Member Benefits

Understanding Your Healthy Michigan Plan

The Healthy Michigan Plan is a managed care health plan contracted with the state of Michigan. Blue Cross Complete of Michigan administers Healthy Michigan Plan benefits to eligible members.

How the Healthy Michigan Plan works

Good health care involves a team to coordinate your care and help you make choices about your health and well-being. Your doctors are part of this team and so are we.

You are the most important member of this team. When you’re directly involved in your health care, you get better care. We support your healthy choices, and the Healthy Michigan Plan has some tools to help.

Completing a health risk assessment

A health risk assessment (PDF) is a form you and your doctor fill out. It helps your health care team see how healthy you are and find ways to help you be healthier. The assessment gives you and your doctor a place to start making the health care choices that are right for you.

Why do I need to fill out an assessment?

The Health Risk Assessment is an aid to help members improve their health. It helps doctors and the health plan ensure that members get enrolled into health education programs geared toward their specific health needs. It takes about 20 minutes to complete the form.

What are my options for completing an assessment?

  • Call your doctor today to schedule a checkup and complete your assessment.
  • You may be able to complete your assessment through a telehealth appointment with your doctor.

By completing the assessment and committing to a healthy behavior each year, you may qualify for reductions in your cost-sharing contribution. Healthy behaviors can include getting your flu shot, participating in an exercise program, or signing up for our no-cost smoking cessation program.

How often should you complete a Health Risk Assessment?

You should complete a Health Risk Assessment with your doctor every year. If it has been more than one year since your last Health Risk Assessment, call your doctor today to schedule a checkup.

If you have any questions about your Health Risk Assessment, call 1-888-288-1722 from 8 a.m. to 5:30 p.m., Monday through Friday. TTY users should call 1-888-987-5832.

Do you need transportation?
If you’re a member of our plan and need a ride to your appointment, call Transportation Services at 1-888-803-4947. TTY users should call 711.

Making healthy choices

Healthy choices can help prevent serious illnesses such as heart disease and diabetes. Healthy choices could also save you money. When you make healthy changes, your cost-sharing amounts may be reduced.

Visit our Health Library for quizzes and tools to help you know your health. Get instant results about your health and risks for diseases and conditions.

Seeing your primary care doctor

Your primary care doctor is your first choice for care. He or she is at the center of your health care team and will help you get the care you need.

You'll need to make an appointment to see your primary care doctor within 60 days, about two months, after you enroll with us. You'll need to see the doctor for your appointment within five months, or about 150 days, of enrolling in the plan.

During this appointment, you and your doctor will complete a Health Risk Assessment together. Then make sure you visit your doctor every year for an annual checkup and to complete your Health Risk Assessment.

Completing your Health Risk Assessment each year is a way to show your commitment to work on healthy behaviors.

Overview of your Healthy Michigan Plan benefits

Here's an overview of some of the benefits you may be eligible for as a Healthy Michigan Plan member.

  • Blood lead testing for members under 21
  • Breast cancer services – services to treat breast cancer as required by federal and state women’s health and cancer protection acts. This includes diagnostic, outpatient treatment and rehabilitative services
  • Child and adolescent health centers
  • Chiropractic services
  • Dental services
  • Diagnostic laboratory, X-ray and other imaging services
  • Doctor office visits
  • Emergency and urgent care services
  • Family planning services
  • Federally qualified health centers
  • Health education such as chronic condition management programs
  • Hearing exams and hearing aids
  • Home health services and skilled nursing home services. You can use these after you leave the hospital. Your doctor will help you arrange these services.
  • Hospice services
  • Hospital services requiring an overnight stay, including:
    • Cost of a semi-private room (sharing a room with one other person)
    • Intensive care nursing services
    • Doctor services
    • Surgical services
    • Anesthesia (medication to relax or put you to sleep before surgery)
    • X-rays
    • Laboratory services
  • Durable medical equipment and supplies
  • Mental health services – for mild to moderate, medically necessary outpatient visits
  • Midwife services when provided by a certified nurse midwife
  • Nurse practitioner services when provided by a certified pediatric or family nurse
  • Out-of-network and out-of-state services when authorized by Blue Cross Complete
  • Parenting and birthing classes
  • Physical exams – routine or annual
  • Podiatric (foot specialist) services when medically necessary
  • Practitioner services such as those provided by physicians and specialists
  • Pregnancy care, including prenatal and postpartum care (before and after birth)
  • Prescriptions and pharmacy services
  • Prosthetics and orthotics
  • Rehabilitative or restorative services – intermittent, or short-term, care that's in a nursing facility for up to 45 days
  • Rehabilitative or restorative services in a place of service other than a nursing facility
  • Renal disease services – end stage
  • Sexually transmitted disease treatment
  • Smoking and tobacco cessation treatment, including drugs and behavioral support (Michigan Tobacco Quit Program)
  • Specialist visits
  • Surgical services that don't require an overnight hospital stay
  • Therapy – physical, speech and language and occupational
  • Transplant services
  • Transportation by ambulance and other emergency medical transport
  • Transportation to non-emergency covered medical services
  • Vaccinations – covered vaccinations don't require prior authorization if provided by local health departments
  • Vision – routine services
  • Weight-reduction services if medically necessary
  • Well-baby and well-child care – Early Periodic Screening Diagnosis and Treatment Program for persons under age 21

The chart below shows the copayments for Healthy Michigan Plan beneficiaries. 

