Information for individuals or members

I currently have health insurance coverage with Blue Cross Blue Shield of Michigan. Do I need to do anything now?

No. The new law will be implemented over the next several years. Blue Cross Blue Shield of Michigan will continue to provide excellent service and will work to implement the new health care laws to best serve our members. We are reviewing the legislation and any potential impact on our members. We are also working to ensure a smooth transition with state and federal regulators who will be drafting many state-level regulations.

When will these new reforms become effective?

Beginning in July 2010, consumers with health problems who have been uninsured for 6 months may be eligible to obtain coverage through a new high-risk pool program. Also, a temporary reinsurance program will be set up to help employers who provide coverage to their retirees maintain that coverage.

Beginning in plan years on or after Sept. 23, 2010, pre-existing condition exclusions are prohibited for children under 19, dependents up to age 26 will be able to obtain coverage through parents' health plans, routine preventive care will be covered without cost-sharing and limits on lifetime coverage will be eliminated. Blue Cross Blue Shield of Michigan already maintains coverage for dependents until the end of the calendar year for insured customers and is working with self-insured customers who want to do the same this year prior to Sept. 23, 2010. We will also work with customers to add back dependents up to age 26 who previously rolled off their parents' policies in accordance with the law's requirement to do so beginning with plan years starting on or after Sept. 23, 2010.

In 2014, individuals and small businesses will be able to purchase coverage through state-based exchanges. Consumers will be able to purchase health insurance regardless of health status and premiums cannot vary because of health status. Individuals will be required to purchase health insurance or pay a penalty. Subsidies will be available on a sliding scale to help individuals or families with incomes up to 400 percent of the federal poverty level to purchase insurance through new state-based exchanges.

Will insurers have to cover everyone regardless of their health status?

Yes. Blue Cross Blue Shield of Michigan has always provided health insurance coverage to anyone regardless of health status. Beginning in 2014, the new law requires that all individuals have coverage and insurers must offer coverage to anyone regardless of health status and cannot vary premiums based on health status.

How will health reform affect my premiums?

There are a number of factors that are driving health insurance premiums. Increasing use of health care services due to an aging population; obesity and chronic illnesses; new treatments; prescription drugs and expensive new technologies are the biggest causes of increasing health care premiums. The new law establishes a few pilot programs, but does not aggressively attempt to control rising health care costs.

We believe that premiums will increase as a result of provisions in the reform legislation that will guarantee richer levels of benefits than most consumers who obtain their own insurance purchase today. Insufficient discounts for the young and healthy will encourage many of them to forgo coverage. New fees and taxes mandated by the new law will also likely increase the cost of premiums as they are phased in.

Blue Cross Blue Shield of Michigan already works with doctors, hospitals, employers and consumers to rein in costs and insurance premiums while improving access to quality health care. In doing so, we've be able to reduce unnecessary hospital readmissions, eliminate infections acquired during hospital visits and promote paying doctors and hospitals for quality outcomes to help achieve this goal. We will of course continue these efforts.

I am currently uninsured. How will I obtain coverage in the future?

Blue Cross Blue Shield of Michigan offers many health insurance options that you may be able to enroll in today. Visit this site, bcbsm.com, for more information.

Beginning in 2014, state health insurance exchanges will enable consumers to compare benefits, prices and networks of providers and purchase coverage.

Prior to the establishment of state exchanges in 2014, a temporary high-risk pool program for purchasing coverage will be created in Michigan to provide coverage to high-risk individuals who have not been covered during the prior six-month period or do not have access to coverage. As soon as more details are available about who will qualify for coverage in the high-risk pool, we will provide them here.

I am graduating from college this year. Will I be able to obtain coverage under my parents' health plan?

Beginning in plan years after Sept. 23, 2010, the new law allows dependents up to age 26 to obtain coverage under their parents' plans that offer dependent coverage. Blue Cross Blue Shield of Michigan already maintains coverage for dependents until the end of the calendar year for insured customers and is working with self-insured customers who want to do the same this year prior to Sept. 23, 2010. We will also work with customers to add back dependents up to age 26 who previously rolled off their parents' policies in accordance with the law's requirement to do so beginning with plan years starting on or after Sept. 23, 2010.

What if I can't afford to purchase coverage?

Blue Cross Blue Shield of Michigan offers many different options, including many that are much more affordable than many people realize. Visit this site, bcbsm.com, for more details. Beginning in 2014, consumers who purchase coverage on their own may qualify for federal subsidies to help offset higher premiums. Federal agencies must work out how subsidies would be paid. The Congressional Budget Office estimates that about 20 million American households will be eligible for subsidies. In addition, eligibility in Medicaid, the federal-state program that provides health coverage to millions of Americans, will expand to cover families with incomes up to 133 percent of the federal poverty level.

Where can I find more information about how health care reform could affect me?

We will provide updated information here as it becomes available and there are links below to some additional resources.

• See the Reform Alerts page for the most up-to-date information.
• See the Blue Cross and Blue Shield Association's Healthcare Reform Reference Guide (PDF).
• Most of our members received an article about the near-term benefit changes and special enrollment period in their August issue of Living Healthy magazine for BCBSM members (PDF) or Good Health magazine for BCN members (PDF).