health insurance

2019 Medicare Open Enrollment Runs October 15 through December 7

Medicare is a program for people who are 65 or older and people with disabilities. You can read more about Medicare here. If you have Medicare now, then...

It's time to review your Medicare Plan!  

October 15, 2018 to December 7, 2018 is the annual Medicare Open Enrollment Period. During Open Enrollment you may:

OpenEnrollment.jpg
  • Change from original Medicare to a Medicare Advantage Plan

  • Change from a Medicare Advantage Plan back to original Medicare

  • Switch Medicare Advantage plans

  • Join a Medicare Part D Prescription Drug Plan

  • Switch Medicare Part D Prescription Drug Plans

IMPORTANT: Review your coverage--especially Part D and Medicare Advantage Plans--every year!

Premiums, co-pays and the drugs covered can change from year-to-year, even within the same plan.  Your current plan should send you an "Annual Notice of Change" before Open Enrollment that outlines any changes for the next year.  Medicare Part D plans are sold and managed by private companies and vary greatly in terms of monthly premiums, annual deductibles, drugs covered and prescription prices.  

Insurers tweak Medicare Advantage Plans every year, and those changes could mean that you can't see your favorite doctor or that you might need to pay more. 

So--review, review, review!

Note: Low-income individuals on Medicare may be able to change their plans more frequently. A MMAP counselor can explain your options.

MMAP Counselors Are There For You--For Free!

Every state has people who will help you figure out your Medicare options. In Michigan, these people--paid staff, and volunteers--work with the Medicare/Medicaid Assistance Program. In Michigan, you can find your local MMAP program here. Nationally, the SHIP (State Health Insurance Assistance Program) can help you find assistance locally. 

MMAP Counselors can help explain how Medigap and Medicare Advantage programs work, and can help you sift through your options for Part D plans. They can help you figure out if you can defer taking Medicare because you are still working. They can help you figure out if you qualify for extra help!

Some People Qualify For Extra Help

If your income is low, you may qualify for extra help. For instance, the Medicare Savings Program may help you pay your Medicare premium, or you may qualify for Medicaid and Medicare which together will cover all your health care costs. To qualify for the Medicare Savings Program you must be low-income and not have many assets.  For married couples, your combined income must be less than $1871.75/month and you must have less than $11,340 in assets (excluding a house and car).  For single people, your income must be less than $1391.67 and you must have less than $7560 in assets.  

If you think you may qualify for Extra Help, talk to a MMAP (Medicare/Medicaid Assistance Program) counselor. 

Just MMAP It!

Washtenaw County is in a MMAP region that includes Livingston, Monroe, Macomb, St. Clair and Oakland counties. There are multiple ways to meet with MMAP counselors and MMAP and the Area Agency on Aging 1B have multiple events scheduled for Open Enrollment.  Call 1-800-803-7174 to schedule an appointment.  Call now because availability is limited!


 

 2019 Open Enrollment Washtenaw County Events - Medicare beneficiaries can make an appointment to meet one-on-one with a MMAP Counselor and review their 2019 Medicare coverage options.  Call 800-803-7174 to schedule an appointment.  Appointments are required.

Washtenaw ISD 1819 S. Wagner Rd. Ann Arbor, MI 48103

  • Tuesday, October 16 9am - 4pm,

  • Monday, November 12 9am - 4pm

  • Thursday, December 6 9am - 4pm

Milan Seniors for Healthy Living 45 Neckel Ct. Milan 48160

Call 734-508-6229 for appts

  • Thursday, October 18 9am-3pm

  • Thursday, November 15 9am - 3pm

Pittsfield Twp. Senior Center 710 W. Ellsworth Rd Ann Arbor 48108

Call 734-508-6229 for appts

  • Wednesday, October 24 9am - 2pm

  • Wednesday, November 14 9am - 2pm

Printable schedule of events for Southeastern Michigan  including Washtenaw, Livingston, Monroe, Macomb, St. Clair and Oakland.

New Medicare Cards

A quick note about Medicare cards. Medicare is no longer using your Social Security number as your Medicare number. Everyone (all 55 million people on Medicare!) will receive a new card before May 2019. You do not need to call to receive your card and no one will call you asking for your Medicare information to receive a new card. Read 10 Things to Know About Your New Medicare card.

