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Fed health care plan touted at MGH conference

HIP Michigan plan covers pre-existing conditions

August 29, 2011
By JOHN PEPIN - Journal Staff Writer ( , The Mining Journal

MARQUETTE - A diverse coalition of health care advocates today urged area residents to enroll in the Health Insurance Program for Michigan, a federally sponsored program offering affordable health care to people who have been denied coverage within the last six months because of pre-existing conditions.

The HIP Michigan plan is offered through the temporary federal high-risk pool created by the Patient Protection and Affordable Care Act, the federal health care reform law passed by Congress last year. The program ends Dec. 31, 2013, when similar coverage will be available through health insurance exchanges.

The program is funded entirely by subscriber premiums, together with an estimated $141 million in federal subsidies. The plan is administered by Michigan-based HMO Physicians Health Plan of Mid-Michigan, which has contracted directly with HHS.

Article Photos

Scott Wilkerson,
administrator of the Health Insurance Program for Michigan, discusses federally-subsidized coverage for residents with pre-existing conditions today at Marquette General Hospital as state Sen. Tom Casperson, R-Escanaba, at left, and state Rep. Steve Lindberg, D-Marquette, listen. (Journal photo by John Pepin)

"HIP Michigan provides health insurance coverage for Michigan residents of all ages who qualify for the program," said state Rep. Steve Lindberg, D-Marquette. "No applicant can be denied coverage or benefits simply because of health status, and the coverage is available on a first-come, first-served basis until the funding runs out."

Michigan's high-risk pool began offering coverage Oct. 1, enabling HIP Michigan enrollees who had been uninsured to schedule surgeries, chemotherapy, doctor visits and treatments long delayed because they had no way to pay for them, coalition officials said.

Scott Wilkerson, administrator of HIP Michigan, said about 500 Michigan residents are currently enrolled in the program, with about 3,500 expected to be provided for given the $141 million federal subsidy.

"We want to use all the federal funding that is available," Wilkerson said. "The biggest issue we're seeing is lack of enrollment in the program and that's why we're here today to talk about it."

State Sen. Tom Casperson, R-Escanaba, said the program could help change the mindset of the uninsured, who think they can't get coverage with pre-existing conditions. He said it could also help hospitals decrease costs.

"It's going to help strengthen our health care safety net," Casperson said.

The coalition - which included hospital, pharmacist, nurses representatives - discussed the program and some new premium changes at a press conference this morning at Marquette General Health System.

The group announced that the U.S. Department of Health and Human Services has approved two new HIP Michigan options to lower the monthly premiums for eligible enrollees without reducing the benefits package. Further changes, announced recently by HHS, are being reviewed for Michigan and if approved, could be implemented this fall by HIP Michigan.

Coalition officials said these changes may impact premium rates even more and help streamline the plan's enrollment process.

The new HIP Michigan options are determined by annual deductibles of $1,000, $2,500 and $3,500.

Currently, the least expensive premium for 19 to 24 year olds is $181 with a $1,000 deductible. Now, under the new HHS approved plan, the price will decrease to $130 for those who want a $2,500 deductible and drop to $109 for those who want a $3,500 deductible.

Currently, the most expensive premium for 60 to 64 year olds is $686 with a $1,000 deductible. Under the new HHS approved plan, the price will decrease to $494 for those who want a $2,500 deductible and drop to $415 for those who want a $3,500 deductible.

Coverage includes medical office visits, prescription drug coverage, emergency care, hospital coverage, home health care, wellness services and behavioral health services. Copays are $20 for a primary care doctor's office visit, $30 for a specialist and $100 for emergency room visits. Generic prescription copays are $10. Brand-name drug copays are $30 or $50.

"For citizens who can't get insurance today because they have pre-existing medical conditions, HIP Michigan offers low-cost coverage that can help protect them from financial ruin if they become seriously ill," said Benji Wood, executive director of the Upper Peninsula Health Access Coalition, one of several organization recommending enrollment in the program. "HIP Michigan can quickly provide critical access - in some cases, lifesaving access - to health insurance and provide relief to those who have struggled to find affordable coverage."

For more information, visit: Applications are also available by calling HIP Michigan at 877-459-3113 from 9 a.m. to 5 p.m. (EST).

John Pepin can be reached at 906-228-2500, ext. 206.



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