Healthy Michigan Plan
About the Healthy Michigan Plan
The Healthy Michigan Plan is a health plan offered to some Michigan residents by the Michigan Department of Health & Human Services (MDHHS). Since it became effective April 1, 2014, it has helped Michigan citizens to get high-quality, affordable health care. You get your Healthy Michigan Plan benefits through Upper Peninsula Health Plan (UPHP).
As a UPHP Healthy Michigan Plan member, you have benefits in addition to those described on the Core Benefits Web page. Those additional benefits include:
Habilitative Services
In addition to rehabilitative/restorative services, UPHP Healthy Michigan Plan members also have habilitative services coverage. Habilitative services are those that help you keep, learn or improve skills and functioning for daily living. These services can be done inpatient or outpatient and may include:
- Physical and occupational therapy
- Speech-language pathology
- Services for people with disabilities
The Healthy Michigan Plan Health Risk Assessment (HRA) is a form you fill out every year with your provider. It asks you questions about your health, like how much you exercise and the food you eat. It helps your provider to determine how healthy you are and what you can do to get healthier. The HRA also asks you to commit to a healthy behavior, such as quitting smoking, losing weight, or getting a flu shot.
Take action to get healthy and stay healthy:
- Schedule an appointment with your primary care provider (PCP) within 60 days of joining the UPHP Healthy Michigan Plan. If you need help scheduling an appointment or picking a PCP, please call UPHP Customer Service.
- Fill out sections 1-3 of your HRA prior to your PCP appointment.
- Bring your partially completed HRA to your PCP appointment. Your provider will help you complete section 4 and pick the best healthy behavior for you.
Depending on your income, you may qualify for a reduction in your copays or contribution amounts for completing the HRA and committing to a healthy behavior.
UPHP Healthy Michigan Plan members are responsible for some of the costs of their health care. This is called cost sharing, and includes costs such as:
- Copays: a fixed amount you pay for your health care services.
- Contributions: the amount of money you pay toward your health care coverage.
Most copays will be made to UPHP through a special health care account called the MI Health Account. You will get a MI Health Account bill every three months. You will not owe a copay at the point of service. Do not pay any copay amount to the office staff or pharmacy at the time of your appointment or when you pick up a medication if it is a service covered by UPHP.
Copays vary based on income as follows:
| COVERED SERVICES | COPAY AMOUNT Income < or = to 100% FPL | COPAY AMOUNT Income more than 100% FPL |
|---|---|---|
| Physician Office Visits (including free-standing urgent care centers) | $2 | $4 |
| Outpatient Hospital Clinic Visits | $1 | $4 |
| Emergency Room Visit for Non-Emergency Services • Copay ONLY applies to non-emergency services. • There is not copay for true emergency services. | $3 | $8 |
| Inpatient Hospital Stay (with the exception of emergency admissions) | $50 | $100 |
| Pharmacy | $1 preferred $3 non-preferred | $4 preferred $8 non-preferred |
| Chiropractic Visits | $1 | $3 |
| Dental Visits | $3 | $4 |
| Hearing Aids | $3 per aid | $3 per aid |
| Podiatric Visits | $2 | $4 |
| Vision Visits | $2 | $2 |
These groups are exempt from copay requirements:
- Members under age 21.
- Individuals residing in a nursing facility.
- Individuals receiving hospice care.
- American Indian/Alaska Native.
- Members dually eligible for Healthy Michigan Plan and Children’s Special Health Care Services (CSHCS).
There are no copays for:
- Emergency services.
- Family planning services.
- Pregnancy-related services.
- Preventive services.
- Federally Qualified Health Center, Rural Health Clinics, or Tribal Health Center services.
- Mental health specialty services and supports provided/paid through the Prepaid Inpatient Health Plan/Community Mental health Services Program.
- Mental health services provided through state psychiatric hospitals, the state Developmental Disabilities Center, and the Center for Forensic Psychiatry.
- Services related to program-specific chronic conditions. A list of program-specific chronic conditions can be found at michigan.gov/healthymichiganplan.
Page Last Updated: 03/31/2023