Total Costs & Metal Categories
When you compare plans in the Marketplace, the plans appear in 4 metal categories: Bronze, Silver, Gold, and Platinum. The categories are based on how you and the health plan share the total costs of your care.
Generally speaking, categories with higher premiums pay more of your total costs of health care. Categories with lower premiums pay less of your total costs.
So how do you find a category that works for you?
- If you dont expect to use regular medical services and dont take regular prescriptions: You may want a Bronze plan. These plans can have very low monthly premiums, but have high deductibles and pay less of your costs when you need care.
- If you qualify for “cost-sharing reductions” : Silver plans may offer good value. If you qualify, your deductible will be lower and youll pay less each time you get care. But you get these extra savings only if you enroll in Silver. If you dont qualify for CSRs, compare premiums and out-of-pocket costs of Silver and Gold prices to find your right plan. See if your income estimate falls in the range for cost-sharing reductions.
- If you expect a lot of doctor visits or need regular prescriptions: You may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.
A Medicaid And Healthy Michigan Planmanaged Care Health Plan
Blue Cross Complete of Michigan is a managed care health plan contracted by the state of Michigan. We help Medicaid members get the health care they need in 32 Michigan counties across the state.
We provide members with the care they need, when they need it. This includes a wide range of benefits, such as transportation services, a 24-hour nurse help line, vision, hearing and dental coverage. We also offer pharmacy, maternity care and integrated care management benefits.
The Healthy Michigan Plan is a health care program from the Michigan Department of Health and Human Services. Blue Cross Complete administers Healthy Michigan Plan benefits to eligible beneficiaries.
Total Health Care And Priority Health Announce Completion Of Merger
: Priority Health, Michigan’s second-largest health insurance plan, announced today that the company’s merger with Total Health Care is now complete. Originally announced in summer 2019, the new partnership between two of Michigan’s most-recognized health insurance brands will allow the companies to work together to provide improved care and access for current and future members of both plans.
“I can think of no better way to start the new decade than by officially welcoming Total Health Care to the Priority Health family,” said Joan Budden, president and CEO of Priority Health. “This partnership was a natural coming together for two organizations that share a strong commitment for providing members with high quality care and bettering the communities we serve. We are excited to have achieved this historic milestone and look forward to working with the Total Health Care team in the new year.”
“The overwhelmingly positive response to this news from the business community, legislators and, most importantly, our members has been remarkable,” said Randy Narowitz, CEO of Total Health Care. “We are grateful for all the support and excited to move forward together with Priority Health as we continue to support vulnerable populations throughout southeast Michigan.”
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Blue Cross Complete Mobile App
Access your account anytime, anywhere. The Blue Cross Complete mobile app keeps you up-to-date on your health care information. You can update your member information. You can also find doctors and hospitals. And, you can see a list of your current medications. To download our app, click on the links below or search for “BCCMI” in the App Store® and Google Play.
Access your data on other mobile apps
Before agreeing to share your health data with a third party health or fitness app, youll be directed to sign in and authenticate the third party app using your Blue Cross Complete online account. If you dont already have an online account, youll be prompted to register before this process can proceed.
Once you review the Third Party Data Privacy Information , youll be directed back to the third party app approval process. There you may approve or cancel third party app selection. If, at any time, youd like to revoke consent to providing your health data to a third party app, you may do so from within your online account.
About The Total Health Care Foundation
The Total Health Care Foundation was formed in 2020 as a result of the merger between Total Health Care, the longest serving HMO in Detroit, and Priority Health, Michigans fastest growing health plan. The mission of the Total Health Care Foundation is to improve the health and well-being of the people of Detroit by investing in organizations dedicated to serving the needs of the community.
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Introducing Arkansas Total Care
Arkansas Total Care is committed to providing whole health solutions for people with IDD and Behavioral Health needs. Our unique, person-centered approach ensures each individual receives comprehensive care coordination tailored specifically for them. With over 20 years of experience, the partners at Arkansas Total Care provide support services that collectively create healthier, happier individuals ultimately improving their overall quality of life.
Do you need more information or have a question? Please reach out to our Member Support Services at 1-866-282-6280 or TTY: 711.
