Michigan Health Insurance - FAQ

What types of individual Michigan health insurance policies are available?
There are a variety of policies which Michigan insurance companies offer on an individual basis. Some of the more common types of policies include:

1. Major Medical - provides coverage for doctor visits, surgery and hospitalization or ongoing illnesses.
2. Hospital and Surgery - provides coverage solely related to hospital stays and surgical services, such as room and board, laboratory tests, X-rays, plus doctors charges
3. Hospital Confinement Indemnity - a policy designed to pay a set amount (an indemnity) for each day you are an "in-patient" at a hospital.
4. Health Maintenance Organizations (HMOs) - centralized service provider, commonly with a general practitioner (limited selection of participating doctors) coupled with coverage by specialists upon referral. Doctor visits, surgery, hospitalization and often reduced-rate prescription medicine are provided. May also cover preventive care, often not included in major medical policies.
5. Specified Disease (also called "Dread Disease") - covers costs associated with a single disease, such as cancer, AIDS, heart attack, etc.
6. Short Term - typically a major medical policy but with coverage lasting only for a specified length of time. Might be purchased to cover the time you are between jobs.
7. Accident Only - provides coverage for doctor visits, surgery and hospitalization resulting from an accident (no coverage for disease or illness).
8. Dental - provides coverage for costs associated with dentists and orthodontists.
9. Vision - provides coverage for sight correction
10. Home Health Care - care provided to enable you to remain in your home while receiving services which can range from assisted living (help around the house) to around-the clock nursing with other health care providers on call.
11. Long -Term Care - coverage provided to individuals who otherwise would not be able to take care of themselves. A range of services from delivery of prepared meals, assistance with managing the residence, to stays in residential facilities. Often associated with long-term illness and the elderly.
12. Limited Benefit - not very common, a bare-bones type of coverage intended to cover specific situations.

How can I get Michigan health coverage?

Michigan Individual insurance:Michigan Health insurance which is purchased by the individual. Some major health insurance companies offer a broad range of coverage's and options to individuals, who pay directly out-of-pocket for the cost of the insurance. Many insurance companies require completion of an application and may require a medical examination before coverage will be offered to the individual.

Government-sponsored insurance: Some states offer health insurance benefits to their residents, often with certain income requirements for eligibility. These plans are designed for the "working poor" - individuals who are employed but no health care coverage is available where they work. This enables the state to protect its residents from catastrophic loss due to illness, disease or accident without placing an additional burden upon its program for the truly indigent.

Association-sponsored insurance: You may belong to a group or organization that offers health insurance as a benefit of membership. Check membership benefit statements, brochures, or ask organizations leaders to determine availability of health insurance through your group or organization.

What kind of exclusions and limitations might be in my health plan?
There are a variety of exclusions and limitations with respect to health insurance. Common exclusions include pre-existing conditions (subject to portability of insurance as discussed below), substance abuse, attempted suicide, mental illness, reimbursement through a Worker'ss Compensation insurance program, cosmetic or elective surgery and procedures, optical and dental coverage, prescription medicine, and procedures determined to be preventive care.

Many individual health insurance policies exclude coverage for medical conditions that exist prior to the inception of the coverage. This is commonly referred to as "pre-existing condition" exclusion. Common pre-existing condition periods are six months and 1 year prior to the inception of the insurance coverage. Other common exclusions include: psychiatric care, alcohol and drug related problems, prescription medicines, and elective or cosmetic surgery and services.

Other common limitations of coverage are listed below under Health Insurance Purchase Considerations.

What if I have a medical problem or have had one in the past, How does that affect me for individual coverage?

You may:

1. Undergo a medical exam
2. Be turned down
3. Be offered coverage but your specific medical problem may be excluded with the addition of a rider.
4. Offered a policy that delays coverage of your medical problem for a period of time.
5. Issued a policy with full protection but charged a higher premium.

I'm between jobs. What are my insurance options?
As a stop-gap measure, you could invest in a short-term policy. Written for a two to six month period, they generally cover hospitalization, intensive care, surgical and doctors care in and out of the hospital, X-rays and lab tests.

I will be graduating from college soon. What coverage should I be looking at?
You may still be under your family coverage until you graduate. Most plans will continue coverage to full time students until age 23 if the student is financially dependent. If not, or after graduation, search around for a plan or policy that covers most medical, hospital, surgical, and pharmaceutical bills. But don't fall for every policy pitch - they will want to cover you against all types of affliction. And many are not worth the money.