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Houghton Health Insurance

Facts and Figures

  • Insurance
    Carriers
    10
  • Number of
    General Doctors
    56
  • Number of
    Hospitals
    1

Insurance Carriers

State Government Insurance Programs Offered

Blue Cross/ Blue Shield of Michigan (BCBSM)


BCBSM: Must be Michigan resident. Cannot be eligible for COBRA, or government programs (must have exhausted this option). HMOs in the state must offer guarantee issue coverage to residents during annual open enrollment periods.

Health Insurance Program for Michigan (HIP)


Federal program established by the United States Department of Health and Human Services www.hipmichigan.com www.PCIP.gov HIP: Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs. HIP: Must be a U.S. citizen or lawfully present in the U.S. and have been uninsured for at least 6 months prior to applying. Must have had a problem getting insurance due to a pre- existing condition.

Medicaid and Healthy Kids


Covers Ambulance, Dental, Doctor visits, Family planning, Health checkups, Hearing and speech, Home health care, Hospice, Hospitalization, Lab and x-rays, Immunizations, Medical supplies, Nursing home care, Medicine, Mental health care, Personal care services, Prenatal care, Surgery, Vision, Substance abuse treatment and Physical therapy. Must be U.S. citizens or qualified aliens living in Michigan. Income limits: Pregnant women and infants ages 0–1: 185% FPL. Children ages 1–18: 150% FPL. Parents/caretakers living with children ages 0–18: 64% FPL. Childless adults: 45% FPL. Aged, blind, and disabled: 100% FPL with asset limit of $2,000 for singles and $3,000 for couples. Medically-needy: Monthly income limit varies by region, from $341 to $408 for singles, and $458 to $5,41 for couples. Asset limit of $2,000 for singles and $3,000 for couples.

MIChild


www.michigan.gov/mdch (Listed under “Health Care Coverage” and “Children & Teens”) Covers Regular checkups, shots, Emergency care, Dental, Hospital, Pharmacy, Prenatal care and delivery, Vision and hearing, Mental health and substance abuse services. Must be Michigan residents and U.S. citizens or qualified immigrants. Must be under age 19. Income must be above 150% but below 200% FPL. Must be uninsured and ineligible for Medicaid. Families who voluntarily drop employer-based comprehensive insurance must wait six months to enroll. If families drop private insurance, they may immediately enroll in MIChild.

Healthy Kids


www.michigan.gov/mdch Covers ambulance, dental, doctor visits, family planning, health checkups, hearing and speech, home health care, hospice, hospitalization, lab and x-rays, immunizations, medical supplies, nursing home care, medicine, mental health care, personal care services, prenatal care, surgery, vision, substance abuse treatment, physical therapy. Must be U.S. citizens or qualified immigrants and Michigan residents. Must either be pregnant women of any age, or children under age 19. Income must be at or below 150% FPL.

Breast and Cervical Cancer Control Program (BCCP)


www.michigan.gov/mdch (Click: Prevention) Clinical breast exams, Pap tests, Pelvic exams, and Screening mammograms. Coverage: Income limit of 250% FPL. Must be uninsured or underinsured and live in Michigan. Breast/cervical cancer screening and for diagnostic follow-up of breast/cervical abnormalities for women ages 40–64, or for women ages 18–39 who have been identified with a cervical abnormality through the Family Planning program (Title X). Not eligible: Women who are enrolled in a managed care program, a health maintenance organization, or Medicare Part B.

Women-Infant-Children (WIC)


www.michigan.gov/mdch (Listed under “Pregnant Women, Children & Families”) Nutrition education and services; breastfeeding promotion and education; monthly food prescription of nutritious foods; access to maternal, prenatal and pediatric health-care services. Eligibility: Must live in Michigan and have a nutritional need determined by WIC staff. Must be a child under 5, a new mom, or a pregnant or breastfeeding woman. Income limit is 185% FPL.

Heath Care Reform

Small business tax credits.  132,000 small businesses in Michigan could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 134,000 Medicare beneficiaries in Michigan hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Michigan who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.

Support for health coverage for early retirees. An estimated 192,000 people from Michigan retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 6 million Michigan residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 459,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Michigan peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 5.5 million residents of Michigan with health insurance from their employer, along with anyone who signs up with a new insurance plan in Michigan.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

"Vista Health Solutions" www.forhealthinsurance.com Tel (888)215-4045 Email [email protected]