Individual Coverage
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SERVICES:
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Federal Subsidy Eligibility
Enrollment/Application Process
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Things you need to know.......
When can I enroll for coverage?
You may enroll in an individual health insurance plan every year during the annual Open Enrollment Period (OEP) which runs from November 1 through January 15 of each year.
To buy individual health insurance outside of the OEP, you must experience a special life event that qualifies you for a Special Enrollment Period (SEP). Special live events that allow you to enroll in a new individual plan include losing group health insurance coverage due to termination from employment or losing other health insurance due to moving to Michigan from out of state or no longer qualifying for coverage under Medicaid. If you marry or have a child, your new spouse or child has an SEP to be added to your individual plan as well. SEPs only lasts 60 days from the date of loss of coverage or other life event, so it is important to act quickly.
What are Essential Health Benefits?
As part of the Affordable Care Act, medical plans for individuals and families must cover 10 kinds of health care services. These services are called essential health benefits:
- Outpatient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric vision
What are the "metal" plans?
The Affordable Care Act (ACA) requires that all individual plans fall into certain categories with respect to how they cover eligible expenses. Here’s a breakdown of what is covered under each metal tier for a standard plan (or those that are not eligible for government-sponsored subsidies based on income level):
Platinum
Under a platinum plan with an actuarial value of 90% people will be responsible for only 10% of medical costs through a combination of deductibles, copays and coinsurance.
Gold
A gold plan has an actuarial value of 80%; therefore, under this plan, people will be responsible for 20% of medical costs through a combination of deductibles, copays and coinsurance.
Silver
A silver plan has an actuarial value of 70%, so members will be responsible at an overall plan level for 30% of medical costs through a combination of deductibles, copays and coinsurance.
Bronze
Bronze plans have an actuarial value of 60%, which means that at an overall plan level, the member (you) will pay for 40% medical costs through a combination of deductibles, copays and coinsurance.
APPLY NOW
The annual open enrollment for individual plan coverage has ended. The next annual open enrollment period for coverage beginning January 1, 2026 will be November 1, 2025 through December 15, 2025.
If you have a change in life circumstances that qualifies you for a special enrollment period, you may be able to make changes to your existing individual medical plan or enroll in a new plan. You generally have 60 days from the qualifying event date to apply for a Special Open Enrollment. Please contact your agent.
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Contact us
5151 Gateway Centre, #200
Flint, MI 48507
Toll Free: 1-866-438-8271
Telephone: 810-239-0200
FAX: 810-239-5318
Please note Total Benefit Systems, Inc. is licensed to conduct business in the State of Michigan. You must be a legal Michigan resident/business to apply for coverage offered by our Agency. Please note, filling out an online application does not guarantee coverage, proof of residency required. Please refer to insurance carrier website for complete details regarding network coverage areas, plan limits and exclusions, eligibility requirements, copayment and deductible requirements and to obtain a summary of benefits. An authorized independent agent for Blue Cross Blue Shield of Michigan and Blue Care Network.