Copayments

The Healthy Michigan Plan has copays. Before enrolling in a health plan, you must pay your copays to the provider when you get care. When you are enrolled in a health plan, most copays will be made to the health plans through special health care account called the MI Health Account. Copays will not be collected during the first six (6) months after enrollment in a health plan, but will be paid to your health plan through your MI Health Account at a later time. 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 the health plan.

The Healthy Michigan Plan requires those with annual incomes between 100% and 133% of the federal poverty level to contribute 2% of income annually for cost sharing purposes. You will get more information about your MI Health Account and contributions for cost sharing after you have been enrolled in the health plan for six (6) months. To make a payment to the MI Health Account, please contact Michigan Enrolls at 1-888-367-6557.

If you do not make payments to the MI Health Account, you may have a penalty. For example, if you have a healthy behavior reward, you could lose it and fall into “consistently failing to pay” (CFP) status. Please contact Michigan Enrolls at 1-888-367-6557 to make a payment to your MI Health Account.

For dates of service on or after April 1, 2017, copays vary based on income as follows:

Covered Services Copay Amount for Income Less Than or Equal to 100% FPL Copay Amount for 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 Service

  • Copay ONLY applies to non-emergency services
  • There is no copay for true emergency services
$3 $8
Inpatient Hospital Stay (with the exception of emergent 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

Copay exemptions for the Healthy Michigan Plan are consistent with Medicaid.

There are no copayments for preventive services, services related to the care of chronic conditions and pregnancy-related products or services.  Cost sharing cannot exceed 5% of your income.


Page Last Updated: 07/17/2017