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Health Insurance (individual and family plans)

Health insurance is critical to protecting yourself and your family. In case you don't believe us, consider that nearly two-thirds of bankruptcies are due to medical bills! We'll help simplify your options, and be sure you're getting the most out of your budget and have confidence in your coverage.
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Individuals and families under age 65

If you are a Michigan resident without access to a group health plan and are ineligible for Medicaid and Medicare, you can purchase Individual or family health insurance. Please contact us for a personalized quote through Marketplace where ACA subsidies are available to reduce the cost of your plan.

Group Health Insurance

If you are looking for a group health insurance quote to get your employees the coverage they need, please visit our employee benefits page.
Employee Benefits

Frequently asked questions

You’ve got questions. We’ve got answers.

What is a deductible?

The amount you pay for covered health care services before the insurance company begins assisting you in picking up costs. You will notice individual deductibles, which is the amount one person needs to meet prior to the insurance kicking in as well as a family deductible, or the maximum amount a family needs to meet for coverage to kick in. After reaching your deductible you may still have to pay copayments or coinsurance until reaching your max out-of-pocket. However, there may be some items that are covered prior to reaching your deductible.

What is the max out-of-pocket?

The out-of-pocket maximum is a cap on the expenses you would have to cover in a given plan year. If that limit is met, the insurance company will pick up 100% of costs. 

What is a coinsurance/copayment?

The coinsurance is the percentage of costs you will pay after meeting your deductible for covered health care service. The copayment or copay is a set rate you will pay for covered services.

How is my monthly premium cost calculated?

Your monthly premium cost is dependent on a few factors that include the following:
  • The type of plan you choose
  • Your age
  • Zip code
  • Number of people taking coverage
  • Tobacco use (4+ times per week)
  • If you are eligible for a subsidy that reduces the cost of your plan
Expect premiums to increase each plan year to reflect the increasing cost of health care as well as your increasing age. 

What is a cost-sharing reduction?

The cost-sharing reduction is available through Health Insurance Marketplace if your income meets a certain threshold. It dramatically reduces your plans deductibles, copayments, and coinsurance. If you qualify, you must enroll in a Silver plan to get the savings benefit. 

What is the difference between the HMO and PPO network?

A Health Maintenance Organization, or HMO, restricts the patient's coverage to a specific network of physicians and may require referrals to visit a specialist. The Preferred Provider Organization, or PPO, allows a patient to select any physician they choose, either inside or outside the network. The PPO network has more flexibility with the health care providers you can see, and you can typically visit a specialist without referral and is therefore more expensive.   

Why are Bronze plans typically a better value?

Unless eligible for a cost-sharing reduction, Bronze plans or high-deductible health plans (HDHP) tend to be a better value even if you expect some medical cost over the course of the plan year. As medical costs have skyrocketed over the years, so have insurance premiums. Basically, a high deductible plan allows you to have more catastrophic type of coverage at more affordable rates. 

Although you generally pay 100% out-of-pocket until reaching your deductible, there is no coinsurance incorporated with these plans meaning your deductible is the same as your max out-of-pocket cost. Whereas Silver and Gold plans have a coinsurance after reaching your deductible that takes you to a similar max out-of-pocket expense as the Bronze plans. That said, to reach a similar max out-of-pocket, I would rather pay lower premiums along the way. Just understand, if you do become sick or injured, you will have to pay 100% out-of-pocket until you reach your deductible until the insurance really even kicks in.

What is an HSA and how do I fund it?

An HSA or Health Savings Account is a tax-exempt savings account that, if paired with a high-deductible health insurance plan, can be used to pay for qualified medical expenses. Funds that are deposited are not taxed, reduce your taxable income, and if used for certain medical expenses are not taxed upon withdrawal. After turning 65, you can withdrawal any remaining contributions for non-medical expenses with no penalty. 

You can setup an HSA with the bank you use or go through an investment company and invest into the market. You do not need to go through the insurance provider you purchased the HSA plan through as they tend to hit you with fees.

What is COBRA? Should I consider COBRA or a Marketplace plan?

COBRA, or the Consolidated Omnibus Budget Reconciliation Act, is a federal law that requires companies who employ 20 or more workers to offer continuation of their group health plan benefits, typically for up to for 18 months. Generally, you have 60 days to sign up for COBRA upon leaving your job. 

When you enroll in COBRA, your employer will no longer be paying toward your premiums. Enrolling in COBRA also means you are not eligible for federal subsides through the Marketplace. That said, call HR at your previous employer and have them send you the full benefit package. You can then compare that with a quote through the individual market and see which one is the more affordable option. 

