5 facts about the new Michigan insurance market

LANSING — Five facts to know about Michigan's new health insurance marketplace, which opens Tuesday and is a major component of the federal health care law:

1. Should I care? Yes, if you don't have health insurance or buy it on your own. Michigan has 1.1 million uninsured residents and hundreds of thousands more who purchase their own. That's roughly 16 percent of the population. The law requires that you have health coverage or face fines.

In 2014, the penalty is $95 or 1 percent of taxable income, whichever is greater. It will rise to $325 or 2 percent of income in 2015, and $695 or 2.5 percent of income in 2016. You may be exempt from fines if you have a financial hardship, religious objection or coverage would cost more than 8 percent of your income.

2. Do I qualify? You will get tax credits to help pay for monthly premiums if you make between 100 and 400 percent of the federal poverty line. That's about $11,500 to $46,000 for an individual or $23,000 to $94,000 for a family of four. Those under 133 percent of the poverty level will qualify for Medicaid around April 1, assuming the Obama administration approves Michigan's expansion plan.

If you have insurance through your employer, you can shop on the exchange, but won't qualify for tax subsidies unless your company's plan is considered unaffordable or inadequate — costing you more than 9.5 percent of household income or covering less than 60 percent of the cost. Some small businesses with low-wage workers also may look at the market, though the law doesn't require them to provide insurance.

3. What's the deadline? Though Tuesday is the first day to enroll, there's no rush, because coverage starts Jan. 1. The deadline to be covered is Dec. 15. You have until March 31 to sign up for a plan without being penalized.

4. How do I pick the best plan? Go to healthcare.gov or call 800-318-2596. You'll have four levels of coverage to consider: bronze, silver, gold and platinum. Plans at every level cover the same benefits, but different percentages of medical costs. You'll pay the difference, up to a cap on out-of-pocket expenses. Those below 250 percent of the poverty level can get help with deductibles and co-pays.

Michigan has put together an online calculator to help you figure out your options, including premium costs. Starting Tuesday, visit michigan.gov/hicap to use the calculator or call 877-999-6442. For extra help, go to enrollmichigan.com for a list of independent navigators to guide you through the process. Hospitals, health clinics, insurers and nonprofits also have application counselors to help.

5. Does Michigan differ from other states? Yes and no. It's among 36 states where the federal government will control all or most of the exchange. State government has a limited role, except to link computer systems to the market.

One thing unique to Michigan is competition. It has the highest number of participating insurers, 13, among states that chose not to run the exchange on their own. You on average will have 43 plans to pick from. You'll pay dramatically different premiums, depending on your income, family size, age, hometown and tobacco use. Michigan's average premium, before tax credits, ranks about middle of the pack nationally.

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