The Healthy Michigan Plan is a Medicaid expansion program that provides low-cost health coverage to Michigan adults ages 19 through 64 who earn at or below 133% of the federal poverty level. For a single person, that’s roughly $18,000 a year; for a family of four, about $37,000. The program covers a wide range of services, from doctor visits and prescriptions to dental, vision, and mental health care.
Who Qualifies
To be eligible, you must meet all of the following criteria: you’re between 19 and 64 years old, you’re a Michigan resident, you meet Medicaid citizenship or qualifying immigration status requirements, and your modified adjusted gross income falls at or below 133% of the federal poverty level.
You won’t qualify if you’re already enrolled in Medicare, if you’re eligible for another Medicaid program, or if you’re pregnant at the time of application. Pregnant individuals are covered under a separate Medicaid category with its own set of benefits. Once you’re no longer pregnant, you may then be eligible for the Healthy Michigan Plan if you meet the income and age requirements.
What the Plan Covers
The Healthy Michigan Plan covers medically necessary services across a broad range of categories. The full list includes doctor visits, emergency services, inpatient and outpatient hospital care, lab work, x-rays, surgery, prescription medications, mental health services, substance use disorder treatment, dental care, vision care, hearing and speech services, physical and occupational therapy, home health care, hospice, nursing home care (up to 45 days per year), personal care services, prenatal and postpartum pregnancy care, chiropractic care, podiatry, immunizations, medical supplies, family planning, and non-emergency medical transportation.
Dental and vision coverage is worth highlighting because many Medicaid programs in other states don’t include them for adults. Under this plan, both are covered services. Mental health care includes both inpatient and outpatient treatment, with inpatient mental health and residential services covered up to 20 days per contract year and outpatient mental health covered up to 20 days per year as well.
What It Costs
The Healthy Michigan Plan is designed to be very low cost. You’ll pay small co-pays when you receive services. For adults 21 and older, typical co-pays are $3 for a dental visit, $2 for a vision visit, $1 for generic or preferred-brand prescriptions, and $3 for brand-name or non-preferred prescriptions.
One unique feature of the plan is that you can cut your cost-sharing obligations by up to 50% through healthy behaviors. Each year, you’re encouraged to complete a Health Risk Assessment with your primary care provider during an annual checkup. By completing this assessment or by achieving or maintaining a healthy behavior goal identified during that visit, your premiums and co-pays can be reduced by half. The annual checkup itself is a covered benefit, and your health plan can even arrange transportation to and from the appointment.
The Health Risk Assessment
The Health Risk Assessment is a form you bring to your yearly checkup. You fill out parts of it yourself, covering questions about your health habits and any conditions you’re managing, and your doctor completes a separate section during the visit. After the appointment, keep a signed copy as your record. You’ll need to complete a new assessment each year to maintain your cost-sharing reductions.
Completing the assessment is voluntary, but it’s required if you want to participate in certain plan programs and receive the financial incentives. Given that it can cut your out-of-pocket costs in half, it’s one of the most practical steps you can take as a member.
How It Differs From Traditional Medicaid
The Healthy Michigan Plan exists specifically for adults who don’t fit into traditional Medicaid categories. Traditional Medicaid in Michigan primarily covers children, pregnant individuals, people with disabilities, and older adults. The Healthy Michigan Plan fills the gap for low-income adults ages 19 to 64 who wouldn’t otherwise qualify.
The benefit packages are similar but not identical. The Healthy Michigan Plan places some limits that traditional Medicaid does not. Skilled nursing facility stays are capped at 45 days per contract year. Inpatient mental health services, including residential treatment, are limited to 20 days per year. Outpatient mental health services are also capped at 20 days annually. Traditional Medicaid does not impose these specific caps. On the other hand, the Healthy Michigan Plan explicitly includes adult dental, vision (including eyeglasses and refractions), hearing services with hearing aids, and personal care services, benefits that were added to ensure comprehensive coverage for this population.
Medically Frail Members Get Extra Protections
If you have a serious physical, mental, or emotional health condition that limits your ability to perform daily activities like bathing, dressing, or household chores, you may be classified as “medically frail.” This designation can happen in three ways: you identify the condition yourself on your application, the state flags it through an analysis of your medical claims, or your healthcare provider refers you for the status.
Being classified as medically frail provides meaningful protections. You’re exempt from any enrollment suspension that could otherwise apply after 48 months. You’re also exempt from workforce engagement requirements that the state may impose as a condition of coverage. These exemptions recognize that certain health conditions make standard program requirements unrealistic.
How to Apply
There are three ways to apply for the Healthy Michigan Plan. You can apply online through MI Bridges at michigan.gov/mibridges, call 1-855-789-5610, or visit your local Department of Health and Human Services office in person. If you apply online, you’ll need to create a MI Bridges account first. The same account lets you manage your case and report any changes to your income or household size after enrollment.
If you’re unsure whether you qualify, applying is the simplest way to find out. The state determines eligibility based on your modified adjusted gross income, which accounts for certain deductions and may differ from your gross pay. You won’t know your exact eligibility until the application is processed.