Understanding Health Insurance

The truth is, few people really understand their health insurance, whether private or through a public program. And programs public and private are always changing, too. No wonder it's hard to figure out.

This is an overview about private and public insurance plans. It may help you find your starting point. From there, the best approach is to communicate and ask questions from prospective providers, insurance carriers and your employer.

Private Health Insurance
Private health insurance means that it's a policy that is only available to certain people-usually, through your job. When you get a full time job, this may be a benefit from your employer. Or, you may be able to join the company's plan if you pay for your coverage.

Health insurance policies are like people-they're all different and offer different degrees of protection for the costs of maintaining your health.

If you have been covered by a working parent's policy, you will become ineligible to continue some time after you turn 18.
• Many policies will cover children up to high school graduation. After high school graduation, some policies will extend your eligibility as long as you are actively enrolled as a full-time student in college (with proof of enrollment each semester).
• If you don't go to college, you will most likely become ineligible when you finish high school. If you go to college, the same will be true upon your graduation.

Special Insurance for Special Health Conditions
If you have a chronic medical condition, you may have qualified for special coverage through one or more of these programs as you've grown up. These basic eligibility requirements can help you plan ahead:

Children's Special Health Care Services
Eligibility for this program is as follows:

Until you are 21-years old: Medical care related to your qualifying diagnosis will be covered.

After you are 21-years old: Children Special Health Care only goes until 21-years old and then the coverage ends. At this time you will need to find other ways to receive medical care for your health condition.

For specific questions contact your local county CSHCS representative.
Phone (Kent County residents): 616.632.7066.

Medicaid
There are many variables that determine a person's eligibility for Medicaid. Generally:

Birth to 18-years old: Children are covered under Medicaid or Mi-Child depending on parents' level of income.

Between 19 and 21 years old (depending on eligibility and coverage): Your existing Medicaid coverage will be discontinued. At that time, you need to reapply with your local Department Human Services (DHS) office. You will likely not be approved unless you have a qualifying disability. If approved, you will need to select an HMO- Medicaid plan that is accepted by your doctor's office, or find a new doctor. You can do this by calling MI-Enrolls: 888.367.6557.

65 years old: At this time you are eligible to apply for Medicare.

For specific information or questions contact the local DHS office. In Kent County, call 616.247.6000.

Special Government Health Programs for Adults
If you are unemployed and/or do not have private insurance, you may qualify for one of these programs.

Kent Health Plan A and B:
Adult Benefit Waiver Program
• Provides health insurance for adults 21-years and older.
• Must be uninsured
• Must fit no- or low-income criteria.
• This program only opens for enrollment a few times a year and you can apply at your local Department of Human Services.

Plan First
• Provides reproductive health care for female adults 19- to 44-years old who meet the income guidelines.
• Benefits cover only reproductive health care needs.
• Apply at your local DHS office or Health Department, by calling 800.642.3195, or go online at michigan.gov/mdch.