Can I take Marketplace coverage if I have access to an employer sponsored plan?

Although you can choose to take Marketplace coverage rather than an employer-sponsored group plan, you will not be eligible to receive premium subsidy and therefore it will almost always make sense to elect to join the group plan. 

What are ACA Subsidies and will I qualify?

ACA subsidies (Advanced Premium Tax Credits) may reduce the cost of your Marketplace plan, and are generally available to people whose gross income falls between 150% and 400% of the Federal Poverty Level. Subsidies are calculated based on household size and household income as determined on your tax return. 

If you are unsure on your adjusted gross income for the upcoming year, we recommend estimating a bit higher since you will have to pay back any difference in the subsidy you received if your income is found to be higher than what was listed on your application.  

How do I access my 1095-A Tax Form?

The 1095-A tax form is used in determining if the subsidy you received during the plan year was correct based on your actual income for that year. Form 1095-A will be mailed to you around February 1. You can also access it via healthcare.gov.

When can I sign up for Health Insurance and can I change plans mid-year?

Open Enrollment runs from November 1 to December 15 for a January 1 effective date of coverage. For plans selected from December 16 through January 15, coverage starts February 1 However, you can sign up or change plans throughout the year if you qualify for a Special Enrollment Period. SEP’s must have taken place within the past 60 days or are expected within the next 60 days and include: a change in your household size, a change of residence, loss of health insurance coverage, and an income below 150% of the Federal Poverty Line. Please call us to run the exact numbers for your situation if you think your income could fall below this level and you would like to switch health insurance plans mid-year. 

What do I need if Marketplace is requesting proof of income documentation?

Typically, a 1040 tax return showing Line 11 “adjusted gross income” is all you will need for submission. However, if you file a Schedule 1 with your taxes, you will need to include that as well. Other acceptable documentation includes W2s and/or 1099s, pay stubs, self-employment documentation, social security statements, and an unemployment letter. 

You can get the proof of income documentation over to an agent and we will gladly submit it to Marketplace on your behalf. 

What should I do if my income changes throughout the plan year?

If your income changes over the course of the year you should contact an agent and make them aware of the expected change as soon as possible and we will update your Marketplace application and let you know how the change will impact your premium amount for the remainder of the plan year. 

How should I make my first payment upon enrollment into my plan?

We recommend calling upon receiving your medical card or invoice, whatever arrives first, and making your first payment by phone to ensure it is made in a timely manner. During this phone conversation, you can set up your preferred payment method. Automatic payments tend to be a much safer and easier approach rather than paying by check each month. Also note, if you have a $0 premium plan, there is no action required. 

Why is Health Insurance Marketplace telling me I need to sign in and make my first payment?

You can ignore this automated email from Health Insurance Marketplace as the invoice will arrive from the carriers themselves. If you have a $0 premium plan, there is no action required. 

What information is needed for my Marketplace Application?

  • Full legal name
  • Date of birth    
  • Each person in household – even if not taking coverage  
    • Any dependent living out of the house
  • Physical Address 
    • Mailing address if different  
    • Anyone on application with a different address 
  • Socials of everyone on App even if not taking coverage 
  • Immigration documentation if not natural born US citizen   
  • If taxes filed jointly or individually 
    • Who is claimed on tax return  
  • Income/Sources of income/Employer name & contact
    • Wages/salaries on W2/Pay Stub
    • Tips  
    • Net income from self-employment 
    • Unemployment 
    • Social Security/Disability 
    • Alimony from divorce  
    • Retirement/Pension income 
      • IRA/401K withdrawals (Except Roth – unless employer contribution) 
    • Investment Income  
      • Dividends/Interest 
    • Rental Income  
    • Other taxable income 
  • Current health insurance coverage if any 
  • Anyone else in household’s employer information 
  • If you are offered HRA (health reimbursement arrangement) through employer 

When can I sign up for Dental and Vision?

Dental and vision have year-round enrollment, although please be aware that dental procedures are going to have a six to twelve month waiting period and orthodontics are not covered. 

Is Dental and Vision included in my health insurance?

The short answer is no. Unless otherwise specified, most health insurance plans do no cover D&V. However, individuals under the age of 19 on BCBS or BCN are automatically provided pediatric vision and all standalone dental plans contain pediatric dental as an essential health benefit. If you are getting health coverage for someone 18 or younger, dental coverage must be available for your child either included in the health plan or as a separate dental plan. Please note that dental coverage is not an essential health benefit for adults and health plans do not have to offer adult coverage.