Michigan
Sources of Insurance Coverage
*Source: KFF, Health Insurance Coverage of the Total Population, 2022
Medicare
In Michigan, 1.59 million residents are enrolled in Medicare, 16% of the state’s population
(2022 data). Of those, 60% are enrolled in a Medicare Advantage plan. For Michigan residents
in the traditional Medicare program, the Michigan Department of Insurance and Financial
Services (DIFS) regulates Medicare supplemental plans and provides consumer-facing
information about plan benefits and enrollee rights. A list of insurers authorized to sell
Medicare supplemental policies is available here.
Medicaid and the Children’s Health Insurance Program (CHIP)
In Michigan, 2.29 million people are enrolled in Medicaid or CHIP, 23% of the population (2022
data). Michigan adopted Medicaid expansion under the Affordable Care Act under a program
called “Healthy Michigan.” It currently covers almost 1 million low-income adults.
In Michigan, the CHIP program is called “MICHILD” and is operated as both an expansion of
Medicaid and a separate CHIP-funded program. Medicaid covers infants up to 195% FPL (up to
160% FPL for older children) and MICHILD fills in for children in households up to 217% FPL. The
state also provides CHIP-funded Medicaid expansion coverage for children in families between
212% FPL and 400% FPL that are affected by the Flint water crisis. Approximately 38% of all
births in Michigan are covered by Medicaid.
Employer
50%
Non-group
5%
Medicaid
23%
Medicare
16%
Military, 1%
Uninsured
5%
Distribution of Insurance Coverage in Michigan (2022)
Employer Non-group Medicaid Medicare Military Uninsured
In Michigan, most Medicaid and CHIP enrollees receive benefits via private managed care
organizations. These insurers have contracts with the Michigan Department of Health & Human
Services.
Employer-sponsored Insurance
In Michigan, 4.94 million people are covered by employer-sponsored insurance (ESI), or 50% of
the total state population (2022 data). Approximately 45.5% of Michigan employers offer ESI.
However, offer rates vary significantly by size of firm. In Michigan, 96.6% of large firms (50 or
more employees) offer ESI, while only 28.7% of small employers offer ESI.
In Michigan, approximately 39.8% of private sector businesses that offer health insurance self-
fund at least one health plan. For large firms (50 or more employees) that offer health
insurance, 60.5% self-fund at least one health plan.
Individual Market Insurance
Approximately 5.2% of Michigan residents are enrolled in the individual market (2022 data). In
2023, 322,273 Michiganders selected a plan through the Affordable Care Act Marketplace,
which in Michigan is run by the federal government. It is more challenging to ascertain
enrollment numbers for off-Marketplace individual market enrollment.
Individual market health insurance (both on- and off-Marketplace) is regulated in Michigan by
DFIS, which conducts oversight to ensure compliance with both state and federal health
insurance laws.
Other Coverage
Some Michiganders are enrolled in other forms of insurance coverage, such as coverage for the
military (TRICARE or U.S. Veterans Administration), which covers 0.5%, or 54,00 residents.
The Uninsured
Approximately 5%, or 453,200 Michigan residents are uninsured (2022 data). Michigan has the
10
th
lowest uninsured rate in the country. Among the non-elderly, people of color are
significantly more likely to be uninsured in Michigan than White people. Hispanic residents
have the highest uninsured rate (11.6%), followed by American Indian/Alaska Natives (11.4%)
and Black residents (6.4%). Asian American residents have the lowest uninsured rate (4.5%)
among all racial groups. Lack of insurance is also highly correlated with income. Approximately
10.2% of people under 100% FPL are the uninsured in Michigan, while just 2.5% of people over
400% FPL are uninsured.
State Regulators: Michigan
CMS is responsible for the oversight of Medicare Advantage plans. The CMS Regional Office for
Michigan is based in Chicago. Media inquiries may be submitted here.
Michigan Department of Insurance and Financial Services (DIFS)
DIFS regulates the business of insurance in the state of Michigan. For health insurance
companies, DIFS is responsible for:
• Licensure: All insurers operating in the state must demonstrate that they are financially
solvent and capable of paying claims. After initial licensure, companies must file
financial information with DIFS on a regular basis. DIFS is also responsible for the
licensing and oversight of health insurance agents and brokers.
• Form review: DIFS reviews health insurers’ contracts and covered benefits to ensure
that they comport with state and federal law, including the Affordable Care Act (ACA),
Mental Health Parity and Addiction Equity Act (MHPAEA), Health Insurance Portability &
Accountability Act (HIPAA), No Surprises Act, as well as state benefit mandates and
network adequacy standards.
• Rate review: Health insurers offering plans to individuals and small employers (with
fewer than 50 employees) must submit proposed premium rates to DIFS, and the
agency has the authority to review and require adjustments before rates can be used.
Insurers offering plans to large employers (with 50 or more employees) must submit
documentation of their premium rates, but DFIS does not have authority to require
changes.
• Marketing: DIFS is responsible for oversight of insurers’ marketing tactics and
discouraging unfair or deceptive tactics. The agency also licenses insurance agents and
brokers.
• Enforcement: DIFS has authority to enforce state and federal insurance laws.
Enforcement tools can range from requesting a corrective action, issuing a cease and
desist order, imposing fines, or seeking an injunction. DIFS reports the results of
company market conduct examinations here. Consumers or providers can file
complaints against insurers here.
• Appeals: Under the ACA, insurers must provide enrollees with an internal review of
adverse benefit decisions and the right to an external, independent appeal. DIFS
operates Michigan’s external review system, and provides information to enrollees
seeking an appeal here.
A list of insurers authorized to sell “major medical” insurance in Michigan is available here. DIFS
also maintains a registry of third-party administrators (TPAs) that administer benefits for self-
funded employer plans, searchable here.
Michigan Department of Health & Human Services
Michigan’s Department of Health & Human Services (DHHS) runs the state’s Medicaid and CHIIP
programs, and manages the contracts with the managed care organizations (MCOs) that deliver
Medicaid and CHIP benefits. A county-by-county list of participating MCOs is available here and
enrollment reports by county are available here.
DHHS conducts quality reviews of MCOS, including assessments of quality, timeliness, and
access to care. The results of these reviews are provided in annual reports published here.
DHHS can conduct an enforcement action against an MCO if it fails to meet its contract
obligations. Enforcement actions can include requiring the MCO to pay damages or to
implement a corrective action plan. The agency can also suspend all or part of new member
enrollments or suspend or terminate the MCO’s contract.
DHHS has also published several reports evaluating plans under the Healthy Michigan program,
including the results of enrollee surveys and assessments of the program’s impact on access to
services, uncompensated care costs, and health outcomes. These reports can be found here.
Michigan State Attorney General
The Michigan Department of Attorney General represents the state in court when there is an
action against an insurance company, entity, or individuals engaged in potentially fraudulent
activity. In addition, the Attorney General’s Consumer Protection Division is responsible for
investigating consumer complaints about provider billing practices.
Other Sources of Information
Health Insurance Navigators, Agents and Brokers (collectively, “consumer assisters”)
Although Michigan’s health insurance Marketplace is run by the federal government, CMS
provides grants to local organizations called “Navigators” that are tasked with assisting
consumers determine eligibility for subsidized coverage programs and helping them with post-
enrollment questions. Michigan-based health insurance agents and brokers perform similar
consumer assistance functions, and are generally paid on a commission basis. These consumer
assisters can be helpful sources of information about health insurance and the challenges
consumers face. They can be located through the “Find Local Help” search portal on
HealthCare.gov.
