As part of the Affordable Care Act (ACA), hundreds of thousands of Michigan residents are able to enroll in the new health insurance options which were opened for application in October 2013. This coverage expansion provides an opportunity to ensure Portage Health’s patients are able to access the care they need, when they need it – and to receive it in an appropriate setting. At the same time, Portage Health recognizes that many individuals may have never applied for or purchased health insurance before, and they may need help.
Portage Health has staff who are now certified and better able to help patients navigate the application process associated with the ACA Marketplace. Certified Application Counselors (CACs) are a local resource and point of entry into the public insurance marketplace. CACs can help you understand the coverage options available within the marketplace and assist you in the application process.
To apply, individuals can go online to www.healthcare.gov and review the application and coverage options in more detail.
For further assistance, consumers can call the federal government’s healthcare hotline at 1 (800) 318-2596, 24 hours a day, seven days a week.
Consumers can also call Portage Health at (906) 483-1512 or toll free 1 (855) 251-6407 to make an appointment with one of Portage Health’s Certified Application Counselors.
A: Starting Oct. 1, individuals who make up to 400 percent of the Federal Poverty Level (FPL), or about $46,000 a year, will be able to shop for coverage in Michigan’s federally-facilitated marketplace (FFM), also known as a health insurance exchange. There they can purchase a comprehensive plan that meets their budget and their health needs, with coverage beginning no earlier than Jan. 1, 2014. Individuals whose income is below $16,000 (and families of four making approximately $31,000) will likely qualify for the Healthy Michigan plan, which is Michigan’s new, expanded Medicaid program. This program offers very low cost-sharing requirements with comprehensive, managed benefits. People can apply for/enroll in Healthy Michigan at any time (there is no open enrollment period) after Oct. 1, 2013, but coverage will not begin for several months (likely late in the first quarter of 2014).
A: The plan benefits are currently being designed by the state and exact cost-sharing information is not yet available. Details will likely be available in late 2013.
A: While there is some assistance available to individual adults earning little to no income, most low-income residents do not qualify for Medicaid today. To qualify for Medicaid prior to expansion, individuals had to meet financial eligibility criteria and belong to one of the following specific groups: children, parents, pregnant women, people with severe disability, and seniors.
A: The threshold is 133 percent of FPL, but 5 percent of an individual’s income is disregarded, effectively raising the limit to 138% FPL.
A: Yes. Many hospitals, through their patient financial services areas and/or using vendors, already assist patients in applying for some sort of health coverage. This experience makes hospitals well-equipped to helping patients apply for the newly-available coverage.
A: Hospitals are encouraged to apply to become Certified Application Counselors (CACs). CACs are individuals or organizations that will assist people in applying for coverage through the FFM. CACs must complete at least five hours of training and an exam, all of which is done at their convenience using online (Web-based) resources. CACs will help individuals complete the application for coverage as well as understand the various benefits and prices of the FFM plans, to a degree.
A: Some hospitals may not have the ability to provide direct assistance to uninsured individuals. In that case, the hospital may choose to educate staff about the other local stakeholders who can assist. Many other organizations, including federally-qualified health centers, libraries and others, have applied to become certified application counselors and will be able to assist. The federal government is working to compile a list of all application counselors and navigators in each state, which will be posted to Michigan’s online insurance marketplace on www.healthcare.gov. Hospitals may consult this list if/when it needs to refer an individual for direct assistance. They can also be advised to call the federal government’s dedicated help line at 1-800-318-2596 24 hours a day, seven days a week
A: To view or complete the application and shop for coverage on the marketplace, visit www.healthcare.gov. Because every state has different plans on their marketplace and different Medicaid eligibility, a person must answer a few simply questions about where they live, their current insurance status and their age. Doing so will direct them to Michigan’s information.
To assist patients and providers, the Centers for Medicare & Medicaid Services (CMS) has posted additional resources that can help address questions related to coverage, network providers, premium payment, copayments, cost sharing and other issues.
Below are links to a number of CMS factsheets available to assist consumers and providers with plan specific information.
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