Understanding Health Insurance Rules in Michigan

Small Business

Understanding Health Insurance Rules in Michigan

Published on January 10, 2018


Updated July 30, 2019
Michigan offers a variety of health insurance options to consumers. Knowing the health insurance rules in Michigan might help you find a plan that provides great coverage and also stay within your budget. Additionally, if you’re a small business owner, it’s important to know the small business rules in Michigan.

Health insurance rules in Michigan: overview

As in all other U.S. states, health insurance plans must be compliant with Affordable Care Act’s (ACA) regulations. This also applies to health insurance rules in Michigan.
Are you an individual without access to group health coverage or unqualified for government subsidized health insurance? You may want to speak to a licensed agent from eHealth to discuss health insurance plans in Michigan, or visit eHealth.com. Otherwise, you can buy a plan directly through the health insurance company, or on the Federal Health Insurance Marketplace. The same goes for business owners unsure about small business rules in Michigan — our licensed agents can help make sure you buy a group plan that fulfills requirements in Michigan.

Small business rules in Michigan: is providing health insurance required?

If you are a small business owner looking to a buy a group health insurance plan, there are some rules for small businesses in Michigan to know about before purchasing health insurance for you and your employees.

  • Although you might have plenty of options for group coverage available, rules for small businesses in Michigan generally do not require you to cover your employees.
  • If you are an employer planning to offer insurance to employees and dependents, the coverage must extend to all employees, but again, you are not required to offer health insurance as a small business owner.
  • Health insurance rules in Michigan also state that if an employer offers health coverage, it must include certain minimum benefits required by Michigan law.

Health insurance rules in Michigan: different health insurance plan options

There are several types of plans listed below – each of them complies with health insurance rules in Michigan. The following plans are considered “managed care” and are often seen in group plans, but individual plans can be similar as well. If you are a small business owner, these would most likely be the plans you’ll choose from to offer your employees.
Health Maintenance Organization (HMO plan) – Will get you coverage from doctors within the network of the HMO. Most HMO plans do not offer the option to go out of network, and you might be required to work in the plan’s service area in order to be eligible.
HMO Point-of-Service plan – This type of HMO plan lets you choose, at the time of treatment, whether you stay in-network or get treated by someone outside the network. Out-of-pocket costs may be more if you decide to go outside the HMO-POS network.
Preferred Provider Organization (PPO) plan – Is essentially an agreement between an insurance company and certain health-care providers, who agree to offer services at a discounted rate. Enrollees can generally choose where they want to go for care, but will most likely find lower prices within the PPO plan network.
Healthy Michigan Plan- Michigan has an option that caters specifically to those in need of low-cost health insurance. This plan covers the federal healthcare law’s essential health benefits, and abides by health insurance rules in Michigan. This low-cost plan is for individuals and covers the following:

  • Hospitalization
  • Ambulatory patient services
  • Maternity care
  • Mental health and substance abuse treatments
  • Lab services
  • Preventative, wellness, and chronic disease services
  • Prescription drugs
  • Rehabilitative/habilitative services and devices
  • Pediatric services for 19-20 year olds

You may qualify if you are:

  • In-between 19-64 years old
  • Have an income below 133% of the federal poverty level
  • A resident of Michigan
  • Not pregnant at time of application
  • Not enrolled in/do not qualify for Medicare

To read about additional Michigan plans and additional health insurance rules in Michigan, visit the Michigan.gov page.
You can also visit eHealth.com or speak to one of our friendly, licensed agents over the phone to learn more about health insurance rules in Michigan and quality plans offered in you state. Finding the best coverage isn’t an easy task, but eHealth can make it simple with free quotes and access to tools that will help you compare any plan with the coverage and price-point you desire.
This article is for general information and may not be updated after publication. Consult your own tax, accounting, or legal advisor instead of relying on this article as tax, accounting, or legal advice.

We’ll let you know when we publish anything new.