Eligibility

• Michigan residents aged 19–64 y

• Income ≤ 138% of the FPLa

• Not qualified for Medicare or other Medicaid programs

Benefits

• ACA Essential Health Benefits

• Some additional services (e.g., family planning and dental care)

Cost Sharing

• Most beneficiaries pay copaysb

• $1–$3 for clinical visits and prescriptions; $50 for inpatient hospital stays

• Beneficiaries pay an average monthly copay based on prior health services utilization

• Beneficiaries at 100%–138% of FPL pay monthly premiums, called “contributions,” equal to 2% of income

• Total cost sharing is capped at 5% of income

Health Savings Accounts

• Cost sharing is tracked and paid through the beneficiary’s MI Health Account

• A summary of the beneficiary's cost sharing, service utilization, and healthy behavior incentives is included in quarterly account statements

• Accounts are administered by a third-party vendor

Healthy Behavior Incentives

• To be eligible for incentives, beneficiaries must:

• Meet with a primary care provider

• Complete a health risk assessment

• Agree to change or maintain a health behavior, or agree that behaviors need to be changed but there are substantial barriers to doing so

• Financial incentives include:

• 50% reduction of monthly contributions

• $50 gift card, for beneficiaries not subject to contributions

• Reduction of copays, if the beneficiary has paid 2% of income in copays

Note. ACA = Affordable Care Act; FPL = federal poverty level.

Source. Michigan Department of Community Health.^15–17 (The protocol documents are no longer available on the Healthy Michigan Plan Web site but may be accessed through archived links, as cited in the reference list.)

^aAlthough federal eligibility rules sometimes describe the upper limit as 133% of FPL, the rules include a 5% “disregard” that means the actual upper limit is 138% of FPL.

^bThese copay amounts are the same as those in Michigan’s standard Medicaid state plan. Select beneficiary groups and health services are exempt from copay requirements.