Vaya Total Care Tailored Plan For Medicaid Members
For Medicaid and NC Health Choice beneficiaries with serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual/ developmental disabilities , or a traumatic brain injury :
- Physical health care services
- Traumatic Brain Injury services
- Long-term services and supports
- Dedicated care manager
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Benefits For Intotal Health Members
INTotal Health serves more than 60,000 Medicaid members in the state of Virginia and offers a wide range of standard and value-added benefits. In addition to the videos above, you can also click the link below to read about our Value-Added INTotal Health Benefits, services covered by DMAS/Fee-for-service Medicaid, services excluded from the managed care program, and benefits and services not offered by INTotal Health or Medicaid.
What Are Essential Health Benefits
Essential health benefits are a comprehensive package of items and services that all health plans must offer, including:
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Beyond Your Monthly Premium: Deductible And Out
- Deductible: How much you have to spend for covered health services before your insurance company pays anything
- Copayments and coinsurance: Payments you make each time you get a medical service after reaching your deductible
- Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.
Medical Care For Everyone
The quality of your care is our highest priority, and were dedicated to giving you the best experience possible. If youre ever unhappy with our care, please let us know and we will work hard to make you happy. If you want easy access to health care and a practice who really knows you, youre going to love Total Care Primary Care. Weve created a new primary care experience that is focused on keeping patients healthy. We believe it will be different than what youve experienced before.
Use the online booking engine to secure your appointment
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Services Obtained Outside Of Intotal Health’s System Or Service Area
INTotal Health has many in-network doctors who give care to our members. If you need help finding an in-network doctor or want to confirm that your doctor is in INTotal Healths network, please call Member Services at 1.855.323.5588 or visit our Find a Doctor tool at . All out-of-network providers require a pre-authorization before giving services. What is Out-of-Network Coverage? Out-of-network coverage is when you go to a doctor who is not with INTotal Health. If you go to an out-of-network doctor, they may ask you to sign a waiver document. By signing this document, you may be at risk for paying for that service, especially if pre-authorization was not given to the doctor. If a pre-authorization was not given and if you receive nonemergent services from an out-of-network doctor, you may have to pay for that service. If you have questions, please call Member Services at 1.855.323.5588.
Trends/changes In Health Care
The Canadian health care system has faced challenges in recent years due to a number of factors, including changes in the way services are delivered, fiscal constraints, the aging of the baby boom generation and the high cost of new technology. These factors are expected to continue in the future.
Since publicly funded health care began in Canada, health care services and the way they are delivered have changed–from a reliance on hospitals and doctors to alternative care delivery in clinics, primary health care centres, community health centres and home care treatment using medical equipment and drugs and a greater emphasis on public health and health promotion.
Medical advances have led to more procedures being done on an out-patient basis, and to a rise in the number of day surgeries. Over the past several decades, the number of nights Canadians spent in acute-care hospitals on a per capita basis has declined, while post-acute and alternative services provided in the home and community have grown.
Primary Care
The episodic and responsive traditional primary health care model has served Canadians well. However, the aging population, rising rates of chronic disease, and other changing health trends have emphasized the need for the health care system to maintain and continue to develop the capacity to respond to the changing needs of Canadians.
eHealth
Wait Times Reduction
Patient Safety
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Introducing Nebraska Total Care
Established to deliver quality healthcare in the state of Nebraska through local, regional and community-based resources, Nebraska Total Care is a Managed Care Organization and subsidiary of Centene Corporation . Nebraska Total Care exists to improve the health of its beneficiaries through focused, compassionate and coordinated care. Our approach is based on the core belief that quality healthcare is best delivered locally.
How to Reach UsIf you are a Heritage Health member and have questions about Nebraska Total Care, you can reach Member Services at 1-844-385-2192 . We have people to help you Monday-Friday, 7 a.m. to 8 p.m., Central.
If you are a Nebraska Total Care member we can send you printed copies of anything you need within 5 days at no cost. Please call Member Services.
Expansion Under The Affordable Care Act
As of December 2019, 37 states and the District of Columbia have accepted the Affordable Care Act Medicaid extension. Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate. Following a 2012 Supreme Court ruling, which held that states would not lose Medicaid funding if they did not expand Medicaid under ACA, several states rejected the option. Over half the national uninsured population lives in those states.
The Centers for Medicare and Medicaid Services estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults. The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion.
Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies. Several states argued that they could not afford the 10% contribution in 2020. Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage,
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What Is The Medicaid Program
Medicaid is a joint federal and state program that helps pay for the medical expenses of certain people with limited income and resources. Medicaid may also cover services that are not usually covered by Medicare . Each state has different provisions on eligibility for the Medicaid program and how to apply for it. If you are eligible for Medicaid in your state, you will automatically be eligible for additional assistance to pay for Medicare prescription drugs .
You may be eligible to participate in the Medicaid program if you have a limited income, or:
- Age 65 or more
- Child under the age of 19
- Pregnant
- Essential medicines
- Eye and dental care .
You must apply for Medicaid if you or someone in your family needs medical attention. If you are not sure if you are eligible for this program, a qualified social worker in your state can evaluate your situation. Contact your local or state Medicaid office to find out if you are eligible to apply for the program. For information about your states Medicaid program, visit the HealthCare website: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip.
Special Programs & Supports
Vaya wants to help you and your family get and stay healthy. If you want to quit smoking or are a new mom who wants to learn more about how to best feed your baby, we can connect you with the right program for support.
- Tobacco cessations services to help you stop smoking or using other tobacco products
- Women, Infants and Children special supplemental nutrition program
- Newborn screening program
Some other great programs offered by Vaya Health are:
System of Care Grant
System of Care is a way of working with children and families based on the idea that families know their own strengths and needs best. SOC is not a service or a program it is a way of working together with children and families to achieve results that are important to them. Vaya was recently awarded a SOC Expansion and Sustainability Grant from the U.S. Substance Abuse and Mental Health Administration to expand services and access to care for children and youth with mental, behavioral, or emotional disorders and offer hands-on support to their families. This grant will allow us to help families:
- Identify needs that are not being met
- Connect with health care providers and community organizations
- Understand resources available to help them reach their goals
Learn more about SOC and how your family can get involved.
Family Partners
Learn more about Family Partners and how your family can get involved.
Housing Initiatives
- Transitions to Community Living
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Is A Tailored Plan The Right Option For Me
The right option for you will depend on your eligibility and your unique health needs. If you are currently enrolled in Medicaid or NC Health Choice and want to learn more about choosing the right plan for you, call the NC Medicaid Enrollment Broker Call Center at , Monday through Sunday from 7 a.m. to 8 p.m. The Enrollment Broker can answer your questions when the Tailored Plan enrollment period begins in August 2022.
If you are not enrolled in Medicaid or NC Health Choice, you can find out if you are eligible by contacting your countys Department of Social Security office. A list of DSS offices is available on the NCDHHS website.
Nhe By State Of Residence 1991
- In 2014, per capita personal health care spending ranged from $5,982 in Utah to $11,064 in Alaska. Per capita spending in Alaska was 38 percent higher than the national average while spending in Utah was about 26 percent lower they have been the lowest and highest, respectively, since 2012.
- Health care spending by region continued to exhibit considerable variation. In 2014, the New England and Mideast regions had the highest levels of total per capita personal health care spending , or 26 and 16 percent higher than the national average. In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita with average spending roughly 15 percent lower than the national average.
- For 2010-14, average growth in per capita personal health care spending was highest in Alaska at 4.8 percent per year and lowest in Arizona at 1.9 percent per year .
- The spread between the highest and the lowest per capita personal health spending across the states has remained relatively stable over 2009-14. Accordingly, the highest per capita spending levels were 80 to 90 percent higher per year than the lowest per capita spending levels during the period.
- Medicare expenditures per beneficiary were highest in New Jersey and lowest in Montana in 2014.
- Medicaid expenditures per enrollee were highest in North Dakota and lowest in Illinois in 2014.
For further detail, see health expenditures by state of residence in downloads below.
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Oregon Medicaid Health Experiment And Controversy
In 2008, Oregon decided to hold a randomized lottery for the provision of Medicaid insurance in which 10,000 lower-income people eligible for Medicaid were chosen by a randomized system. The lottery enabled studies to accurately measure the impact of health insurance on an individual’s health and eliminate potential selection bias in the population enrolling in Medicaid.
A sequence of two high-profile studies by a team from the Massachusetts Institute of Technology and the Harvard School of Public Health found that “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years”, but did “increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”
The study found that in the first year:
