Help With Health Care Resources for the uninsured Northern Michigan Revised September 2014
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Table of contents Introduction...2 How to get health insurance coverage in Michigan...2 Overview... 2 Healthy Michigan Plan... 4 Health Insurance Marketplace... 6 How to find free and low cost health care services and other health care resources...8 State and federal programs... 8 Dental... 9 Vision... 12 Mental health and substance abuse services... 13 Free and low cost health centers... 16 Help lines and special programs... 21 Additional resources... 22 Understanding health insurance and how to access health care services...22 5 costs that make up a health plan... 22 Finding a doctor... 23 Making the most of your appointment... 23 Where to go for health care... 23 1
Introduction Your health is important to us. That s why we ve developed this brochure, Help with Health Care, for people who are uninsured and need help with health care in Michigan. It s designed to help you understand how to get health insurance coverage and find free and low cost health care services. It s divided into three sections: 1. How to get health insurance coverage in Michigan 2. How to find free and low cost health care services and other health care resources in Michigan 3. Understanding health insurance and how to access health care services This brochure includes services in the following counties: Alcona, Alger, Alpena, Antrim, Baraga, Benzie, Charlevoix, Cheboygan, Chippewa, Crawford, Delta, Dickinson, Emmet, Grand Traverse, Gogebic, Houghton, Iosco, Iron, Kalkaska, Keweenaw, Leelanau, Luce, Mackinac, Manistee, Marquette, Missaukee, Menominee, Montmorency, Ogemaw, Ontonagon, Oscoda, Otsego, Presque Isle, Roscommon, Schoolcraft and Wexford. 1 How to get health insurance coverage in Michigan The Affordable Care Act gave more people the chance to get health coverage. In Michigan, you have many health plan choices. Although health reform is complex, many resources are available to help you understand it and find a plan that meets your needs and budget. Did you know? Reduced cost-sharing, also called a subsidy, lowers the amount you pay out of pocket for deductibles, coinsurance and copayments. This helps cover costs such as doctor visits. 2
If you have limited income, you may qualify for a tax credit or reduced cost-sharing through the Health Insurance Marketplace. Or, you may qualify for the Healthy Michigan Plan. Number of people in your family/ household If your household income is in this range, you may be eligible for a premium tax credit through the Health Insurance Marketplace If your household income is in this range, you may be eligible for reduced cost-sharing through the Health Insurance Marketplace 1 $16,106 $46,680 $16,106 $29,175 2 $21,708 $62,920 $21,708 $39,325 3 $27,311 $79,160 $27,311 $49,475 4 $32,914 $95,400 $32,914 $59,625 5 $38,517 $111,640 $38,517 $69,775 6 $44,120 $127,880 $44,120 $79,925 7 $49,722 $144,120 $49,722 $90,075 8 $55,325 $160,360 $55,325 $100,225 Income levels are based on the 2014 federal poverty guidelines. These guidelines are updated each year. Did you know? Premium tax credits help lower the cost of a monthly premium 3
1. The Healthy Michigan Plan The Healthy Michigan Plan is the state s new Medicaid option. This plan was created to expand Medicaid to more people. It provides health care benefits to Michigan residents at a low cost. To be eligible for the Healthy Michigan Plan you must be: Ages 19 64 Not currently eligible for Medicaid Not eligible for or enrolled in Medicare Not pregnant when applying for the Healthy Michigan Plan Have income at or below 133% of the federal poverty level ($16,000 for a single person or $33,000 for a family of four) A resident of Michigan The Healthy Michigan Plan includes many health care benefits and services covered under the federal health care law. This means it s easier to get the health care you need at a cost you can afford. The Healthy Michigan Plan includes the following services: Doctors visits Emergency visits Lab services and fees Mental health and substance abuse treatment Preventative and wellness treatment and chronic disease management Rehabilitation service and equipment Dental care Hospitalization Maternity care Prescription drugs Pediatric services for 19 to 20 year olds including dental and vision care There are three easy ways to enroll in the Healthy Michigan Plan: Visit /mibridges* Call the Michigan Health Care Hotline at 1-855-789-5610 Visit your local Department of Human Services office 4
After you enroll in a Healthy Michigan Plan, you will be asked to fill out a Health Risk Assessment Form. You may receive the form in the mail, or at your doctor s office. The form is also online at /healthymiplan.* You should also make an appointment with your doctor. Together, you will go over the Health Risk Assessment Form. After the appointment, your doctor will sign the form and mail it back to your health plan. The form should be completed each year. The Healthy Michigan Plan has copays. After you are enrolled in a health plan, most copays will be paid through a special health care account called the MI Health Account. The monthly amount you pay will be based on the services you receive in the first six months. If you have an income between 100-133% of the federal poverty level, you will also be required to contribute a small amount of your yearly wages for cost sharing purposes. You will get more information about your MI Health Account, copays and contributions from your health plan. You can also see the chart of copayments below. Covered services Copay Physician office visits (including free-standing urgent care centers) $ 2 Outpatient hospital clinic visit $ 1 Emergency room visit for non-emergency services Copayment ONLY applies to non-emergency services There is no co-payment for true emergency services Inpatient hospital stay (with the exception of emergent admissions) Pharmacy $ 3 $ 50 $ 1 generic $ 3 brand Chiropractic visits $ 1 Dental visits $ 3 Hearing aids $ 3 per aid Podiatric visits $ 2 Vision visits $ 2 5
You can reduce your copays by working to improve your health. Copays are not required for certain services that help you get or stay healthy. These include preventive services and services that help you manage a chronic condition. 2. The Health Insurance Marketplace The Health Insurance Marketplace is a government website. You can visit the Marketplace at healthcare.gov.* This is where you can shop for and compare health plans. You can apply for health coverage and tax credits. If your income is between 100 percent and 400 percent of the federal poverty level, you may be eligible for tax credits or a subsidy. This will help lower the cost of your health coverage. To get an estimate of the subsidy for which you might be eligible, go to bcbsm.com/subsidy. There are four types of plans available in the Marketplace: Bronze plans cover 60% of health care costs Silver plans cover 70% of health care costs Gold plans cover 80% of health care costs Platinum plans cover 90% of health care costs To enroll in a plan on the Marketplace, you will need: q Number of dependents. This is the number of people you claimed on your last tax return. q Social Security number(s) or immigration document number(s). Did you know? Reduced cost sharing is only available if people chose a silver plan. In some cases, it will be less expensive to choose a silver plan than a bronze plan. q Estimated household income. This is the yearly income for you and each of your dependents. This can be found on last year s W-2 tax forms. q Policy numbers for current insurance. Questions about health insurance or how to get coverage? 6
If you have questions about health care reform, health plans and enrolling in coverage: Visit HealthCareReformBasics.com/Now for information on health care reform Visit Healthcare.gov for information on the health insurance marketplace Visit bcbsm.com/getinsurance for information on Blue Cross health plans and costs Visit insurance.bcbsmseminars.com for information on educational sessions near you Call Blue Cross Blue Shield of Michigan at 1-855-269-9898 with any other questions If you would like to speak with us in person, you can visit one of our 11 statewide walk-in centers. Visit bcbsm.com/index/healthinsurance-help/locations.html and type in your ZIP code to find your nearest walk-in center. 7
2 How to find free and low cost health care services and other health care resources If you have health insurance, please check with your health plan to see what providers are in your network. If you do not have insurance, below is a list of free or low-cost health care clinics by county. This may help you find local and low-cost health care near you. Please call ahead for hours, services offered or to make an appointment. State and federal programs The Michigan Department of Community Health has an online directory of free or low-cost health care services and resources at /healthcarehelp.* Below you can find a list of health departments by county. Alcona Alcona Alpena County Department of Human Services 711 W. Chisholm St. Alpena, MI 49707 989-354-7200 Alger Alger County Department of Human Services 101 Court St. Munising, MI 49862 906-387-4440 Antrim Antrim County Department of Human Services 205 E. Cayuga St. Bellaire, MI 49615 231-533-8664 Arenac Arenac County Department of Human Services 3709 Deep River Rd. Standish, MI 48658 989-895-2100 /dhs Baraga Baraga County Department of Human Services 108 Main St. Baraga, MI 49908 906-353-4700 8
Bay County Bay County Department of Human Services 1399 W. Center Rd. Essexville, MI 48732 989-895-2100 /dhs Benzie Benzie County Department of Human Services 448 Court Plaza Govt. Ctr. Beulah, MI 49617 231-882-1330 Charlevoix Charlevoix Emmet County Department of Human Services 2229 Summit Park Dr. Petoskey, MI 49770 231-348-1600 Cheboygan Cheboygan County Department of Human Services 827 S. Huron St. Cheboygan, MI 49721 231-627-8500 Chippewa Chippewa County Department of Human Services 463 E. 3 Mile Rd. Sault Ste. Marie, MI 49783 906-635-4100 Clare Clare County Department of Human Services 725 Richard Dr. Harrison, MI 48625 989-539-4260 /dhs Clinton Clinton County Department of Human Services 105 W. Tolles Rd. St Johns, MI 48879 989-224-5500 /dhs Crawford Crawford County Community Mental Health 230 Huron Grayling, MI 49738 989-348-7691 Delta Delta County Community Mental Health 305 Ludington St. Escanaba, MI 49829 906-786-5394 Dickinson Dickinson County Community Mental Health 1401 Carpenter Ave., Suite A Iron Mountain, MI 49801 906-779-4100 9
Eaton Eaton County Department of Human Services 1050 Independence Charlotte, MI 48813 517-543-0860 /dhs Gladwin Gladwin County Department of Human Services 675 E. Cedar Ave. Gladwin, MI 48624 989-426-3300 /dhs Gogebic Gogebic County Community Mental Health 301 E. Lead St. Bessemer, MI 49911 906-663-6200 Grand Traverse Leelanau Grand Traverse Leelanau County Community Mental Health 701 S. Elmwood, Suite 19 Traverse City, MI 49684 231-941-3900 Houghton Houghton County Community Mental Health 200 Quincy St. Hancock, MI 49930 906-482-0500 Iosco Iosco County Department of Human Services 2145 E. Huron Rd. East Tawas, MI 48730 989-362-0300 Iron Iron County Community Mental Health 337 Brady Ave. Caspian, MI 49915 906-265-9958 Kalkaska Kalkaska County Community Mental Health 503 N. Birch St. Kalkaska, MI 49646 231-258-1200 Luce Luce County Community Mental Health 500 W. McMillan Newberry, MI 49868 906-293-5144 10
