Otsego Health Insurance
Facts and Figures
- Insurance
Carriers
10
- Number of
General Doctors55
- Number of
Hospitals
1
State Government Insurance Programs Offered
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.
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.
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.
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.
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.
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.
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.