Health insurance in Michigan
- Michigan has a state-federal partnership exchange.
- Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
- Michigan has nine insurers offering plans on its exchange for 2020, plus two insurers that offer plans only off-exchange.
- Nearly 263,000 Michiganders enrolled in 2020 plans during the last open enrollment period.
- Short-term health plans are available in Michigan with initial plan terms up to 185 days.
- Michigan’s legislature has a GOP majority, but their margin shrank in 2018 election and voters elected a Democratic governor.
- Michigan expanded Medicaid, but implemented a work requirement in 2020. The work requirement was soon overturned by a federal judge.
- Medicare covers more than 2 million people in Michigan
Michigan exchange overview
Michigan has a state-federal partnership exchange. Nine insurers offer coverage for 2020 in the exchange. In addition, there are two insurers that offer individual market coverage in Michigan only outside the exchange.
Open enrollment for 2020 health plans has ended, although residents with qualifying events (including loss of employer-sponsored coverage) can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
After increasing individual market premiums by an average of just 1.7 percent for 2019, Michigan’s insurers reduced their average premiums by about 2.5 percent for 2020.
Premium subsidies are available for people with income up to 400 percent of the poverty level. For 2020 coverage, that amounts to $49,960 for a single individual and $103,000 for a family of four.
In addition to the insurers offering plans in the exchange, two off-exchange-only insurers — Alliance Health and Life, and Health Alliance Plan — are offering plans for 2020. Both kept their rates unchanged for 2020, after also leaving them unchanged in 2019. Premium subsidies are not available for off-exchange plans, so they’re generally only a good option for people who know they won’t be eligible for a subsidy.
In 2020, enrollment in Michigan’s exchange reached 262,919, down from about 274,000 the year before. As was the case in Michigan, enrollment peaked in 2016 in the majority of the states that use HealthCare.gov, and has declined since then for a variety of reasons: The Trump administration’s decision to reduce funding for exchange marketing and enrollment assistance, the elimination of the individual mandate penalty, the expansion of short-term plans, and the higher premiums that unsubsidized enrollees had to contend with in 2017 and 2018.
Read more about the Michigan health marketplace.
Michigan and the Affordable Care Act
Michigan was considered a red state following the 2014 elections, and support for the Affordable Care Act has been mixed. But the tide has been turning more recently. Following the 2018 election, Michigan’s state legislature is still GOP-dominated, but the margins are much smaller than they were. And Democrats were elected to serve as governor, secretary of state, and attorney general.
Sens. Carl Levin and Debbie Ann Stabenow, both Democrats, voted in favor of the Affordable Care Act in 2010. Levin retired in January 2015 and was replaced by U.S. Rep. Gary Peters, a Democrat. Peters voted for the ACA in the House in 2010.
Michigan’s delegation to the U.S. House of Representatives split along party lines in the 2010 ACA vote. Eight Democrats voted yes, while seven Republicans voted no. Michigan lost a House seat following the 2010 census. Republicans clinched a 9-5 majority following the 2014 elections, but the House representation as of 2020 includes seven Democrats, six Republicans, and one Independent.
At the state level, Republicans control both the House and Senate, although their margins became smaller following the 2018 election. The legislature did not authorize a state-run health insurance exchange, despite former Gov. Rick Snyder’s preference for that approach. Michigan was among the handful of states that implemented a partnership exchange.
Former Governor Rick Snyder, a Republican, pushed for an alternative approach to Medicaid expansion in Michigan and ultimately gained bi-partisan support for Healthy Michigan. Medicaid expansion in Michigan uses the ACA’s eligibility guidelines (ie, up to 138 percent of the poverty level), but the state obtained approval from the Obama Administration to charge premiums when enrollees’ incomes are above the poverty level.
Medicaid expansion took effect under the ACA on January 1, 2014, but Michigan was a few months behind due to the state’s waiver process. Enrollment began April 1, 2014, and 702,028 people were enrolled in Healthy Michigan as of May 2020. That was down from 632,254 in August 2019, but the increase in Medicaid enrollment is not surprising, given that so many people have lost their jobs as a result of the COVID-19 pandemic.
Before the pandemic, however, the state sought to reduce Healthy Michigan’s enrollment with a work requirement. Michigan enacted legislation in 2018 directing the state to seek federal approval for a work requirement. The waiver proposal was submitted to CMS in September 2018, and was granted federal approval in late 2018.
The work requirement took effect in January 2020, but was overturned by a federal judge in March 2020, just prior to the explosion of the COVID-19 pandemic and widespread job losses. The judge’s ruling was not surprising, given that work requirements in Kentucky, Arkansas, and New Hampshire had already been overturned in 2019.
Read more about Medicaid expansion in Michigan.
Short-term health insurance in Michigan
Michigan regulations limit short-term health insurance plans to no more than 185 days in duration and prohibit renewal. An applicant can purchase additional short-term plans, but cannot have more than 185 days of short-term coverage from one insurer in any 365-day period.
Read more about short-term health insurance in Michigan.
Other ACA reform provisions
The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program encourages the formation of a new type of medical insurance company. CO-OPs are non-profit, consumer-run plans, and they were intended to increase choice and competition. In 2014, CO-OPs operated in 23 states, including Michigan Consumer’s Mutual CO-OP.
Within days of 2016 open enrollment beginning in the fall of 2015, Consumers Mutual announced its closure and ceased operations at the end of 2015. As of 2020, there were only four CO-OPs remaining, offering plans in five states (Maine, Montana, Idaho, New Mexico, and Wisconsin).
Medicare in Michigan includes state protections for consumers
Medicare enrollment in Michigan stood at nearly 2.1 million people as of early 2020.
Michigan has a Medigap subsidy program to help offset the cost of Medigap coverage for enrollees with modest income. And the state also protects access to certain Medigap plans for people who are disabled and enrolling in Medicare under the age of 65.
State-based health reform legislation
Here’s a summary of recent Michigan bills related to healthcare reform: