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Health Insurance Michigan

With the rising costs of health care, the need for affordable health care plans cannot be overemphasized. Health insurance in Michigan is designed to cover medical expenses, protecting you from high medical costs that may affect your finances if you have to pay out of pocket. Health insurance ensures that the insured pays less for covered in-network health care and guarantees access to free preventive care, like regular screenings, vaccines, and selected routine check-ups - overall attributing to the increase of well being. In a bid to reduce healthcare costs and make health insurance more affordable, the Inflation Reduction Act was introduced in 2022. The Act also reduces health insurance premiums for hundreds of thousands of Michigan residents by approximately $790 annually on average. At the same time, coverage was expanded to about 63,000 Michiganders and capped insulin co-payments for the tens of thousands of Michigan Medicare beneficiaries using insulin. Michigan health insurance exchanges are one of the most robust in the United States, with ten carriers offering coverage for 2023.

The Department of Insurance and Financial Services (DIFS) regulates health insurance in Michigan and provides access to updated information on health insurance in the state. Aside from the state’s regulation, the Department of Health and Human Services (HHS) regulates health insurance at the federal level. The DIFS allows Michigan residents to get health insurance at affordable prices through public health institutions and private health insurance providers in Michigan. Some federally regulated and administered health programs are Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP). Health insurance caters to everyone in the state, regardless of age and status. For instance, Medicare is mainly designed for persons aged 65 or older, although a person can get it earlier if they have a disability, like End-Stage Renal Disease (ESRD) or ALS (also known as Lou Gehrig's disease). On the other hand, CHIP is mainly designed to provide low-cost health insurance to eligible children under 18 years old.

Many residents ask questions like “is health insurance required in Michigan? Or “do you have to have health insurance in Michigan?” The answer is no, but it is a great investment in your health, so that you will easily get medical coverage and quality care when needed.

Michigan health insurance falls into four main categories:

  1. Major health plans that comply with the Affordable Care Act, which, if purchased individually (not through an employer) - can be possibly subsidized, based on the applicant’s income.
  2. Major health plans that do not comply with the Affordable Care Act, which provide emergency, last resort, or supplemental health coverage, for those who may not qualify for ACA subsidies, or choose to save money through lower-cost options. (Short term Health Insurance)
  3. Medical Indemnity Plans - help which are typically purchased as supplemental coverage for major health plans, to help offset the costs of coinsurance and copays in case of hospitalization, illness, and office visits.
  4. Specialized Coverage - specialist coverage plans which can be purchased as stand-alone policies or as a supplement to the major health insurance plan. (Dental insurance, Vision insurance, Hearing insurance, etc.)

Residents can determine their eligible ACA-compliant plans based on their income by completing a Marketplace application via the Michigan healthcare gov website. Michiganders who qualify for the state’s Medicaid or MIChild programs can apply all year long. You can consult a Michigan-licensed health insurance agent to answer your questions and help determine which health insurance plan to choose. An agent can also help with your Michigan health insurance application. To find health insurance Marketplace help in your vicinity, you can visit the Find Local Help online directory, input your city, state, or ZIP code, and search. You should then schedule a meeting to talk in person, via telephone, or by email.

Before buying health insurance in Michigan, speak with a state-licensed health insurance agent for proper guidance based on your specific set of needs. The agent can answer questions on how to apply for health insurance in Michigan or how to buy health insurance in Michigan. Michigan health insurance application is typically made through the Affordable Care Act-compliant health insurance marketplace, through the non-ACA compliant alternative plans health plans (short term and supplemental), or offered through the employer.

How Does Health Insurance Work in Michigan?

Health insurance in MI works by pooling the risks and resources of several individuals in a bid to financially protect each one from financial loss due to expensive medical bills resulting from a disability, illness, or accident. It is an agreement between an insurance company and the insured where the insurance company agrees to pay a specified portion of a person's medical expenses in exchange for a premium. The medical expenses that health insurance covers are hospitalization costs, cost of medicine or doctor consultation fees, checkups, routine treatments, etc., depending on the type of policy purchased. In most cases, the insurer only covers part of the medical expenses, as the insured must pay a deductible before their insurance kicks in. Health insurance may involve other forms of payments, although different health insurance plans require different out-of-pocket payments: Premium, Deductible, Coinsurance, and Copayment

  • Premium: It is the amount of money you must pay for your health insurance plan upfront every month to keep your health plan active. Different Michigan health insurance plans require different forms of payment methods. For instance, an employer typically pays part of the insurance premiums for employer-sponsored health plans while the employee pays what is left. On the other hand, for health insurance for self-employed in Michigan, the insured is required to single-handedly pay their premiums for their health plan, except if they get health insurance through their spouse’s health plan. You can ask a health insurance agent questions about how Michigan self-employed health insurance works.

While the premium is paid monthly, there is no cap on the annual amount. Meanwhile, the rest of the out-of-pocket expenses for most health insurance plans in Michigan have a maximum annual amount, upon reaching which, the insurer starts covering all expenses in full.

MOOP Limits in Michigan
Plan Type 2022 2023
Individual ACA Plan $8,700 $9,100
Family ACA Plan $17,400 $18,200

The Maximum Out of Pocket Limit (MOOP) typically includes.

  • Deductible: It is the amount an insured is required to pay out of pocket in the event of a covered health care service before their health plan kicks in. Deductibles are a good factor to consider when asking yourself, “how much does health insurance cost per month in Michigan.” Typically, low deductibles attract high premiums because the insurer will have to bear a larger part of your health risk. Conversely, high deductibles lower the premiums.
  • Coinsurance: This is the percentage (typically 10%-20%) of your medical bill that you must pay after paying your annual health insurance deductible. If you have a low premium, your coinsurance will be high, and vice-versa. Hence it affects the cost of health insurance in Michigan.
  • Copayment: It is a specified amount you must pay for a covered health care service, visit, treatment, or prescription drug after paying your deductible. Typical copay in Michigan is $15 - $100, depending on the type of service received. If you have a low premium, your copayment will be high, and vice-versa. Copayment also affects the health insurance cost in Michigan.

Note: Your health insurance plan may not cover some of your healthcare expenses, and you are restricted to a selected pool of network providers. Therefore, contact a Michigan-licensed health insurance expert to determine what your Michigan health insurance plans cover and exclude. An agent can also help you compare health insurance quotes in Michigan to get an affordable plan that best suits your needs and answer questions like, what is the best health insurance in Michigan? or what is the cheapest health insurance in Michigan?

There are multiple health insurance plans in Michigan, and the DIFS provides residents with detailed and updated information to help them make informed decisions regarding their health coverage. As the DIFS regulates health insurance in Michigan, other federal laws also guide health insurance in the state. For instance, the Consolidated Omnibus Reconciliation Act (COBRA) is a federal law that permits the insured to tentatively continue employer group health coverage after they, their spouse, or their parent leaves their employer (with 20 or more employees). All employers with 20 or more employees must comply with COBRA. Only health plans sponsored by the federal government and some church-related organizations are exempted from COBRA.

Furthermore, the Patient Protection and Affordable Care Act, also referred to as the Affordable Care Act (ACA), was enacted in March 2010. It is the comprehensive health care reform law, whose main aim is to ensure every resident has access to affordable health insurance. The ACA also provides consumers with subsidies known as premium tax credits, which lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).

The health insurance plans available in Michigan include:

Health Insurance Plans in Michigan
Employer Group Health Plans Self-Funded Health Plans
Wellness Plans
Individual Coverage Healthy Michigan Plan
Health Insurance Marketplace
Cost-Sharing Reductions (CSR)
Advance Premium Tax Credits (APTC)
Qualified Health Plan (QHP)
Catastrophic Health Plans
Minimum Essential Coverage Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Preferred Provider Arrangement (PPA)
High Deductible Plans
Health Plans Limited Benefits Short-Term Limited Duration Plan
Limited Benefit Plans (Accident Only or Hospital Indemnity)
Specified (Dread) Disease Plan
Incidental Policies, such as individual policies for dental and vision
Government-provided health plans Medicare
Medicare Advantage

Even though Michigan residents are not mandated to have health insurance, every resident should have it in order to have 24/7 access to quality healthcare anytime it is needed and to protect them from expensive medical expenses. According to the Michigan Household Survey on Health Insurance, the rate of Michigan residents without health insurance is 7.8%. This report also showed that over half of Michigan's uninsured adults have difficulty getting medical care without health insurance. Michigan residents can get health insurance through:

  • The Michigan Health Insurance Marketplace
  • The Federal Government Health Insurance Marketplace
  • Employer Group Health Plans gotten from their employees
  • Their spouse or parent’s health insurance plan. Only children and young adults below 26 years old can get health insurance through their parent’s health insurance plans
  • Church-related organizations
  • Health plans provided by the government like health insurance programs like Medicare, Medicaid, MIChild, and Children’s Health Insurance Program (CHIP)

Consult a Michigan-licensed health insurance agent for proper guidance on the health insurance policy. The agent can answer questions on flexible group insurance plans and health insurance plans that offer low-cost coverage. Before purchasing any Michigan health plan, ensure you have the complete details, including the riders and exclusions; your agent can help with this. You can also inquire about low income health insurance Michigan plans.

Michigan Low Income Health Insurance

Michigan state health insurance programs, excluding Children’s Special Health Care Services, have an income test. In addition to the income test, some of the programs also have an asset test; both tests may vary with each program. With some programs, an applicant may have more than the required income limit and still be able to obtain health care benefits if their medical expenses equal or exceed their deductible, which may be referred to as a spend-down amount.