Your copay amounts are sent to you through your MI Health account. Every three months you will get a MI Health bill. Your doctor's office can tell you which copay amount will appear on your MI Health statements. There are two ways to pay:

Online:

  • Go to healthymichiganplan.org and click Make MI Health Account Payment. Pay using your bank account information, credit or debit card.
  • Payments can be made using Discover, MasterCard and Visa.

By mail:

  • Pay by mail using the payment coupons that came with your statement. Each coupon shows the amount you owe for one month, the due date, how to pay and where to send your payment.
  • Send a check or money order with your payment coupon. Don’t send cash. If you don’t have payment coupons and want to pay by mail, call the Beneficiary Help Line at 1-800-642-3195 (TTY: 1-866-501-5656).
Service

Copay amount:
Income less than or equal to 100% of the FPL

Copay amount:
Income more than 100% of the FPL

Physician office visit (including freestanding urgent care centers)

 $2 $4
Pharmacy

$1 preferred
$3 non-preferred

$4 preferred
$8 non-preferred

Vision care visit

 $2 $2

Dental care visit

$3

$4

Hearing aids

$3 per aid

$3 per aid

Chiropractic visit

 $1 $3

Podiatry visit

 $2 $4
Emergency room visit for non-emergencies (no copay for emergency services) $3 $8

Outpatient hospital visit

 $1 $4

Inpatient hospital visit (doesn't apply to emergent admissions)

 $50 $100
The following groups are exempt from copay requirements:
 
  • Beneficiaries under age 21
  • Individuals residing in a nursing facility
  • Individuals receiving hospice care
  • Native Americans and Alaskan Natives consistent with Federal regulations at 42 CFR 447.56(a)(1)(x)
  • Beneficiaries dually eligible for Healthy Michigan Plan and Children’s Special Health Care Services

There are no copays for:

  • Emergency services
  • Family planning products or services
  • Any pregnancy-related products or services or if you're pregnant
  • Services related to preventive care
  • Services related to chronic conditions, such as heart disease and diabetes
  • Services received at a federally qualified health center, rural health clinics or tribal health centers
  • Mental health specialty services and supports provided and paid through the Prepaid Inpatient Health Plan and 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 these conditions can be found online at michigan.gov/healthymichiganplan*.

Dental services are a covered benefit for Healthy Michigan Plan members. Your dental benefits include coverage for:

  • Oral exams
  • Teeth cleanings
  • X-rays
  • Fillings
  • Extractions
  • Partial dentures, complete dentures and denture repairs

Some procedures require special permission ahead of time, called prior authorization. Your dentist knows when a prior authorization is needed and will submit the required documentation for you. You’ll receive a letter to notify you if a procedure has been denied with an explanation and your appeal rights.

You won’t have to pay for any covered services at the dentist office. The Healthy Michigan Plan has co-pays for certain services. Co-pays for dental services are paid through your MI Health account. You don’t have to pay a co-pay at the dentist.

Make it a habit to schedule and keep regular appointments with your dentist. Taking action now may help you avoid major issues in the future. Visiting the dentist every six months for cleanings and checkups can help identify health issues early.

View the Healthy Michigan Plan dental benefits FAQ (PDF) for answers to frequently asked questions. For more information about Blue Cross Complete dental services, call 1-844-320-8465. TTY users should call 711. Or, visit our dental page to learn more about your dental benefits. 

Hearing exams and hearing aid evaluations are available from a network provider. We cover the purchase and fitting of hearing aids, including batteries.

After your hearing exam, if the doctor recommends you get a hearing aid, here's what we cover:

  • Hearing aid exam to evaluate what type or brand of hearing aid you need
  • One hearing aid unit (or one per ear if medically necessary), which includes earphone (receiver or oscillator), ear mold, necessary cords, tubing and connections. The hearing aid unit must be a conventional amplification device. It must also be an in-the-ear, behind-the-ear or on-the-body type and identified as basic to your hearing requirements.
  • Fitting of the hearing aid including one follow-up visit to evaluate its performance and to determine its conformance to prescription
  • Batteries, maintenance and repair for hearing aids

These are services that help a person keep, learn or improve skills and functioning for daily living. They may include physical and occupational therapy, speech language pathology and other services.

If you're enrolled in Medicare, you'll be disenrolled from the Healthy Michigan Plan. Other federal or state government programs may also exclude you from being able to enroll in this plan.

For a full list of Healthy Michigan Plan benefits, see the Blue Cross Complete Member Handbook (PDF).

For information on your core benefits, visit the Core Benefits page. 

*Blue Cross Complete of Michigan doesn’t control this website or endorse its general content.