(LANSING) Many Michigan consumers across the state will begin the process of shopping for health coverage when the Health Insurance Marketplace (Marketplace) opens this Sunday, November 1, 2015. The Department of Insurance and Financial Services (DIFS) is offering Michigan consumers tips on shopping for health coverage for the 2016 plan year.

“Michigan continues to have a competitive market on the Marketplace, with 14 insurance companies offering individual plans in 2016,” said DIFS Director Patrick McPharlin.

Starting November 1, it is recommended that consumers log into their Marketplace account or call the Marketplace Call Center at (800) 318-2596 to review and update their 2016 application. While the application will be pre-populated with the consumer’s 2015 data, they should verify the information is correct.  In addition, new insurance premiums and updated incomes may result in a different Advanced Premium Tax Credit (“APTC”) and Cost Share Reduction (“CSR”) for consumers, if eligible.  These amounts help reduce monthly premiums and out-of-pocket costs such as co-pays and deductibles.

Before consumers start shopping, they may wish to visit the Health Coverage Basics for Michigan page on the DIFS website to learn more about different types of policies available to consumers, certain minimum coverage requirements, and explanations of many key terms.

“This is a new year and plans change. We want to make sure that consumers are not caught off guard,” said McPharlin. “When shopping for coverage make sure you ask yourself some questions: Are there more affordable plans available to me that were not an option last year? Am I happy with the changes to my current plan? Are my doctors in the plan’s network? Will my prescriptions be covered? What will my benefits and costs be?”

To help answer some of these questions, DIFS put together some things for consumers to consider when shopping for insurance coverage on the Marketplace:

  • Try to balance the cost (monthly premium) of a policy with the protection it offers. It is important for consumers to understand that the monthly premium alone does not indicate the total cost they will pay for health care. Generally speaking, the lower the monthly premium, the greater the portion of health care costs the consumer will pay when seeking medical treatment.
  • Determine what will have to be paid for covered services through a deductible, coinsurance, copayments, and out-of-pocket limit. To see a definition and explanation of these terms, consumers are encouraged to visit the Glossary of Health Coverage and Medical Terms. If a consumer is buying a plan for their family, determine if the deductible amount is per person or a combined family total. All new individual plans limit out-of-pocket costs to $6,850 for an individual and $13,700 for a family. 
  • Determine what benefits are covered without having to meet the deductible in advance. All new plans must cover certain preventive care services at no out-of-pocket costs. In addition, some plans may exempt a certain number of physician visits or prescription drugs from the deductible. Some plans may not exempt any services from the deductible other than the required preventive services. Consumers should determine what co-payments are required before and after a deductible is met.
  • Determine the access to care. Consumers may want to find out if they would need to designate a primary care physician, if they would need a referral to see a specialist, and what providers would require a prior approval. If a consumer has a preferred doctor or hospital, they may want to pick a plan that participates with that provider.

It is also important for consumers to be aware of the 2016 enrollment dates:

  • November 1, 2015: Open Enrollment starts — first day consumers can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2016.
  • December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016.
  • January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15.
  • January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016.
  • January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.

There are more tools, tips, guides, and resources available for use 24 hours a day, seven days a week on the DIFS Health Insurance Consumer Assistance Program’s (HICAP) website, www.michigan.gov/hicap. This site contains information on the Marketplace and the Affordable Care Act. HICAP also has a toll-free number, 877-999-6442, for consumers who wish to speak to someone about their questions or concerns.

For more information about DIFS or the services provided, please visit the website at www.michigan.gov/difs, follow them on Twitter or “Like” them on Facebook.

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