent of health care costs, compared to bronze plans, which cover 60 percent of costs.
A catastrophic plan is an option for people under 30 or with certain exemptions. Catastrophic plans offer low monthly premiums but a high deductible. It offers minimal coverage. For 2020, the deductible for all catastrophic plans is $8,150. A bronze plan costs more monthly but may save you money if you need to use your insurance.
Body mass index
Statistically, a high body mass leads to serious health conditions. Insurers know this and will analyze your BMI to determine your risk-level. A high BMI leads to high insurance rates.
In 2018, Michigan had a 36 percent obesity rate, the 8th highest in the country. Of the Michigan residents who used QuoteWizard to compare health plans, 33 percent of shoppers have a BMI in the obese range.
Tobacco use
Due to the substantial health risks caused by smoking, smokers pay more for insurance. 19.3 percent of Michigan residents are smokers, the 14th highest rate in the country.
Age
Age can play a large role in your policy prices. According to HealthCare.gov, older people pay up to three times more in premiums than younger people do. Michigan residents who used QuoteWizard to shop for health insurance are, on average, 41 years old.
Location
Every state has different rules, regulations, and providers in their health care marketplace. Because of this, your location has a big impact on how much you'll be paying in premiums.
Health insurance rates are community rated. Costs are based on the combined claims people in your area file. So, if your neighbors file a high number of claims, your rates may rise.
How health-conscious your state is therefore plays a role in your prices. Living in a healthier state can keep your costs low. According to America's Health Rankings, Michigan is the 35th healthiest state in the US.
Michigan health insurance companies
Michigan has plenty of provider options for even the pickiest insurance shopper. These companies offer individual and family plans in Michigan:
- Blue Cross Blue Shield of Michigan and Blue Care Network
- McLaren Health Plan
- Meridian
- Molina
- Physicians Health Plan
- Priority Health
- Total Health Care
- Oscar Health
Your policy options vary based on where in the state you live. Check provider websites to find how your choices.
Michigan health insurance laws
Thanks to the Affordable Care Act, insurance companies cannot use certain factors when pricing your policy.
- Pre-existing conditions: The ACA doesn’t allow insurance companies to charge higher rates to people with pre-existing conditions. Providers used to charge higher rates to people with pre-existing conditions.
- Gender: According to a Health Services Research study, women historically pay more for health care coverage. With the ACA, insurance companies can't charge women and men different premiums for the same plan.
- Insurance and medical history: Health insurance companies also can't analyze your medical history and past insurance coverage. Before the ACA, providers would look at these factors then charge steep prices, if they even offered coverage to begin with.
There are limits to how much you can pay out-of-pocket for marketplace plans. The out-of-pocket maximum for 2020 is $8,150 for an individual plan and $16,300 for a family plan.
Michigan law requires health insurance companies to provide at least some coverage for the following services:
- Hospice care
- Emergency room services
- Home health care services
- Breast cancer treatment services
- Emergency transportation/ambulance
- Substance abuse disorder inpatient and outpatient
- Imaging
That’s only part of what Michigan insurers must cover. Find the entire list here.
Medicare and Medicaid in Michigan
Medicare and Medicaid are government-funded programs that help people access affordable health care. Medicare aids seniors, and Medicaid helps low-income families and children.
Medicare
Residents over 65 are eligible for Medicare. According to the Michigan Department of Health and Human Services, you may be able to get help with some Medicare costs. Depending on your income, you may qualify for help with:
- Medicare premiums
- Medicare coinsurance
- Medicare deductible
Check the Medicare Savings Program brochure to find out if you qualify for savings.
Medicaid
Here are Michigan’s Medicaid income requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Michigan Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Patrick M. McPharlin
- Insurance Hotline:
- (877) 999 – 6442
- Office Hours:
- Monday - Friday
9:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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