Medicare cards will no longer include your Social Security number. Everyone should have a new cared before May 2019.   Read more.

Medicare cards will no longer include your Social Security number. Everyone should have a new cared before May 2019. Read more.

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2017 Medicare Open Enrollment Runs October 15 through December 7

Medicare is a program for people who are 65 or older and people with disabilities. You can read more about Medicare here. If you have Medicare now, then...

It's time to review your Medicare Plan!  

October 15, 2017 to December 7, 2017 is the annual Medicare Open Enrollment Period. During Open Enrollment you may:

  • Change from original Medicare to a Medicare Advantage Plan
  • Change from a Medicare Advantage Plan back to original Medicare
  • Switch Medicare Advantage plans
  • Join a Medicare Part D Prescription Drug Plan
  • Switch Medicare Part D Prescription Drug Plans

 

review your coverage--especially Part D and Medicare Advantage Plans--every year!

Premiums, co-pays and the drugs covered can change from year-to-year, even within the same plan.  Your current plan should send you an "Annual Notice of Change" before Open Enrollment that outlines any changes for the next year.  Medicare Part D plans are sold and managed by private companies and vary greatly in terms of monthly premiums, annual deductibles, drugs covered and prescription prices.  

Insurers tweak Medicare Advantage Plans every year, and those changes could mean that you can't see your favorite doctor or you might need to pay more. 

So--review, review, review!

MMAP Counselors Are There For You--For Free!

Every state has people who will help you figure out your Medicare options. In Michigan, these people--paid staff, and volunteers--work with the Medicare/Medicaid Assistance Program. In Michigan, you can find your local MMAP program here. Nationally, the SHIP (State Health Insurance Assistance Program) can help you find assistance locally. 

MMAP Counselors can help explain how Medigap and Medicare Advantage programs work, and can help you sift through your options for Part D plans. They can help you figure out if you can defer taking Medicare because you are still working. They can help you figure out if you qualify for extra help!

Some People Qualify For Extra Help

If your income is low, you may qualify for extra help. For instance, the Medicare Savings Program may help you pay your Medicare premium, or you may qualify for Medicaid and Medicare which together will cover all your health care costs. To qualify for the Medicare Savings Program you must be low-income and not have many assets.  For married couples, your combined income must be less than $1847/month and you must have less than $11,090 in assets (excluding a house and car).  For single people, your income must be less than $1376 and you must have less than $7390 in assets.  

If you think you may qualify for Extra Help, talk to a MMAP (Medicare/Medicaid Assistance Program) counselor. 

Just MMAP It!

Washtenaw County is in a MMAP region that includes Livingston, Monroe, Macomb, St. Clair and Oakland counties. There are multiple ways to meet with MMAP counselors and MMAP and the Area Agency on Aging 1B have multiple events scheduled for Open Enrollment.  Call 1-800-803-7174 to schedule an appointment.  Call now because availability is limited!

 

2018 Washtenaw County Events - Medicare beneficiaries can make an appointment to meet one-on-one with a MMAP Counselor and review their 2018 Medicare coverage options.  Call 800-803-7174 to schedule an appointment.  Appointments are required.

Thursday, November 2,  2017  10am - 3pm Jewish Community Center of Greater Ann Arbor 2935 Birch Hollow Dr Ann Arbor, MI 48018

Monday, November 13, 2017 10am - 6pm   Washtenaw ISD 1819 S Wagner Rd Ann Arbor, MI 48103

Thursday, December 7, 2017 10am - 6pm  Washtenaw ISD 1819 S Wagner Rd Ann Arbor, MI 48103

 

Events in SE Michigan including Washtenaw, Livingston, Monroe, Macomb, St. Clair and Oakland.  

Washtenaw County Events and Partner sites with in-person appointments available.

Livingston County Events and Partner sites with in-person appointments available.

Monroe County Events and Partner sites with in-person appointments available.

