What is the marketplace?

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Preventive care

Hospitals

Physicians

Prescription drugs

Mental health

Rehabilitation

Habilitation services

Substance abuse

Dental and vision for children

Maternity care

Essential Health Benefits Coverage

Levels of Coverage

• Insurance companies won’t be able to turn people down because of pre-existing conditions, including pregnancy and disability.

• This took effect in 2010 for children and on Jan. 1, 2014 for everyone.

• You can get lower costs on coverage: The Marketplace application will tell you if you’re eligible for a new way to get lower costs on your monthly premiums or out-of-pocket costs for private insurance. You’ll also learn if you can get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

• You can get help in your area: Navigators are available to give you personalized assistance with the process.

Security and Control

Financial Protections

• No annual or lifetime limits

• Spending caps will limit the amount consumers pay out of pocket each year.

• Insurance companies have to spend at least 80-85% of premiums on medical care.

• Eligible for tax credits

• Insurers must justify premium increases

• Depending on the plan you choose in the Marketplace, you may be able to keep your current doctor.

• Most health insurance plans offered in the Marketplace have networks of hospitals, doctors, specialists, pharmacies, and other healthcare providers.

• When comparing plans in the Marketplace, you will see a link to a list of providers in each plan’s network.

Can I keep my own doctor?

Moderate-Income Families

• Families and individuals will receive tax credits to help pay for health insurance, depending upon income.

• Tax credits are available to everyone between 400% and 133% of the Federal Poverty Limit to make purchasing insurance more affordable. (Everyone below 133% FPL will be part of the Healthy Michigan program that begins April 1st.)

• Tax credits are designed to keep premium costs between 2%-8% of income, on a sliding scale.

Cost-Sharing Assistance

What about Medicaid?• State health insurance programs under

Medicaid will cover all families and individuals with incomes up to 133% of the Federal Poverty Level ($15,282 for an individual, $31,322 for a family of four)

• In Michigan, the expanded Medicaid program will not begin until April 1, 2014

• Even if you were told you didn't qualify for Medicaid in the past, you may qualify under the new rules. Eligibility remains the same for women and children

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Job-Based Insurance

• If you have job-based insurance, you’re considered covered.

• You may be able to change to Marketplace coverage

• Your income will determine your eligibility for lower

cost premiums

By 2014, you must...

What about the fees?

What about small business?

• No mandate on small

businesses

• Rewards good actors with subsidies

• Small businesses and non-profits qualify

• Credits carry over up to 20 years

• Maximum subsidy is 50% for smaller businesses

How does the marketplace work?

Navigators are here to help

What documents do I need?

• Social Security Numbers (or document numbers for legal immigrants)

• Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements)

• Policy numbers for any current health insurance plans covering members of your household

Stay Connected

Join our MCH’s email list

Follow Us on Twitter @Enroll Michigan

Like Us on Facebook @EnrollMichigan

Use the Legislative Action Center athttp://www.consumersforhealthcare.org

Navigators and Community Events are available at

http://www.enrollmichigan.comOPEN

ENROLLMENT ENDS