Open Enrollment for 2015 health insurance plans is fast approaching, and hundreds of thousands of Michiganders have recently signed up to receive state aid to pay for their healthcare plans.

The Healthy Michigan Plan — Michigan’s Medicaid expansion — was approved in late 2013 and began accepting applications April 1. Six months in, the number of enrollees in the plan has already far exceeded projections for the first year.

Michigan is one of the most recent states to expand the Medicaid program. The plan provides healthcare to Michigan residents ages 19 to 64 with incomes below 133 percent of the federal poverty line. For an individual without a family to support, this would be an income of $16,000 or less per year.

Medicaid is a social welfare program that began long before President Obama’s 2010 Patient Protection and Affordable Care Act. Beginning in 1965, this program provided funding for states to expand healthcare to low-income individuals. Medicaid is funded by both the states and the federal government, and is administered by each state. States were not required to adopt a Medicaid program, but every state currently has a program in place.

The ACA increased federal funding for Medicaid, but also required that states would pay 10 percent of the expansion by 2020. Then, in 2012, the U.S. Supreme Court ruled that states could continue to receive their original funding for Medicaid without expanding the program. As of now, a little over half of the states — 27 states and the District of Columbia — have chosen to expand Medicaid.

Researchers from the University Medical School analyzed data from the first 100 days of the Healthy Michigan Plan, during which there were surprisingly high levels of enrollment.

Prof. John Ayanian, director of the Institute for Healthcare Innovation and Policy, coauthored a paper in the New England Journal of Medicine that analyzed early data from the expansion. In its first few months, the plan enrolled over 327,000 people, more than were predicted to enroll in the entire year. By Oct. 20, 2014, the number of enrollees had reached 424,852.

Ayanian suggested some reasons for the plan’s early success. One reason is the late rollout of the plan. Most state Medicaid expansions began Jan. 1, 2014. Michigan’s did not begin until April 1, 2014. Ayanian said these extra three months allowed state officials to communicate to people that they were eligible for assistance. The extra months also gave the state more time to prepare the plan’s enrollment website, ensuring its efficiency. An efficient website was especially necessary due to the initial problems with HealthCare.gov — the ACA’s online insurance marketplace — that were widely publicized in the media.

“The key state officials made it a priority to test the computer systems that were required to enroll people to make sure they were working effectively before enrollment began,” Ayanian said.

Ayanian said Michigan’s success could also serve as an example to largely Republican states. Historically, Republicans have opposed the expansion of Medicaid. While Michigan generally votes Democratic in the presidential election and is represented in the U.S. Senate by two Democrats, the state has a Republican governor and Republicans control both houses of the legislature.

“It’s a good model particularly for other states that have Republican governors or legislatures and have reservations about expanding the Medicaid program,” Ayanian said.

Open Enrollment for 2015 insurance coverage under the ACA will begin again Nov. 15. This year, the Healthy Michigan Plan will also be in place throughout the Open Enrollment period. Carrie Rheingans, project manager for the Washtenaw County Health Initiative, said HealthCare.gov will inform Michigan residents who qualify for benefits under the Healthy Michigan Plan. These individuals can then go to the plan’s website to register for said benefits.

“HealthCare.gov points you in the direction you need to go,” Rheingans said.

Last year, Michigan had not yet expanded Medicaid when Open Enrollment ended. For this reason, Rheingans said low-income individuals could not sign up for the expanded benefits until after having registered for their insurance plan.

People already enrolled in the Healthy Michigan Plan will also see a change in the coming months. Previously, no one registered under the plan would have to pay any fees, excepting copays, which would usually be only $1 or $2 per month. Now, if an individual falls between 100 and 138 percent of the federal poverty level, he or she will have a monthly fee in addition to copays. This fee begins six months after one starts receiving services through Medicaid, and the amount is based on how much healthcare one has received over the past six months.

“Those folks will also be asked to make what they’re calling ‘monthly contributions’ to their health insurance,” Rheingans said. “They’ve looked at the cost of all of it and what quantity of services you’re using, and they make an average over those six months to say that’s about how much you should be paying every month going forward for the next since months.”

Rheingans said though the fee should be low for most people, it still may cause difficulties for the people it affects, especially because many in this income range do not have bank accounts through which they can easily pay the fees.

“It’s hard to know what is ‘expensive,’ because folks who are between 100 and 138 percent of the poverty line, it’s not like they’re rich people,” she said. “It’s still yet another payment, and people have to have a bank account to make these payments.”

The open enrollment period for this year extends from Nov. 15 to Feb. 15, 2015. During this time, individuals can sign up for a new health insurance plan or look at options for switching from their current plan. 2014 Marketplace plans will expire Dec. 31.

Students can get information about healthcare options through campus resources, such as University Health Service, or community resources, such as the Washtenaw County Health Initiative. Information is also available online at HealthCare.gov and www.michigan.gov/healthymiplan.

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