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Pre-existing conditions, the ACA and the AHCA

Under the Affordable Care Act (ACA) of 2014, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. They cannot limit benefits for that condition either. Once you have insurance, they can’t refuse to cover treatment for your pre-existing condition.
— U.S. Department of Health and Human Services https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html

On May 4, 217 Republican Representatives voted to approve the American Health Care Act.  This Act is meant to repeal and replace the ACA.  One provision of this act is a change to the way pre-existing conditions are treated.  The bill in its current state does continue to cover pre-existing conditions under certain circumstances.  You must have continuous care.  Because this plan also removes the mandate that everyone must have health insurance, you can choose to not buy health insurance.  If you get cancer, you will have to pay a penalty and then you are allowed to get coverage.  The insurance company can CHARGE YOU whatever they want.  Let's just say that again.

Yes, you can have health insurance if you have a pre-existing condition but the health insurance company can charge you a lot of money. many people will not be able to afford that coverage.

High Risk Pools: We've been here before 

Click the image above to go to the video from Kaiser Health News 

Click the image above to go to the video from Kaiser Health News 

What about the high risk pools (HRP)?  What about them?  In the past, many states had high risk pools. They were extremely expensive, and many people did not get the care they need. Julie Rovner explains why this "sounds like a good idea" but isn't.  Sounds Like A Good Idea: High Risk Pools

 

 

If you are wondering what's included in the list of pre-existing conditions, so are we.  This is a partial pre-existing conditions list from CNN:  

Acne

Acromegaly

AIDS or ARC

Alzheimer's Disease

Amyotrophic Lateral Sclerosis

Anemia (Aplastic, Cooley's, Hemolytic, Mediterranean or Sickle Cell)

Anxiety

Aortic or Mitral Valve Stenosis

Arteriosclerosis

Arteritis

Asbestosis

Asthma

Bipolar disease

Cancer

Cardiomyopathy

Cerebral Palsy (infantile)

Chronic Obstructive Pulmonary Disease

Cirrhosis of the Liver

Coagulation Defects

Congestive Heart Failure

Cystic Fibrosis

Demyelinating Disease

Depression

Dermatomyositis

Diabetes

Dialysis

Esophageal Varicosities

Friedreich's Ataxia

Hepatitis (Type B, C or Chronic)

Menstrual irregularities

Multiple Sclerosis

Muscular Dystrophy

Myasthenia Gravis

Obesity

Organ transplants

Paraplegia

Parkinson's Disease

Polycythemia Vera

Pregnancy

Psoriatic Arthritis

Pulmonary Fibrosis

Renal Failure

Sarcoidosis

Scleroderma

Sex reassignment

Sjogren's Syndrome

Sleep apnea

Transsexualism

Tuberculosis

The Kaiser Family Foundation, a nonpartisan research group, has estimated that 27 percent of Americans younger than 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under the system that existed before the Affordable Care Act. (New York Times, 5/6/17)  

One last point, this bill was passed by the House of Representatives and has a long way to go before it is signed by the President and becomes law.  Please make your voice and opinion heard by your elected officials.  It does make a difference. 

If you have questions, post them in the comments section and we will do our best to answer.  

-Meredith Buhalis

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Deductions: "Modifying" Your Adjusted Gross Income Can Save You Money

The Gift Of "MAGI": What Is That?

Adjusted Gross Income is your annual income, as defined by the IRS. If you file taxes using the 1040, you will find it on Line 37. [It is line 4 on the 1040EZ and line 21 on a 1040A.]

For purposes of applying for health care--both Marketplace and Medicaid--and for assessing whether or not health coverage is affordable--the federal government uses "Modified" Adjusted Gross Income, fondly referred to by those of us in "the biz" as MAGI.

*Do you know the story of The Gift of the MAGI?   Pronunciation /ˈmeɪˌdʒaɪ/.

What Gets Modified In Order To Get To A Modified Adjusted Gross Income? Add Backs AND Deductions 

Income includes everything on the list below. More common items are in bold.

