Michigan Health Insurance Consumer Guide

You can purchase individual/family coverage in the Michigan Marketplace (exchange) if you meet these criteria:⁵

• You must be a resident of Michigan and lawfully present in the U.S.
• You must not have Medicare coverage.
• You must not be incarcerated.

Although most people are thus eligible to enroll in a Marketplace plan, there are additional criteria to qualify for financial assistance in the Marketplace. To be eligible for subsidies:⁶

• You must not have access to an affordable employer health plan. Use our employer health plan affordability calculator to see if you may be eligible for subsidies to offset the cost of a Marketplace plan.
• You must not be eligible for Medicaid/CHIP.
• You must not be eligible for premium-free Medicare Part A.⁷
• If you’re married, you must file a joint tax return.
• You must not be able to be claimed as a dependent on someone else’s tax return.

Subsidy eligibility is also based on how your income compares with the premium for the second-lowest-cost Silver plan in the Marketplace (for premium subsidies) and whether your income is more or less than 250% of the federal poverty level (for cost-sharing reductions).

In Michigan, the open enrollment period for individual and family insurance runs from November 1 to January 15.

Enrollments completed by December 15 will take effect on January 1, while enrollments completed between December 16 and January 15 will take effect on February 1.

Outside of open enrollment, you can enroll in new coverage or make changes to your existing coverage during a special enrollment period if you’ve experienced a qualifying life event. Learn more about qualifying events.

Michigan residents use HealthCare.gov to enroll in individual and family health plans. You can also sign up with a licensed agent/broker or a Navigator. There is also an option to enroll through various third-party websites authorized by the Centers for Medicare & Medicaid Services.⁸

In Michigan, consumers may find affordable health insurance by enrolling through the ACA Marketplace (HealthCare.gov).

Nearly nine out of ten enrollees are eligible for advance premium tax credits (APTC), which reduce the amount that they have to pay each month for their coverage. In 2024, the average premium subsidy in the Michigan Marketplace amounted to $426/month.⁹ Subsidy-eligible enrollees in Michigan paid an average net premium of $98/month after subsidies in 2024.¹⁰

People with household incomes up to 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan.¹¹

Both the premium tax credits and the CSR benefits are only available in Michigan if you enroll in a Marketplace plan.

Source: CMS.gov¹²

Depending on your household income, you may be eligible for Medicaid/CHIP. Michigan is among the states where Medicaid has been expanded under the ACA, making it easier for low-income adults to qualify for coverage. Learn more about Michigan Medicaid.

For 2024 coverage, nine insurers offer exchange plans in Michigan.²

A tenth insurer, HAP CareSource, plans to offer coverage in the Michigan exchange for 2025,¹³  and has filed rates and plans via SERFF.¹⁴

There were ten Marketplace insurers in Michigan in 2023, but one of them, U.S. Health & Life/Ascension Personalized Care, opted to withdraw from the market at the end of 2023. According to U.S. Health & Life’s discontinuation notice, there were more than 5,000 enrollees in five Michigan counties whose coverage terminated at the end of 2023.¹⁵ These individuals were able to select replacement 2024 coverage from another insurer during open enrollment.

For 2025, ten insurers have submitted rates and plans for Michigan Marketplace/exchange coverage. The proposed rates, which amount to a proposed overall increase of 10.5% before any subsidies are applied, are under review by the Michigan Department of Insurance and Financial Services.¹⁶

The insurers have proposed the following average rate changes for 2025:

Source: Michigan SERFF and ACA Signups.¹⁷

Rates for 2025 will be finalized before open enrollment begins in November 2024. Your premium change might be quite different from the average that applies to your insurer, as it also depends on where you live (rates vary by region for each carrier), your age, and your income.

The average premium changes described above are for full-price (unsubsidized) premiums. However, most Marketplace enrollees qualify for subsidies, so they do not pay full price.¹⁸ For these enrollees, net premium changes depend on changes in their own plan’s price as well as changes in their subsidy amount from one year to the next.

For perspective, here’s an overview of how average premiums have changed in Michigan’s individual/family market over the years:

• 2015: Average decrease of 1%.¹⁹
• 2016: Average increase of 6.5%.²⁰
• 2017: Average increase of 16.7%.²¹
• 2018: Average increase of 26.9%.²²
• 2019: Average increase of 1.7%.²³
• 2020: Average decrease of 2.1%.²⁴
• 2021: Average increase of 1.1%.²⁵
• 2022: Average increase of 4.7%.²⁶
• 2023: Average increase of 5.5%.²⁷
• 2024: Average increase of 5.3%.²

418,100 people enrolled in private health plans through the Michigan Exchange/Marketplace during the open enrollment period for 2024 coverage.¹⁸

This was a substantial record high (see below for prior year enrollment totals). The increases in recent years have been driven in large part by the subsidy enhancements created by the American Rescue Plan and Inflation Reduction Act.

And the 2024 growth is also due in part to the fact that Medicaid disenrollments resumed in 2023, after being paused for three years during the pandemic. As of February 2024, CMS reported that 138,106 Michigan residents who had previously been covered by Medicaid had transitioned to Marketplace coverage.²⁸

Source: 2014,²⁹ 2015,³⁰ 2016,³¹ 2017,³² 2018,³³ 2019,³⁴ 2020,³⁵ 2021,³⁶ 2022,³⁷ 2023,¹⁰ 2024³⁸

• Michigan health insurance Marketplace – HealthCare.gov (800) 318-2596
• Michigan Health Insurance Consumer Assistance Program (HICAP) – (877) 999-6442
• Michigan Department of Insurance and Financial Services – Serves as a resource for Michigan residents with questions or complaints related to health insurance.
• Arab Community Center for Economic & Social Services (ACCESS) – A federally funded Navigator organization that provides outreach and enrollment assistance to Michigan residents who need help obtaining health insurance.
• Michigan Medicare/Medicaid Assistance Program (MMAP) – A local service that provides health benefits counseling and assistance to Medicare beneficiaries, including those who are eligible for both Medicaid and Medicare.
• Medicare Rights Center – A nationwide service (website and call center) that can provide a wide variety of assistance to Medicare beneficiaries who have questions about enrollment, eligibility, benefits, and claims.