Affordable Michigan health insurance includes:

Health plans Eligibility requirements
Children U-19 Medicaid
  • Low-income children under age 19
  • An income test is required
MI child health insurance (a good option for Michigan health insurance for children)
  • Children under age 19
  • Low-income uninsured children of Michigan's working families. It, however, has a higher income limit than U-19 Medicaid
  • A $10 monthly premium is required to cover all the children in one family
  • An income test is required
Children's Special Health Care Services (CSHCS)
  • The child must be under 21 years old and have a qualifying medical condition
  • Persons aged 21 or over with cystic fibrosis or certain blood coagulation disorders are eligible
Under 21 (Medicaid)
  • An income test and an asset test is required
  • If the income is more than the income limit, the person will be assigned a deductible.
Supplemental Security Income (SSI) for Children
Special Disabled Children (Medicaid)
  • The child must meet current SSI income, and resource standards
Pregnant Women Pregnant Women health program
  • Must be pregnant
  • The plan is available during the month the insured’s pregnancy ends and during the two calendar months after the month the pregnancy ends. The insured will still be covered regardless of how the pregnancy ends (e.g., live birth, miscarriage).
  • An income test is required. There is an income limit for this program.
Group 2 Pregnant Women
  • Income exceeds the income limit for the pregnant women program above
Maternity Outpatient Medical Services (MOMS)
  • Pregnant or recently pregnant women who qualify for Emergency Services Only (ESO) Medicaid
Adults Healthy Michigan Plan
  • Must be a resident of Michigan
  • Must be between ages 19 and 64
  • Have their income at or under the 133% of the federal poverty level under the Modified Adjusted Gross Income (MAGI) methodology
  • Is ineligible for or not enrolled in other Medicaid programs.
  • Is not pregnant at the time of application
Caretaker Relatives
  • An income test and asset test is required for this program.
  • If the income test exceeds the income limit, the enrollee may incur medical expenses that are equal to or more than the deductible and still qualify for this program
Supplemental Security Income (SSI) for Adults
  • Adult low-income earners who are aged, blind, or disabled.
  • The Social Security Administration (SSA) determines SSI eligibility.
Aged, Blind, Disabled (AD Care)
  • An income test and asset test are required for this program.
  • If the income test exceeds the income limit, the enrollee may incur medical expenses that are equal to or more than the deductible and still qualify for this program.
Disabled Adult Children (DAC)
  • A person with a disability or blindness that began before age 22
  • The person must also be receiving DAC benefits from Social Security.
MI Choice
  • Adults aged 65 or older and adults with disabilities.
Medicare Savings Program (MSP)
  • An asset test is required
Families Low-Income Families (LIF)
  • For families under the Low Income Family (LIF) Program.
  • Income and asset tests are required.
  • Families that receive cash assistance under the Family Independence Program (FIP) are automatically eligible for this program.
Special N Support
  • For families under the Low Income Family (LIF) Program Medicaid or cash assistance (FIP) but no longer qualify because of income from spousal support payments. Note that Special N Support is only available for four months. Your Family Independence specialist at the DHHS will inform you if you qualify for this program.
Transitional Medical Assistance (TMA)
  • The family no longer qualifies for LIF/FIP because a parent has more than the required income from employment.
  • For families that have received LIF or cash assistance (FIP) in no less than three of the last six months. Note that TMA is only available for up to one year, and the family does not need to complete a new application.

Most of the low cost health insurance in Michigan listed above provide a comprehensive package of health care benefits, including vision, dental, and mental health services. Contact the local MDHHS office in your county to apply for any of the programs. Also, consult with a Michigan-licensed agent for proper guidance and to ask questions about free health insurance Michigan and affordable health insurance for children in Michigan. An agent can also help you get and compare Michigan health insurance quotes that are tailored to your needs.

How Does Group Insurance Work in Michigan?

In Michigan, one of the common ways people get health insurance is through their employers, known as the State of Michigan employee health insurance. The state mandates employers with 50 or more employees to provide health coverage to employees and their dependents. Employers who fail to do this are subject to a tax penalty, while the employee gets to receive a tax credit in the Health Insurance Marketplace. On the other hand, the state does not mandate employers with less than 50 employees to provide health coverage. However, they may get a small business health care tax credit if they choose to offer health coverage, regardless. While employers with less than 50 employees are not mandated to provide health coverage, they are required to provide their employees with information about the Marketplace, whether they offer health coverage or not.

For employers who will offer health coverage to eligible employees, they are required to initiate the coverage within 90 days of the employees’ employment start date. Some employers require up to a 90-day waiting period before new employees are qualified to enroll in coverage. Typically, Michigan employers have an annual open enrollment period where they can apply, modify, or disenroll in coverage. Employees are informed of the changes in benefits or premiums in group health insurance in Michigan during the annual open enrollment period.

Note that special enrollment periods (SEPs) may be permitted when specific life events occur (birth/adoption, marriage/divorce). Employees can check with their employer's human resources department for more information about SEPs.

In an Employer Group Coverage, the employer is the master policyholder, while the employees are certificate holders in the employer group health plan. Being the policyholder of the group coverage, the employer can:

  • Negotiate the terms of the group insurance policy with the health insurer
  • Allow the employees to choose from more than one plan
  • Limit or modify the plan’s benefits
  • Increase the employees’ premium contribution
  • Switch health insurers
  • Stop the health insurance company from providing coverage

With employer group health plans, the insured may receive:

  • Free preventive services
  • Dependent coverage to age 26 (group health plans is a good option for family health insurance in Michigan)
  • Limits on out-of-pocket maximums
  • Specific minimum benefits required by Michigan health insurance laws
  • No yearly or lifetime dollar limits on essential health benefits

If a Michigan resident loses their employer-provided group health coverage, they may exploit their Consolidated Omnibus Reconciliation Act (COBRA) rights. COBRA is a federal law that allows you to temporarily continue an employer group health plan after you, your spouse, or your parent stops working with an employer with 20 or more employees. If you choose to use COBRA, you would be required to pay the full cost of the plan, including the portion that used to be paid by the previous employer. It also makes you eligible for Medicaid or the Healthy Michigan Plan. You can purchase health insurance through the available special enrollment period. In Michigan, the group plan options available are:

  • Small group health plan: This is available to business employers with not more than 50 employees and can be purchased through a Michigan-licensed health insurance agent or directly from an insurance company.
  • Large group health plan: An employer with over 50 employees can get a group plan from an insurance company in the state. They could also be self-funded or self-insured. Self-funded Michigan health insurance plans mostly work best for employers who are large enough to offer substantial coverage and pay expensive claims for medical services out of the company’s cash reserves. On the other hand, employers may contract with insurers and third-party administrators to manage their self-funded health plans.
  • Wellness Plans: An employer may offer this type of plan to encourage employees to engage in healthy behaviors, maintenance, or improvement programs. If a Michigan health insurer’s health insurance rate is based on tobacco use, they are required to offer a wellness program for each group policy. The insurer may provide the employees with the following in the wellness program:
    • A rebate or reduction in premium
    • A reduction in co-insurance, co-payments, and deductibles
    • A combination of these incentives

To ask specific questions about group health insurance or State of Michigan retirees health insurance, you can consult with a state-licensed insurance agent. Generally, retirees get Medicare.

How Does Individual Health Insurance Work in Michigan?

Not everyone has access to employer-sponsored group plans in Michigan; hence individual health insurance plans are designed to make health insurance available to persons without group insurance. Individual health insurance, sometimes referred to as Michigan personal health insurance, basically works as an alternative to group insurance and provides medical cover for the following category of persons:

  • Self-employed
  • Persons whose employers do not offer group plans
  • Persons whose group plans do not cover their spouses or dependents
  • Persons ineligible for the Healthy Michigan Plan, Medicare, or Medicaid

You can enroll for individual health insurance during the annual open enrollment period or even outside the open enrollment through a Special Enrollment Period (SEP). However, the special enrollment period is only allowed for persons with qualifying events, including:

  • Loss of qualifying health coverage (a group health plan or Medicaid)
  • Change in family size (marriage/divorce, new baby, or adoption)
  • Relocation
  • Other situations permitted by the DIFS.

Individuals have 60 days from when their Michigan health insurance plans ended to enroll in a new plan through a SEP. Enrollees may be required to provide proof of eligibility for a SEP, such as proof of new residency or birth/marriage certificate. Interested persons can find out the options available to them by calling the DIFS at (877) 999-6442, the Michigan enrollment phone number.

The Michigan Affordable Care Act (ACA) mandates that individual and small group health plans offer certain services known as Essential Health Benefits (EHBs). These essential health benefits fall into the following 10 categories:

  1. Preventive health and wellness services and chronic disease management, such as routine vaccines, breast and colon cancer screenings, diabetes screenings, high blood pressure, and high cholesterol.
  2. Mental health and substance use disorder services (this also includes behavioral health treatment)
  3. Emergency services
  4. Hospitalization
  5. Maternity and newborn care
  6. Pediatric services, including oral and vision care
  7. Prescription drugs
  8. Rehabilitative and habilitative services and devices
  9. Laboratory services
  10. Ambulatory patient services

Note that the ACA requires most health plans to provide free preventive services, which means that insurers cannot charge a deductible, co-insurance, or co-payment for preventive care if it is provided by an in-network provider.

Some of the Michigan individual health insurance plans are:

  • Healthy Michigan Plan
  • Health Insurance Marketplace
  • Cost-Sharing Reductions (CSR)
  • Advance Premium Tax Credits (APTC)
  • Qualified Health Plan (QHP)
  • Catastrophic Health Plans

Consult with your state-licensed health insurance agent to ask specific questions about MI individual health insurance if you need any clarification. An agent can also help you apply for Michigan health insurance that suits your health needs.

What Does Health Insurance Cover in Michigan?

MI health insurance covers a wide range of health conditions based on the type of purchased coverage. Most commonly, ACA-compliant major health insurance plans offer much more coverage than the major short term health plans.

The Michigan Affordable Care Act mandates that health insurance plans cover ten categories of services, including:

  1. Inpatient and outpatient hospital care (including ambulatory patient services)
  2. Hospitalization (like surgery and overnight stays)
  3. Prescription drugs
  4. Rehabilitative and habilitative services and devices to help sick people (i.e., people with injuries, chronic conditions, or disabilities) to gain or recover mental and physical skills
  5. Emergency services
  6. Mental health and substance use disorder services (this includes behavioral health treatment: counseling and psychotherapy)
  7. Pregnancy, maternity, and newborn care
  8. Laboratory services
  9. Preventative and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care (note that adult dental and vision coverage are optional, but plans are required to offer dental coverage for children)

Short term health insurance in Michigan, on the other hand, typically does not include routine visits, maternity coverage, mental health, and treatment of pre-existing conditions.

Consult with a MI health insurance agent to ask questions about the coverage your health plan offers. Michiganders get health insurance in the state through government-sponsored plans or Michigan health insurance providers. When you get a Michigan insurance quote for health insurance, check with your agent about all the benefits and exclusions.

Does Health Insurance Cover Car Accident Bills?

A common question Michigan residents ask is, “does health insurance cover auto accident injuries in Michigan? The answer is yes; health insurance covers medical costs associated with car accidents, depending on the situation. In most cases, accident-related injury costs are covered by auto insurance, but your health insurance will pay if:

  • The medical bills incurred exceed a specific dollar amount; or
  • You have coordinated your No-Fault auto insurance policy with your health insurance. In this case, your healthcare provider may request your health and auto insurance information if you seek care for injuries related to a car accident. Note that if a person’s auto insurance is coordinated with health insurance provided by a Medicaid, Medicare, Medicare Supplemental, or Medicare Advantage policy, they may not receive first-hand health coverage for an accident-related injury. These policies are usually secondary and only pay after you have exhausted other coverages.

Michigan experienced 1,131 traffic crash fatalities in 2021, which was a 4% increase from 1,083 fatalities in 2020. The 1,131 traffic crash fatalities marked the highest number of Michigan traffic fatalities since 2005, when 1,129 fatalities were recorded. Residents are encouraged to get health insurance in addition to their auto insurance for maximum protection.

Does Health Insurance Cover Vasectomy?

No, most ACA-compliant health insurance plans do not cover vasectomies because they are not part of the essential health benefits specified in the Affordable Care Act (also known as Obamacare). This implies that insurers that provide private health insurance in Michigan are not likely to cover vasectomies. However, if your health plan covers the procedure, you will need to use an in-network doctor and pay a copay, coinsurance, or deductible. Original Medicare does not cover vasectomies, but Medicare Advantage plans may cover them. Vasectomies typically cost between $350 and $4,000, or more. According to the National Survey of Family Growth data, an estimate of between 175,000 and 354,000 vasectomies are performed yearly in the U.S. Contact your health insurance provider or insurance agent to determine whether your plan covers vasectomy.

How Much is Health Care Without Insurance in Michigan?

The cost of health care without insurance varies in Michigan, depending on the health condition that requires treatment. It can range from a few hundreds to thousands or hundreds of thousands of dollars. For instance, an emergency room visit typically costs between $1,200 and $2,300. The Michigan Health Department outlines the cost of treating diabetes, which is as follows:

  • Diagnosed diabetes - $9,963
  • Undiagnosed diabetes - $2,864
  • Prediabetes - $443
  • Gestational diabetes - $3,305

However, these costs are predicted to triple over the next few years.

Types of Medical Visits Average Cost Without Insurance
Organ Transplants Kidney $154,000
Lung $386,000
Heart $790,000
Child Delivery Normal Birth $3,700
Cesarean $19,000
Other Procedures MRI $12,000
Pneumonia $13,500
Kidney / Urinary Tract Infection $17,000
Concussion $18,000
Femur Fracture $19,000
Hip/ Knee Replacement $42,000
Major Joint / Upper Limb Reattachment $49,000
Spinal Fusion $101,000

Another example is cancer treatments, which can cost up to $400,000 per year, as recorded by the National Cancer Institute. MRI without insurance can cost upwards of $12,000. When considering the cost of healthcare without insurance and asking yourself, “how much does health insurance cost per month in Michigan”, note that the average health insurance cost in Michigan is as low as $350 per month, which is drastically less than you could be stuck having to pay out of pocket. .