  • Wages, Salaries, tips, etc.
  • Taxable interest
  • Taxable amount of pension, annuity, or IRA distributions and social Security benefits
  • Business income, farm income capital gain, other gains (or loss)
  • Unemployment compensation
  • Ordinary dividends
  • Alimony received
  • Rental real estate, royalties, partnerships, S corporations, trusts, etc.
  • Taxable refunds, credits, or offsets of state and local income taxes
  • Other income

This list is from the UC Berkeley Labor Center MAGI handout.

Add Backs

There are a few things you need to "add back" as income--the most common of those is non-taxable social security benefits. Other possible add backs include tax-exempt interest and foreign earned income for Americans living abroad.

Deductions

If you do a Marketplace or Medicaid application, after you are asked about your income, you are asked if you have any deductions such as alimony or student loan interest. The actual list of potential deductions is quite a bit longer, and might make a difference for you. 

Here is the list. More common items are in bold.

  • Educator expenses
  • Certain business expenses of reservists, performing artists, and fee-basis government officials.
  • Health savings account deduction
  • Moving expenses
  • Deductible part of self-employment tax
  • Self-employed SEP, SIMPLE, and qualified plans
  • Self-employed health insurance deduction
  • Penalty on early withdrawal of savings
  • Alimony paid
  • IRA deduction
  • Student loan interest deduction
  • Tuition and fees
  • Domestic production activities deduction

What This Means

On the Marketplace, cost-sharing goes up to 250% of the poverty level (or $60,750 for a family of 4) and tax credit subsidies go up to 400% of the poverty level (or $97,200 for a family of 4). In some cases, putting money in an IRA, paying tuition, or setting up a health savings account can make your MODIFIED Adjusted Gross Income lower, and you could qualify for more benefits. [Note: Not all Marketplace plans allow the use of health savings accounts, but some of them do.]

Of course, we're not tax experts--so you might want to check with yours!

Resources:

UC Berkeley Labor Center MAGI handout

Advocate's Guide to MAGI from the National Health Law Program. 

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Are You A New College Grad? Your Guide To Getting Health Care

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How Does Your Income Affect the Cost of Your Marketplace Plan?

If you're looking for health insurance on the Marketplace, there are three things you should keep in mind when setting a budget for your plan:

  1. Your monthly premium: the amount you have to pay each month to keep your plan active.
  2. Your deductible: the amount you have to pay by yourself for your health care before insurance will help cover your costs.
  3. Your out-of-pocket maximum: the highest amount you will pay all year. Once you pay this amount your insurance covers all the costs for the rest of the year.

Thankfully there’s assistance to help pay for all three for those who need it!

Premium Tax Credits Help Lower the cost of Your Monthly Premium

You might have heard of premium tax credits, but how does the government decide how much you have to pay and how much help you get? It all comes down to income. The Affordable Care Act has set guidelines for the maximum percentage of your income you’ll have to put towards your monthly premium. Those percentages are called premium caps. That cap is used to calculate the dollar amount you will have to pay and then you get a premium tax credit to cover the rest of the cost of your plan. The more you make, the higher your cap, and the less you make the lower your cap. So the lower your income the more you can get in premium tax credits. The table below shows the premium caps based on level of income.

Cost-Sharing Subsidies Help Lower Your Deductible and Out-of-Pocket Maximum

If you make less than 250% of the poverty level and choose a silver plan, then you can get extra help with your out-of-pocket expenses. This extra help is a cost-sharing subsidy. The subsidy works by lowering your out-of-pocket maximum and your deductible, and raising the percentage of costs covered by your insurance. Normally a silver plan covers 70% of the cost and you have to pay the other 30%. But with cost-sharing subsidies your insurance might cover 73%, 87%, or even 94% of your expenses – meaning you have to pay less out of pocket. The amount of help you get is based on your income and, again, the lower your income the more help you receive.

Check out this example to see how premium tax credits and cost-sharing subsidies can work together to make your health care affordable!

If You Make More, You Pay More; If You Make Less, You Pay Less

If your income does not qualify you for significant cost-sharing subsidies on the silver plans, you may find that a bronze, gold, or platinum plan is better for you. 

To get an idea of what assistance you might be eligible for, visit the Marketplace at www.healthcare.gov/see-plans.

--K. Okarski

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Medicaid Sticking Point: The "Other Insurance," aka Third Party Liability

Transitions can be difficult. For the most part, getting Medicaid is a wonderful thing, but occasionally there is a fly in the ointment. 

