Plan types, costs, networks and enrollment, explained in plain English for Michigan individuals, families and the self-employed.
Ask Samantha a questionCall (734) 525-9450An HMO usually requires you to use in-network doctors and get a referral from your primary care doctor to see a specialist, and it generally costs less. A PPO costs more but lets you see specialists without a referral and offers some out-of-network coverage at a higher cost.
A copay is a fixed amount, such as $30 for an office visit. Coinsurance is a percentage of the cost, such as 20%, that you pay after meeting your deductible. Copays are predictable; coinsurance depends on how expensive the care is.
Your deductible is what you pay for covered care before the plan starts sharing costs. Your out-of-pocket maximum is the most you’ll pay for covered in-network care in a plan year; after you reach it, the plan pays 100% of covered in-network costs.
Insurers negotiate lower rates with in-network providers. Out-of-network care can cost much more, and some plans won’t cover it at all except in emergencies. Always confirm your doctor and hospital are in network for your specific plan.
Some services, such as imaging, surgeries and certain medications, need approval from your insurer before you receive them. If pre-authorization is required and not obtained, the claim can be denied, so confirm it’s approved before your appointment.
Most plans cover recommended preventive services, like annual checkups, many screenings and vaccines, with no copay when you use an in-network provider. Your premiums pay for it, but there’s no charge at the visit. If the visit turns into diagnosing a new problem, cost-sharing may apply.
Urgent care is usually faster and much less expensive for minor injuries, infections and flu symptoms. For chest pain, trouble breathing, severe bleeding, stroke symptoms or serious injuries, go to the ER or call 911. Choose by how serious it is, not by cost.
You may qualify for a Special Enrollment Period after events like losing other coverage, moving, getting married or having a baby. You usually have 60 days from the event to enroll. If you don’t qualify, we can talk through options until the next open enrollment, which starts November 1. See Michigan open enrollment.
Most self-employed Michiganders choose a Marketplace plan, where premium tax credits may be available based on income, or a small-group plan if they have employees. Self-employed people can often deduct their premiums. We’ll compare both paths for your situation. See self-employed health insurance.
Talk to a local, independent agent. Consultations are always free.
Book a free callCall (734) 525-9450