With the passage of the Patient Protection and Affordable Care Act of 2010, all states have been faced with modifying their insurance regulations to comply with the requirements of federal statutes. Major changes have been made in insurance for children, who may now remain on their parents’ health policies until they reach age 26. It does not matter if they are students or not, or if they have married. Additionally, children may not be excluded for pre-existing conditions.
Almost all states have worked with the federal government to establish high-risk pools for people with pre-existing conditions, which will remain in place until January 1, 2014. At that point, the required health care exchanges will go into effect.
General Insurance Regulations
The Department of Labor and Economic Growth regulates Michigan health insurance companies. The state requires guaranteed renewability, meaning a policy may not be canceled or refused to long as the premium have been paid and the contract met.
Currently, the state’s Patient Bill of Rights prevents insurers from discriminating against previous health conditions when issuing group policies. Employers can, however, prevent higher premium rates for the group by limiting the number of hours individual employers put in per week. If the employee works less than 30 hours a week, they may not qualify for group coverage.
Until 2014, insurers in Michigan may turn down applicants for any reason on individual health insurance policies. Blue Cross/Blue Shield is the only Michigan health insurance company that is required to sell individual health insurance policies regardless of health status or pre-existing conditions. They also may not impose an exclusion period on anyone who is HIPAA eligible. For anyone else there is a maximum exclusion period of up to 12 months.
Creation of Health Care Exchanges
Currently, Michigan is continuing to study options for the implementation of the Michigan Health Marketplace, which will be a non-profit corporation to oversee both individual and small business health plans sold through the exchange.
Pre-Existing Condition Insurance
The state’s Pre-Existing Condition Insurance Plan program provides coverage for both primary and specialty medical care, as well as hospital stays, and prescription medications. Premiums range from $104 to $515 a month, with deductibles set at $1000, $2500, and $3500 according to plan level. The maximum out-of-pocket limit is $5950, currently being established.
Medicaid eligibility is figured on the basis of income as a percentage of the Federal Poverty Level. Infants under the age of one year qualify for benefits at 185% FPL, while all others up to age 19 are eligible at 150%.
The MIChild program offers aid to children who are unable to qualify for Medicaid, but who have no health insurance. Family income must be below 200% of the federal poverty level to apply for this coverage.
Approximately 15% of Michigan residents receive Medicare, with more than 383,000 receiving assistance with prescription drug coverage. The state-run MMAP, run by the state’s Department of Services to the Aging, offers counseling services to Medicare recipients and information regarding the various Medicare plans and assistance programs available to them.