If you had medical coverage before, from an employer or the Marketplace, and that ended, you may need to let Medicaid know. The private insurance may have ended a while ago! But if Medicaid thinks that you still have that primary insurance, and you don't, you can have trouble getting access to your Medicaid health benefits. 

The trouble begins because Medicaid is always the insurance of last resort. That means, if you have private insurance that pays 80% of the bill, Medicaid will wait and pay the last 20% of the bill. This completely makes sense, unless. . . you don't actually have that private insurance, but Medicaid still thinks that you do. 

In that case, Medicaid's record of the phantom insurance means that Medicaid will not pay the hospital bill, because the phantom insurance has not paid the first part. 

Getting rid of the phantom insurance takes a little bit of elbow grease. The easiest way to remove the insurance is to call the MI Enrolls help line, (888)-367-6557. Choose the option for "other things," and explain that you have an insurance policy listed on your account that no longer is active. They will ask you for information about the insurance company, policy number, and the individuals listed. They will then send a confirmation request to the insurance company, confirming the end date for that coverage. This process generally takes about ten days, so don't wait until you are in the emergency room to get this problem fixed!

--R. Kraut

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Thanks To The ACA: Pre-existing Conditions Are Covered

Fine print insurance.png

How quickly it all fades into the background. 

Back in the day (just a few short years ago!), if you had asthma, or diabetes, or if you had cancer ten years ago--you might not be able to get health coverage because of your pre-existing conditions

As a friend reminisced on Facebook today, 

Pre-ACA, 10 years ago--on the day I was told that I needed to have surgery in the next week because of an abnormal PAP--the nurse pulled me aside to mention to me that I needed to make sure I never let my insurance lapse. An abnormal PAP requiring surgery counts as a pre-existing condition. I am not now, nor have I been for five years, considered medically high risk. I would still be considered to have a pre-existing condition.

Today, the fact that you had surgery a few years ago wouldn't matter. The Affordable Care Act individual mandate operates on the idea that "everybody is in for insurance, and so the risks are spread out." The part that not everybody understands is this: in order to make it possible to cover pre-existing conditions, everybody--not just people with pre-existing conditions--needs to be in the insurance pool. 

If you wait until you're sick to get covered, well...that would be like waiting until you got into a car accident to try to get auto insurance! Which wouldn't make sense, right?

Don't wait--get covered! You can visit the Washtenaw Health Plan Monday through Friday, 9-4, 555 Towner, Ypsilanti MI, or call us at (734) 544-3030 for a free insurance assessment.

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Health Insurance Scams - How to Spot Them and What to DO

runningdollarsign

Now that everyone is required to have health insurance or pay a penalty, scammers and evil-doers are out there trying to take your money.  Below you will find trusted sources for information and tips on how to tell the real deal from the scammers.  

scamtype

If it sounds too good to be true, it probably is. 

If someone calls you and tells you about a health insurance plan that covers everything and will only cost you $35 dollars/month, be suspicious.  First ask them for the health insurance company name and their web address.  If they won't tell you either of those, it is a scam. If someone won't give you a call back number, they probably are not from a reputable company.  

If someone starts asking you lots of questions about your health (do you have asthma, cancer, high blood pressure), it is either a scam or a short-term plan. Year-round plans during open enrollment or special enrollment periods can only ask you your age, your address, and whether or not you are a smoker. 

Healthcare.gov is the Real Deal. 

The website to visit is

HTTP://WWW.HEALTHCARE.GOV/  

NOT healthcare.com.  

If you scroll to the bottom of the webpage at healthcare.COM printed in tiny letters is the following statement:  

HealthCare.com is a PRIVATELY OWNED website that is NOT owned or operated by any state or federal government agency.

Phone Call Scams

phone

The Marketplace (healthcare.gov) may call you if they were unable to answer your call and you left your phone number. They may also call to remind you that it is time to enroll, but the reminder calls are recordings.  If a person calls you and you are not sure who they are, ask for a callback number.  If the person is hesitant to provide a number, they are a scam. The Marketplace phone number is 1-800-318-2596 and you can call them 24 hours a day, 7 days a week.  

