In Michigan, adults with lower incomes may qualify for the Healthy Michigan Plan, while others buy a private plan through HealthCare.gov, and the two use different applications. The Healthy Michigan Plan is Michigan’s Medicaid expansion, run by the Michigan Department of Health and Human Services (MDHHS). Marketplace plans, with premium tax credits for people who qualify, come through HealthCare.gov. The rules are the same in Detroit, Grand Rapids, Lansing, Flint, Ann Arbor, Saginaw, Traverse City, Marquette, or anywhere else in Michigan.
This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in Michigan. We are not MDHHS, HealthCare.gov, CMS, or an insurance company, and we do not decide who qualifies for Medicaid. We do not quote prices or name plans here. See the official rules on the Healthy Michigan Plan page.
The short answer
- Healthy Michigan Plan: for Michigan residents ages 19 to 64 with income at or below 133% of the federal poverty level, who don’t qualify for Medicare or another Medicaid program and aren’t pregnant when they apply.
- The Marketplace: private plans for people who don’t qualify for Medicaid and don’t have other coverage that works for them. Premium tax credits are generally available to households earning between 100% and 400% of the federal poverty level.
- You don’t have to guess. If you apply on HealthCare.gov and it looks like someone in your household qualifies for Medicaid, HealthCare.gov says it sends your information to the state, and the state contacts you.
For the Marketplace step by step, read our Michigan open enrollment guide. Here we focus on one question: which door is yours?
Who qualifies for the Healthy Michigan Plan
MDHHS lists these rules. You may be eligible if you:
- Are 19 to 64 years old.
- Have income at or below 133% of the federal poverty level. MDHHS counts income using Modified Adjusted Gross Income (MAGI).
- Don’t qualify for or aren’t enrolled in Medicare.
- Don’t qualify for or aren’t enrolled in another Medicaid program.
- Aren’t pregnant at the time you apply.
- Live in Michigan.
MDHHS says the plan covers the essential health benefits under the federal health care law, such as doctor visits, emergency care, hospital stays, prescriptions, mental health care, and preventive care. Members may owe copays to the doctor’s office, pharmacy, or other provider.
Children and pregnant people apply through MI Bridges too, but for other Michigan programs. MDHHS describes MIChild, for example, as coverage for uninsured children under 19 in low-income working families, with a higher income limit than Medicaid for children.
How to apply for each
Healthy Michigan Plan. MDHHS lists three ways: apply online at MI Bridges, call the Michigan Health Care Helpline at 1-855-789-5610, or visit your local MDHHS county office. HealthCare.gov also says you can apply for Medicaid any time of year.
Marketplace. Open Enrollment on HealthCare.gov starts November 1 and ends January 15. Enroll by December 15 for coverage that starts January 1. If MDHHS says you don’t qualify for Medicaid, HealthCare.gov says in most cases the state sends your information to the Marketplace, and you get a letter about applying for a plan.
New Healthy Michigan Plan work requirements
MDHHS says new federal rules add work requirements for people ages 19 to 64 on the Healthy Michigan Plan:
- When it starts. For people applying, starting January 1 the application will ask about approved activities or exemptions. For people already on the plan, the requirements apply at renewals dated on or after March 1.
- How to meet them. Either complete at least 80 hours of approved activities in one month of the review period, such as a job, volunteering, a work program, or school, or meet a minimum monthly earnings amount that MDHHS lists on its page. You can combine activities to reach 80 hours.
- Who is exempt. MDHHS lists many exemptions, including people who are pregnant or gave birth in the past 12 months, parents or caregivers of a child 13 or under, caregivers of a person with a disability, people who are medically frail, and some others.
Not sure if you are on the Healthy Michigan Plan? MDHHS says you can check your MI Bridges account or call the beneficiary help line at 1-800-642-3195. See the MDHHS work requirements page for the full list, and keep your mailing address current so you don’t miss a letter.
If you go to the Marketplace
These rules matter for people who buy a plan through HealthCare.gov:
- Your savings are based on what you expect to earn next year, not last year. A careful estimate helps you avoid a surprise at tax time.
- Above 400% of the federal poverty level, the premium tax credit generally isn’t available.
- Extra savings on deductibles and copays (cost-sharing reductions) are available only on Silver plans, for incomes up to 250% of the poverty level.
- If your income goes up during the year, report it right away. There’s no longer a cap on how much extra premium credit you may have to pay back.
One household, two programs
It’s common for one Michigan family to use both. A parent might qualify for the Healthy Michigan Plan, a child for MIChild or Medicaid, and a spouse with higher income for a Marketplace plan. Each person’s situation counts, so list everyone in the household on the application and let the system sort it out.
If you live across the line in Ohio, Indiana, or Wisconsin, coverage follows the state where you live. Our agent is not licensed in those states.
Protect your account
- When you work with an agent, you’ll get a text or email asking you to approve that agent. Only approve someone you chose.
- Never share your HealthCare.gov login. A licensed agent doesn’t need it.
How we help
We help Michigan families by phone and online, in English or Spanish. Learn more on our Michigan health insurance help page. We look at who in your household might fit the Healthy Michigan Plan and who might fit the Marketplace, your income estimate, your doctors, and your prescriptions. For the Healthy Michigan Plan we point you to MI Bridges, and for the Marketplace we can go through the application with you and compare plans.
Ready when you are
Have a rough income estimate for next year and a list of everyone in your household, and we can sort out the right door together.
Call (321) 315-0054 | agent@inshh.com
You may qualify after tax credits. Eligibility varies.
Featured photo: Pictured Rocks National Lakeshore, Michigan by R Boed, CC BY 2.0, cropped with text added.
