Working Together For Michigan Consumers To be Healthy


The Affordable Care Act (ACA), which became federal law in 2010, includes vital protections and benefits for Michigan’s seniors. Some of these protections are being phased in, and some have already taken effect.

Lower prescription drug costs

Q: Does the Affordable Care Act help those with Medicare pay less for prescriptions?

A: Yes, it does. Health reform saved 84,168 Michigan residents with Medicare $49 million in 2011 in lower prescription drug costs. By 2021, savings for the average person will amount to nearly $4,200.

Closing the Medicare Part D donut hole

Q: Does health reform assist with the Medicare Part I donut hole?

A: Yes, it does. Last year, roughly 134,000 Medicare beneficiaries in Michigan hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs. Under the ACA, Medicare beneficiaries in Michigan who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. Participants do NOT need to fill out any forms.

Support for health coverage for early retirees

Q: Does health reform help those who retired before they were eligible for Medicare?

A: An estimated 192,000 people from Michigan retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time. Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

Healthcare reform offers a long list of general benefits to consumers. Keep reading for a few examples.

Getting more out of your healthcare coverage

Q: How much of my dollars are actually going toward my care?

A: That’s a great question! Thanks to health reform, 80 cents out of every dollar in healthcare premiums must be paid out to for a policyholder’s medical care. If the full 80 percent is not paid out, the Affordable Care Act (ACA) stipulates that your insurance company must send you a refund check every year. Here in Michigan, Michigan Consumers for Healthcare have already made a difference on this front! When the state of Michigan asked for a waiver to divert more than $53 million in consumer rebates back to the insurance industry, our coalition members fought that ruling and won! Because of the Michigan Consumers for Healthcare members, a federal ruling denied the waiver request – meaning less of your healthcare dollars go to insurance industry salaries and bonuses. This rule is referred to as the “medical loss ratio” provision of the Affordable Care Act.

Community Health Centers

Q: How does the ACA help Community Health Centers?

A: Health reform will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 184 Community Health Centers in Michigan, but also support the construction of new centers.

Choice and access

Q: Will Michigan consumers have more choices?

A: Yes. Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider!

Affordable insurance for uninsured with pre-existing conditions

Q: What about pre-existing conditions.

A: $141 million federal dollars are available to Michigan to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the federal government will administer the program for those residents.

>>Learn more about how Michigan consumers benefit from healthcare reform.