How Much is Urgent Care Without Insurance?

The cost of urgent care without health insurance in Michigan ranges between $60 and $300 for a basic Level I urgent care visit, while an advanced Level II visit costs between $130 and $450. Residents requiring comprehensive medical services provided by a physician may pay $100-$300. Urgent care refers to a walk-in clinic service that provides medical care to patients who need to see a physician for diagnosis or prescription but do not have a serious issue that requires the emergency room.

How Much Does a Psychiatrist Cost Without Insurance?

A psychiatric visit without MI health insurance typically costs between $100 and $300 per session and is determined by the psychiatrist’s experience, expertise, demand, and ratings or the clinic’s location. Initial psychiatric sessions usually cost more, sometimes up to $500, because of the extra time it takes to evaluate a new patient. During your initial psychiatric visit, the psychiatrist may demand that you take lab tests, blood tests, psychological tests, or undergo any other investigative process required to determine the mental health problem. After your first appointment, the cost of the psychiatrist visit becomes less.

How Much is a Doctor Visit Without Insurance?

The cost of a doctor's visit without health insurance in Michigan ranges from $300 to $600, depending on the type of doctor you want to see (primary care physician or specialist), hospital location, treatment, tests required, and whether you are a new or returning patient.

Type of Doctor Average Cost Without Insurance
Psychiatrist $160
Cardiology $340
Primary care $190
Dermatology $270
Ophthalmology $310
OB/GYN $280
Orthopedics $420

How Much is a Dentist Without Insurance?

A routine visit to a dentist costs between $80 and $120 without dental Michigan health insurance. However, if you require a full cleaning, with an exam, and X-ray, the cost may be between $100 and $500 per visit, or between $200 and $1,200 per year if you go every 6 months. The cost of a dentist visit depends on the location, local rates, and what the visit entails. This means that if you need more than a routine check, such as cavity filling, deep dental cleaning, or a root canal, the cost of the dental visit will be significantly higher. Dental insurance does not just cover a portion of the costs, it also gives the insured access to pre-negotiated rates, which are typically lower than the ones given to the uninsured public.

Types of Dental Visits Average Cost Without Insurance
Cleaning $140
Fillings $135
Inlays $682
Root Canal $1,222
Periodontics $4,878
Veneers $596
Crown & Bridges $1,340
Braces $6,500
Oral Surgery $490

How Much Do Prescription Drugs Cost Without Insurance?

Prescription drugs in Michigan cost between $100 and $800 or more without health insurance in Michigan, depending on the type of prescription (generic or brand-name prescriptions), where your prescription was filled, and how long you will be on the medication. Some drugs may cost as much as $1,200 for one month or as little as $30. Individuals can save money on prescription drugs by getting Michigan health insurance, although it does not cover every prescription drug. Prescription assistance programs can also help patients fund their medications at affordable rates.

What Are Alternative Health Insurance Plans in Michigan?

Alternative health plans are supplementary low-budget plans, designed to help relatively healthy individuals to save on their medical costs. They typically do not cover pre-existing conditions and the insurers have yearly payment limits. Unlike ACA-compliant major health plans, alternative health plans are not ACA-compliant, which means they are not legally mandated to cover essential health benefits, such as prescription, preventive and wellness services, emergency services, and chronic disease management. Some alternative health plans typically have waiting periods. With these plans, insureds cannot benefit from government subsidies like tax credits and cost-sharing reductions that can help reduce your premiums and out-of-pocket costs. Some alternative health insurance plans in Michigan are:

  • Short-term health insurance
  • Limited benefit plans
  • Subscription plans
  • Association plans
  • Direct primary care

Before getting an alternative plan in Michigan, ensure you consult with a MI-licensed insurance agent who can make recommendations on the best plans based on your needs and help you get them at affordable prices, after comparing plans among multiple insurers.


Short-term limited duration health insurance (STLD) is a health insurance policy that provides major health benefits for a limited period of time. It is also known as temporary health insurance in Michigan. The Michigan law allows a person to purchase an STLD plan for not more than 185 days out of any 365 days with the same insurer. Short-term limited duration health insurance is available to Michiganders who are in any of the following situations:

  • Between jobs and without group health coverage
  • Yet to receive health insurance from their new employer due to the waiting period some employers require before getting their new employees health coverage
  • Need an affordable health insurance for a short period of time
  • Mid-year while waiting for the annual open enrollment to purchase an individual health plan

Short term limited duration health insurance comes in a variety of plan types, varying on the amount of coverage, annual maximum out-of-pocket (MOOP) amounts, and deductible. The maximum MOOP for short-term health insurance is $25,000. In 2023, short term health insurance in Michigan could be obtained with deductibles ranging between $1,000 and $15,000, priced between $70 and $2,130 - depending on the age, gender, and smoker status.