Mackinac Mackinac County Community Mental Health 199 Ferry Ln. Saint Ignace, MI 49781 906-643-9550 Manistee Manistee County Community Mental Health 1672 US 31 S. Manistee, MI 49660 231-723-8375 Marquette Marquette County Community Mental Health 234 W. Baraga Ave. Marquette, MI 49855 906-228-9691 Menominee Menominee County Community Mental Health 2612 10th St. Menominee, MI 49858 906-863-9965 Missaukee-Wexford Missaukee-Wexford County Department of Human Services 10641 W. Watergate Rd. Cadillac, MI 49601 231-779-4500 Montmorency Montmorency County Department of Human Services 11636 M-32 West Atlanta, MI 49709 939-785-4218 Ogemaw Ogemaw County Department of Human Services 444 E. Houghton Ave. West Branch, MI 48861 989-345-5135 Ontonagon Ontonagon County Department of Human Services 730 S. 7th St. Ontonagon, MI 49953 906-884-4951 Oscoda County Department of Human Services 200 W. Fifth St. Mio, MI 48647 989-826-4000 Otsego Otsego County Department of Human Services 1999 Walden Dr. Gaylord, MI 49735 989-732-1702 11
Presque Isle Presque Isle County Department of Human Services 1242 W. Third St. Rogers City, MI 49779 989-734-2108 Roscommon Roscommon County Department of Human Services 111 Union St. Roscommon, MI 48653 989-275-5107 Schoolcraft Schoolcraft County Department of Human Services 300 Walnut St., Courthouse, Rm. 175A Manistique, MI 49854 906-341-2114 Children s Special Health Care Services 800-359-3722 Women, Infant and Children Programs 800-942-1636 /wic Dental and vision The following organizations provide dental or vision services only. Dental services Alger Sterling Area Health Center Dental Clinic 5095 Rifle River Trl. Alger, MI 48610 989-654-2491 Chippewa Sault Tribal Health Center Dental Program 2864 Ashmun St. Sault Ste Marie, MI 49783 906-632-5260 Iron Dickinson-Iron Dental Center 211 S. Fourth St., Suite B Crystal Falls, MI 49920 906-875-6133 upruralhealth.org Mackinac West Mackinac Dental Clinic W. 14034 Melville St. Engadine, MI 49827 906-477-6090 upruralhealth.org 12
Marquette Sawyer Dental Center 301 Explorer, Suite B Gwinn, MI 49841 906-372-9267 upruralhealth.org Discount Dental Plans 888-632-5353 dentalplan.com Vision services Eye Care America 800-222-3937 eyecareamerica.org Lions Club International 630-571-5466 lionsclubs.org Vision USA 800-766-4466 aoa.org Mental health and substance abuse services Every county in Michigan has a community mental health agency. The agency provides mental health and substance abuse services for residents in that county. For more information, see the list of agencies below by county or visit mhweb.org/directory.htm.* Alcona Northeast Michigan Community Mental Health Montmorency 311 Lake St. Harrisville, MI 48740 nemcmh.org Alger Pathways Alger Office 601 W. Superior St. Munising, MI 49862 906-786-6441 pathwaysup.org Alpena Northeast Michigan Community Mental Health Alpena 400 Johnson St. Alpena, MI 49707 989-356-2161 nemcmh.org Antrim North Country Community Mental Health Antrim County 203 E. Cayuga Bellaire, MI 49615 231-533-8619 norcocmh.org Baraga Baraga County Center 15644 Skanee Rd. L Anse, MI 49946 906-524-5885 cccmh.org 13
Charlevoix North Country Community Mental Health - Charlevoix County 6250 M-66 North Charlotte, MI 49720 231-547-5885 norcocmh.org Cheboygan North Country Community Mental Health Cheboygan County 825 S. Huron, Suite 4 Cheboygan, MI 49721 231-627-5627 norcocmh.org Chippewa Hiawatha Behavioral Health Chippewa Office 3865 S. Mackinac Trl. Sault Ste Marie, MI 49783 906-632-2805 hbhcmh.org Crawford Northern Lakes Mental Health - Crawford 204 Meadows Dr. Grayling, MI 49738 989-348-8522 northernlakescmh.org Delta Pathways - Delta Office 2820 College Ave. Escanaba, MI 49829 906-786-6441 pathwaysup.org Dickinson NorthPoint Behavioral Healthcare Kingsford Office 715 Pyle Dr. Kingsford, MI 49802 906-774-0522 nbhs.org Emmet North Country Community Mental Health Emmet County 1420 Plaza Dr. Petoskey, MI 49770 231-347-6701 norcocmh.org Gogebic Gogebic Community Mental Health 130 U.S. 2 Wakefield, MI 49968 906-229-6120 gccmh.org Grand Traverse Leelanau Northern Lakes Mental Health Grand Traverse/Leelanau 105 Hall St. Traverse City, MI 49684 231-922-4850 northernlakescmh.org 14
Houghton Rice Memorial Center 901 W. Memorial Dr. Houghton, MI 49931 906-482-9400 cccmh.org Rice Memorial Center CLK Branch 56938 Calumet Ave. Calumet, MI 49913 906-337-5810 cccmh.org Iron NorthPoint Behavioral Healthcare Iron River Office 703 Second Ave. Iron River, MI 49935 906-265-5126 nbhs.org Kalkaska North Country Community Mental Health Kalkaska County 625 Courthouse Dr. Kalkaska, MI 49646 231-258-5133 norcocmh.org Luce Pathways Luce Office 14126 County Rd. Newberry, MI 49868 906-293-3284 pathwaysup.org Mackinac Hiawatha Behavioral Health Mackinac Office 114 Elliot St. St. Ignace, MI 49781 906-632-2805 hbhcmh.org Manistee Centra Wellness Network 2198 US -31 S Manistee, MI 49660 231-723-6516 centrawellness.org Marquette Pathways Marquette Office 200 W. Spring St. Marquette, MI 49855 906-225-1181 pathwaysup.org Menominee NorthPoint Behavioral Healthcare Menominee Office 401 Tenth Ave. Menominee, MI 49858 906-863-7841 nbhs.org Montmorency Northeast Michigan Community Mental Health Montmorency 630 Caring St. Hillman, MI 49746 989-742-4549 nemcmh.org 15
Ontonagon Ontonagon County Center 515 Quartz St. Ontonagon, MI 49953 906-884-4804 cccmh.org Otsego North Country Community Mental Health Otsego County 800 Livingston Blvd. Gaylord, MI 49735 989-732-7558 norcocmh.org Northern Michigan Substance Abuse Services, Inc. 2090 W. M-32 Gaylord, MI 49735 989-732-1791 nmsas.net Presque Isle Northeast Michigan Community Mental Health Presque Isle 156 N. 4th St. Rogers City, MI 49779 989-734-7223 nemcmh.org Roscommon Northern Lakes Mental Health Roscommon 2715 S. Townline Rd. Houghton Lake, MI 48629 989-366-8550 northernlakescmh.org Schoolcraft Hiawatha Behavioral Health Schoolcraft Office 125 N. Lake St. Manistique, MI 49854 906-341-2144 hbhcmh.org Wexford/Missaukee Northern Lakes Mental Health Wexford/Missaukee 527 Cobbs St. Cadillac, MI 49601 231-775-3463 northernlakescmh.org Free and low-cost health centers Below is a list by county of places you can go for free or low-cost medical care. Many of these clinics may provide additional services, such as dental services, vision services and mental health treatment. Always call before you go to make sure the hours and services meet your needs. Alcona Alcona Health Center Harrisville 205 N. State St., Suite A Harrisville, MI 48740 989-724-5655 alconahealthcenters.org 16
Alcona Health Center Lincoln 177 N. Barlow Rd. Lincoln, MI 48742 989-736-8157 alconahealthcenters.org Alpena Alcona Health Center Alpena 1185 US-23 North Alpena, MI 49707 989-356-4049 alconahealthcenters.org Alcona Health Center Ossineke 11745 US-23, South Ossineke, MI 49766 989-471-2156 alconahealthcenters.org Free Clinic of Alpena 1600 W. Chisholm Alpena, MI 49707 989-354-3888 Antrim Bellaire Family Health Center 307 E. Cayuga St. Bellaire, MI 49615 231-533-8649 ejfhc.org Central Lake Family Health Center 7960 W. Old State St. Central Lake, MI 49622 231-544-3700 ejfhc.org Charlevoix East Jordan Family Health Center 601 Bridge St. East Jordan, MI 49727 231-536-2206 ejfhc.org Boyne Area Free Clinic, INC 624 State St. Boyne City, MI 49712 231-582-4605 boyneareafreeclinic.com Cheboygan Northern Care Center 117 W. State St. Cheboygan, MI 49721 231-333-3019 Chippewa Community Health Access Coalition Sault Ste. Marie 143 Arlington St. Sault Ste. Marie, MI 49783 906-635-7483 upchac.org Bay Mills Health Center 12124 W. Lakeshore Dr. Brimley, MI 49715 906-248-5527 baymillshealthcenter.com Community Care Clinic 509 Osborn Blvd. Sault Ste. Marie, MI 49783 906-635-4401 warmemorialhospital.org 17
Crawford Ausable Free Clinic 1200 N. Down River Rd. Grayling, MI 49738 989-348-0740 ausablefreeclinic.org Delta Escanaba Medical Clinic 710 S Lincoln Escanaba, MI 49829 906-786-4628 Dickinson Kingsford Medical Clinic 800 East Blvd. Iron Mountain, MI 49801 906-774-4000 Care Free Dental of Dickinson & Florence 500 S. Stevenson Ave. Iron Mountain, MI 49801 906-774-7900 carefreedental.org Emmet Community Health Center of Northern Michigan 3434 M-119, Suite C Harbor Springs, MI 49740 231-348-9900 alconahealthcenters.org Grand Traverse Grand Traverse County Youth Health and Wellness Center 880 Parsons Rd. Traverse City, MI 49686 231-922-6416 Traverse City Clinic 10767 Traverse Hwy. Traverse City, MI 49684 231-947-0351 nmhsi.org Traverse Health Clinic 3147 Logan Valley Rd. Traverse City, MI 49684 231-935-0799 traversehealthclinic.org Houghton Quincy Hill Health Center 51024 U.S. Highway 41 Hancock, MI 49930 906-483-2358 upruralhealth.org Iosco Alcona Health Center Oscoda 5671 N. Skeel Dr., Suite 8 Oscoda, MI 48750 989-739-2550 alconahealthcenters.org Iron Iron River Medical Clinic 1500 W. Ice Lake Rd. Iron River, MI 49935 906-265-5378 18
Luce Community Health Access Coalition Newberry 500 W. McMillan Newberry, MI 49868 906-293-8355 upchac.org Mackinac Community Health Access Coalition St. Ignace 594 N. State St. St. Ignace, MI 49781 906-643-7253 upchac.org Mackinac Straits Rural Health Center 1140 N. State St. St. Ignace, MI 49781 906-643-0466 Manistee Bear Lake / Onekama Clinic 6433 Eight Mile Rd. Bear Lake, MI 49614 231-889-5600 nmhsi.org Marquette Marquette General Family Medicine Marquette 5087 U.S. 41 S. Marquette, MI 49855 906-249-5589 mgh.org Upper Peninsula Medical Center 1414 W. Fair Ave., Suite 36 Marquette, MI 49855 906-225-3905 penmed.com Upper Great Lakes Family Health Center Gwinn 135 E. M-35 Gwinn, MI 49841 906-346-9275 uglhealth.org Upper Great Lakes Family Health Center Sawyer 301 Explorer St. Gwinn, MI 49841 906-346-4924 uglhealth.org Marquette Alger Health Center 700 W. Washington St. Marquette, MI 49855 906-228-8238 upruralhealth.org Menominee Northern Menominee Health Center N16088 Balsam Ln. Spalding, MI 49886 906-497-5263 upruralhealth.org Northern Menominee Health Center South Harbors 1110 Tenth Ave. Menominee, MI 49858 906-864-0151 upruralhealth.org 19
Missaukee Great Lakes Family Care McBain 117 N. Roland St. McBain, MI 49657 231-825-2643 alconahealthcenters.org Montmorency Thunder Bay Health Services Atlanta 11899 M-32 Atlanta, MI 49709 989-785-4855 tbchs.org Thunder Bay Health Services Hillman 15774 State St. Hillman, MI 49746 989-742-4583 tbchs.org Ogemaw Ogemaw Clinic 1827 E. Greenwood Rd. Prescott, MI 48756 989-873-6200 sterlinghealth.net Ontonagon Ewen Medical & Dental Center 200 S. Elm St. Ewen, MI 49925 906-988-2210 upruralhealth.org Presque Isle Thunder Bay Health Services Onaway 21258 W. M-68 Onaway, MI 49765 989-733-2082 tbchs.org Onaway School Based Health Center 4549 M-33 Hwy. Onaway, MI 49765 989-733-4980 tbchs.org Thunder Bay Health Center Rogers City 205 S. Bradley Hwy. Rogers City, MI 49779 989-734-2052 tbchs.org Roscommon MidMichigan Health Park Houghton Lake 9249 W. Lake City Rd. Houghton Lake, MI 48629 989-422-5122 midmichigan.org/chs Mid Michigan Medical Offices Roscommon 135 Lake St. Roscommon, MI 48653 989-275-8931 midmichigan.org/chs 20
Houghton Lake School Based Health Clinic 4433 W. Houghton Lake Dr. Houghton Lake, MI 48629 989-366-2061 midmichigan.org/chs Roscommon School Based Health Clinic 299 E. Sunset Dr. Roscommon, MI 48653 989-275-6658 midmichigan.org/chs Wexford Great Lakes Family Care 520 Cobb St. Cadillac, MI 49601 231-775-6521 alconahealthcenters.org Stehouwer Free Clinic 201 N. Mitchell St., Suite L-1 Cadillac, MI 49601 231-876-6152 Helplines and Special Programs Mammogram and Pap Smear Referral Program 800-922-6266 Nursing Home Helpline 866-485-9393 21
Additional Resources United Way 2-1-1 Collaborative can help with food, housing, employment, health care, counseling and more. Dial 2-1-1 or visit mi211.org* for quick and easy access to information about services in your community. Findcare.org* lists over 500 health care clinics in Michigan. This makes it easy to find the clinics, the services they offer and how to contact them. 3 Understanding health insurance and how to access health care services Once you ve enrolled in a health plan, you can use it to cover medical care costs, fill prescriptions at the pharmacy or get emergency care. There are five costs that make up a health plan. They are: 1. Premiums. A fixed monthly amount paid to the insurance company for health coverage. This cost varies based on what s covered in your plan and the doctors you see. 2. Copayments. Fixed dollar amounts you pay at the time of your services, such as a doctor visit. 3. Deductible. A fixed dollar amount paid by you for medical services before the insurance company starts to pay. You pay 100 percent of covered medical costs until the deductible amount is reached. Preventative services are covered 100 percent and don t count toward the deductible. 4. Coinsurance. A fixed percentage of cost of covered services that is shared with the insurance company after the deductible is met. For example, an 80/20 coinsurance means the insurance company pays 80 percent and you pay 20 percent. 5. Out of pocket maximum. This is the maximum amount you pay in deductibles, copayments and coinsurance in one plan year. Once you meet the out of pocket maximum, the health insurance company will typically cover 100 percent of covered services for the rest of the plan year. 22
To get the best care possible, it s important for you to play an active role in your own health care. Work closely with your doctor to get the best possible care. Ask questions about prevention, diagnosis, treatment and recovery. This will help ensure your safety, prevent errors and improve your overall health. Below are some tips on how to find a doctor, make an appointment and talk with your doctor. Find a doctor For Blues members visit: bcbsm.com/find-a-doctor. If you have a different health plan, go to healthgrades.com* to find a list of doctors along with their ratings. Make the most of your appointment Locate your health plan ID card, photo ID or Social Security number. Gather a list of current medical records including medications, immunizations, allergies and family medical history. Write down questions and concerns you want to cover with your doctor. Understand your costs. Follow your doctor s advice and schedule follow-up appointments. Where to go for health care Your primary care physician, or PCP, is the best place to start when an illness or injury occurs. When your PCP isn t available, it s okay use a local urgent care center. Urgent care centers treat illnesses that are not life-threatening. They also treat medical issues that may grow worse if you leave them untreated. The hospital or emergency room should be used only in the case of serious, potentially life-threatening medical emergencies. *Blue Cross Blue Shield of Michigan does not control this website or endorse its general content. 23
I m sick or hurt... Where do I go? (Or, where do I take my child or parent?) CALL OR SEE MY DOCTOR Need medical care and feel safe to wait a day. Examples are: Runny nose Simple backache Sore throat Earache GO TO URGENT CARE Need medical care today and feel safe to wait a few hours. Examples are: Tried but could not reach my doctor Reached the doctor and told to go to an Urgent Care Center GO TO EMERGENCY ROOM OR CALL 911 Need medical care now and do not feel safe to wait. Examples are: Trouble breathing or chest pain Fainting Sudden numbness or weakness Uncontrolled bleeding Severe pain or serious injury 24
You may download copies of this brochure from our website in PDF format. Go to bcbsm.com and type Help with Health Care Brochures in the search box. You may also call our toll-free hotline at 1-800-658-6715 to order extra copies free of charge. When you leave your message, be sure to include your name, address, phone number, number of brochures you d like and which version you need (Southeast Michigan, Mid-Michigan, West Michigan or Northern Michigan and the Upper Peninsula). CB 9139 SEP 14 R032735