Michigan Health and Hospital Association Encourages Members to Consider Paying Patients' Premiums for the New High Risk Pool Established Pursuant to the Patient Protection and Affordable Care Act

Since October 1, 2010, Michigan residents who have a pre-existing condition, have been without health insurance for six month or more, and have within the past six months either been denied health insurance or offered health insurance with a rider excluding certain health conditions can obtain insurance through the Health Insurance Program (HIP) or Michigan. This program is administered by Physicians Health Plan of Michigan and is offered through the temporary federal high risk pool created by the Patient Protection and Affordable Care Act. It can serve up to 3500 people and will be offered through January 1, 2014. HIP offers most or all of the benefits of a standard health insurance plan and is supposed to be moderately priced. However, since premiums increase with the applicants’ age, many older people find the premiums – $563.27 for individuals 55-59 and $686.61 for individuals 60-64 – unaffordable.

The Michigan Health and Hospital Association (MHA) is encouraging its members to publicize the program with its patients and to consider paying all or part of the premiums of certain individuals who currently require a significant amount of uncompensated care. In a letter dated November 10, 2010, MHA’s President, Spencer Johnson, wrote that “Patient enrollment in this new high risk pool can help your hospital achieve its social mission of providing care to all patients who walk through your door while also reducing the financial burden on your facility.” He suggested members could “opt to pay certain monthly HIP Michigan enrollee premiums to obtain reimbursement for future care provided, and thereby avoid potential uncompensated care.”

Although paying patients’ premiums is expensive, hospitals might find it less expensive than paying for the uncompensated care they would otherwise provide to patients who qualify for HIP. At a meeting of the Medical Care Advisory Committee on February 22nd, MHA representatives confirmed that providers could decide to pay premiums just for a short period of time to ensure coverage when high medical costs are anticipated. While the MHA representatives could not confirm that any providers had already agreed to pay premiums for patients or that providers had established protocols for doing so, MHA is continuing to encourage members to consider this option and has created an on-line toolkit to promote the program. Advocates may try negotiating with hospitals about paying premiums for clients who, for example, receive emergency room care frequently or anticipate they will require a significant amount of uncompensated care.

For more information on HIP, call HIP’s Customer Service department during business hours at 1-877-459-3113 or go to: https://phpmm.org/ForMembers/HIP/tabid/4182/Default.aspx.