All Marketplace representatives have access to your account after you identify yourself. Marketplace representatives never ask you for financial information, such as bank names and account numbers. They will never ask you to pay for insurance over the phone.

What Does A Scammer Sound Like?

This a recording of a scammer who calls and leaves a voicemail.  This same voicemail was left for hundreds of people.   Do not call this person back, they are not from Healthcare.gov and can not sign you up for real health care.  

Protect Yourself

The Coalition Against Insurance Fraud has a list of fake health plans and health care scams with 10 warning signs. To protect yourself, they suggest:

  • Slow down: Avoid signing up if you feel pressured to buy
  • Ask to read the policy
  • Call the insurance company to verify the program offered is a real plan and not just a medical discount card.

Read more here.

What to do if you are believe you are the victim of a health insurance scam

If you believe you are the victim of a health insurance scam, contact the Federal Trade Commission (FTC).  Fill in this form online: http://www.ftccomplaintassistant.gov

You can report Medicaid fraud or abuse by calling 855-MI-FRAUD (643-7283) or by filing an online complaint

To contact your local Medicaid office or find out about your Medicaid benefits, contact your local DHHS office or call the Medicaid Helpline at 1-800-642-3195. 

 

resources about healthcare scams:

Protect yourself from Marketplace fraud  https://www.healthcare.gov/how-can-i-protect-myself-from-fraud-in-the-health-insurance-marketplace/

Read about recent scams or sign up for Scam Alerts from the FTC:  http://www.consumer.ftc.gov/scam-alerts

Stop Medicare Fraud http://www.stopmedicarefraud.gov/

 

-M. Buhalis

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Help! I missed the December 17th deadline. Now what?

DON'T PANIC!

keepcalmandgethealthcare

The December 17th deadline was to get onto the Marketplace and enroll in a health plan that would start on January 1, 2016. Open Enrollment continues until January 31, 2016. Enrolling after December 15 changes the date your 2016 insurance starts.  

(medicaid is always open for enrollment.  If you qualify for medicaid, you can apply online at MiBridges.michigan.gov Anytime.  check your income here.)

 

I had Marketplace insurance in 2015 but I didn't update my application. 

If you had Marketplace insurance in 2015 and you didn't get onto the Marketplace, you have been re-enrolled into the same plan with a new tax credit based on your 2014 Tax Return.  You can still change plans before January 31, 2016.  If you waited you will have your auto-enrolled plan for January and new plan starting on February 1 (if you enroll before January 15) or March 1 (if you enroll after January 15). 

I did not have Marketplace insurance in 2015.  

If you didn't have health insurance in 2015, you still have time to enroll.  Enroll before January 15, 2015 and your coverage will start February 1.  Enroll before January 31 and your coverage will start March 1.  Not sure if you qualify for the Marketplace?  If your income is above the Medicaid income guidelines and you don't have an employer offer of coverage, you need to go on the Marketplace (healthcare.gov).

My employer offers insurance but I think it is too expensive.

Employer coverage tool from healthcare.gov  

Employer coverage tool from healthcare.gov 

If you have an offer of insurance from your employer, you must enroll if it is considered affordable.  The rules are slightly complicated, so you may want to visit an organization that can help you figure this out. Before you come to an appointment or call, have your employer fill out an employer coverage tool.  Having complete information about your employer's insurance offer is necessary in determining your options.  Find an agency here.

If the insurance meets minimum standards, and the cost of the insurance for the individual is less than 8% of the household income, it will definitely be considered affordable.

To find out if your employer insurance is affordable, have your employer fill out an employer coverage tool.  

I don't know what health coverage is right for me.  What do I do? 

ConfusedPerson

Find an agency who assists with health care and call them.  Nonprofit agencies in Washtenaw County are listed  Looking throughout Michigan? Look here.

Call the Marketplace (1-800-318-2596) or go to their website healthcare.gov/see-plans.

Start here to see what you and your family may qualify for.  It is not unusual for parents to be on the Marketplace and children to qualify for Medicaid or MIChild.

M. Buhalis


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