Michigan short term health insurance are different from comprehensive health plans due to the following reasons:

  • They are not required to cover preexisting conditions - and can deny coverage based on it
  • The applicant gets the policy immediately after the short-term limited duration health insurance company in Michigan receives their application
  • They mostly cannot be renewed. The insurer reserves the right to modify or discontinue the plan without notice.
  • They are not ACA-compliant and do not include:
    • Essential health benefits required by the Michigan Obamacare Act, (Affordable Care Act)
    • Cost-sharing limitations
    • Prohibition on annual or lifetime benefits
    • Protections against rescission

For questions about MI short-term health insurance policies, contact a knowledgeable health insurance agent or the Department of Insurance and Financial Services (DIFS) toll-free at (877) 999-6442.


Limited benefit health plans provide limited health benefits aimed at supplementing comprehensive health insurance, but it does not serve as an alternative to them. In some cases, these plans work as a good supplement to high-deductible primary and short-term health plans. The Michigan Affordable Care Act does not regulate these plans. With limited benefit plans, the amount of coverage the company pays per episode of injury or illness is reduced. Some limited benefit plans only cover specific diseases, while others offer you discounts on health services or only cover you when you're hurt in an accident. They include:

  • Critical illness plans: These Michigan health insurance plans pay the insured a tax-free lump sum after they are diagnosed with an illness that the plan covers, such as Alzheimer, Amyotrophic Lateral Sclerosis (ALS), End Stage Renal Disease (ESRD), cancer, stroke, paralysis, and other illnesses that fall under your policy’s definition of critical illnesses.
  • Indemnity plans: These plans only pay an amount specified in your policy, regardless of total charges. Depending on your insurer, you may not be restricted to a network of health practitioners. Indemnity plans also usually have deductibles. These plans cover the cost of medical consultations, tests, and prescriptions but may not cover some preventive care, like checkups. Indemnity plans can help you cover the costs that the major health insurance requires you to pay out of pocket (coinsurance and copay).
  • Hospital cash policies: These plans provide fixed daily cash payments made to the insured for hospitalization (arising from a covered accidental injury or illness) that lasts more than 24 hours.
  • Accident only: Accident-only plans pay a specified financial benefit when the insured is injured or dies as a result of a covered accident.
  • Hospital Indemnity: This plan covers hospital stays or accident-related inpatient rehabilitation resulting from a covered illness or injury. The plan’s benefits are paid in a fixed dollar amount daily during the period of hospitalization or illness, irrespective of how much expenses are incurred.

Medical indemnity plans in Michigan typically cost $50 - $280 per month, depending on your age, location, smoker status, and the selected amount of coverage. Speak with a Michigan-licensed health insurance agent who has access to various competing insurers offering limited benefit health plans.


Subscription health insurance plans in Michigan provide health coverage to a group of persons who are required to pay a fixed fee in installments at regular intervals, which could be monthly, quarterly, semi-annually, or annually. These plans cover visits and procedures provided by healthcare providers within the plan's limits. Although the number of visits is typically limited, consultation time with health service providers lasts longer than with regular health plans.

Subscription health coverage is mostly for persons seeking health coverage that provides access to doctors and a wide range of health care services. Subscription health insurance plans in Michigan are typically affordable, but members may have to pay out-of-pocket for certain diagnoses and treatments.


Discount health plans are health insurance plans in Michigan that give discounts on healthcare services that beneficiaries receive. Discounts vary, depending on the provider and the treatment involved. It does not provide healthcare coverage like typical major health insurance (ACA or short-term) and is significantly less expensive. Persons with primary health coverage typically do not need to get discount health plans since one of the benefits of Michigan health insurance is the discount resulting from the network-negotiated rates. These plans are not ACA-compliant and are not fit to be a person’s only health plan. However, dental/vision discount health plans are a good combination with regular primary health insurance because primary health insurance plans do not cover most adult dental and vision services.


Association health plans (AHP) in Michigan provide health insurance savings to employers of small companies, freelancers, and the self-employed. AHP mainly caters to employers with common interests, such as the same industry or profession, who come together to form a formal organization. AHPs’ top benefit is the ability to gather several employers to leverage its scale for better rates when negotiating with health providers, insurers, and other vendors assisting with the provision of health benefits. AHPs operate under the rules of large group health plans, which can help reduce the amount spent on administration and overhead costs as opposed to small group plans. Depending on who funds and holds the financial risk associated with medical claims, these plans can be fully insured or self-insured. Association health plans can also be Health Maintenance Organizations (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organizations (EPO). Association health plans are a good option for cheap health insurance in Michigan.


Direct Primary Care (DPC) is a form of health insurance in Michigan that allows the insured to have a direct relationship with their physician in exchange for a minimal flat rate paid periodically. Individuals pay periodically as a membership or subscription to get direct, primary healthcare services that are personalized to meet their specific health needs under the terms of the plan’s contract. Direct primary care covers the insured’s annual check-up, real-time consultation with their personal physician via advanced communication technology, and other urgent care needs. It guarantees the insured answers to general questions about staying healthy and, in some cases, provides home-based medical visits, which are highly personalized, coordinated, and comprehensive. The benefits DPC provides include:

  • A direct relationship with a physician
  • More consultation time with a physician
  • Most direct primary care plans are available at any time
  • It is affordable and covers lab tests, imaging, and prescription drugs


Telehealth and telemedicine services have expanded over the recent years, in some part thanks to COVID-19, as more and more businesses incorporated virtual doctor visits into the employee health plans. In 2021 over 95 percent of businesses offered telehealth, compared with 67 percent in 2018. In Michigan, telemedicine employs the use of a telecommunication technology that supports audio-visual communication to connect a patient with a health care practitioner in a different location. The Michigan Health Department requires that there is a two-way telecommunication system that supports real-time communication between the patient and the health care professional. Another requirement is that both the originating and distant site provider ensures the privacy of the beneficiary and the security of information shared via telemedicine.

The types of services allowed via telemedicine in Michigan include:

  • End Stage Renal Disease services (ESRD)
  • Behavior change intervention (smoking cessation)
  • Behavioral Health &/ or Substance Use Disorder
  • Education Services
  • Psychiatric diagnostic procedures
  • Subsequent hospital care
  • Inpatient consultations
  • Remote Retinal Imaging, Dx and Management
  • Nursing facility subsequent care
  • Office or other outpatient consultations
  • Office or other outpatient services
  • Training service (Diabetes Self-Management)
  • Telehealth Site Facility Fee (only allowed at originating site)

Although telehealth virtual visits are conducted via a telecommunication system, certain medical services require the patient to be physically present and telehealth cannot be used to replace this, but can be used as a supplement. These services include:

  • Nursing facility services - require that the initial visit be face-to-face
  • ESRD – requires at least one in-person physical visit to view the vascular site
  • Certain psychiatric services performed as an assessment are best done in person. Generally, the health provider determines the things that must be observed in person.


Hospital at home insurance in Michigan makes intensive, hospital-level care available in a patient's home for a specific period if the patient has an acute condition. The Michigan Health Department permits the operation of hospital-at-home services, thereby enabling patients who require acute-level care to receive care in their homes instead of being admitted to a hospital with the assistance of skilled teams and remote-monitoring technology.

What Are Additional or Stand-Alone Health Insurance Options in Michigan?

Also known as alternative health insurance in MI, stand-alone health insurance options supplement the coverage provided by an individual’s primary health insurance by covering healthcare costs that are not included as part of the benefits of a primary healthcare plan.
Some additional health insurance plans in Michigan include:

  • Short Term Health Insurance
  • Medigap (Part D)
  • Critical Illness insurance
  • Dental Insurance
  • Vision Insurance
  • Hospital Indemnity Insurance
  • Accident Insurance
  • Disability Insurance
  • Long-Term Care Insurance

What Health Insurance Rights Do I Have in Michigan?

The health insurance rights you have as a Michigan resident with an ACA-compliant health insurance plan include:

  • The right to get information about any health insurance plan you have in the state
  • The right to remain on your parent's health plan until you are under 26 years old, even if you are married or working
  • Your health plan must provide you access to healthcare when needed
  • In emergencies, your medical fees should not go beyond the In-network deductible, copay, and coinsurance
  • Hospitals must not hide information on the fee for treatment if they do not belong to your in-network
  • The right to receive free preventive care like blood pressure screening, colorectal screening, and immunizations
    The Department of Insurance and Financial Services (DIFS) helps enforce these rights, and if you have a grievance against your health insurer or insurance agent, the DIFS can step in. However, you must first speak courteously with a company representative or agent to attempt to find a solution. Ensure you provide dates, amounts, and other relevant facts. Every health insurance company in Michigan is required to have an Internal Formal Grievance Process through which insureds can resolve issues they have with the insurer. You can initiate the grievance process by submitting a written grievance to your health insurer. If the issue does not get resolved, you may file a complaint with the DIFS online.
    NOTE: Since non ACA-compliant health plans do not have to follow the Affordable Care Act, they are allowed to discriminate based on the internally set list of qualifications and disqualifications.
    Speak with a Michigan licensed health insurance agent to discuss your health insurance needs.