Learn About Our Plans

COMMUNITY (COMMERCIAL AND MARKETPLACE)

  • FULLY-INSURED PLANS

Fully-insured health plans are the more traditional way to structure an employer-sponsored health plan. With a fully-insured health plan, the company pays a premium to the insurance carrier. The premium rates are fixed for a year, based on the number of employees enrolled in the plan each month.

McLaren Health Plan offers fully-insured plans for small and large group employers on the Health Maintenance Organization (HMO), Point-of-Service (POS) and High Deductible platforms.

  • SMALL GROUP PLANS

Small group plans can be purchased on the Health Insurance Marketplace or directly from McLaren Health Plan. They are for employers with 50 or fewer employees.    
McLaren Health Plan offers fully-insured plans for small groups on the Health Maintenance Organization (HMO) platform.  

  • LARGE GROUP PLANS

Large group plans are not available on the Marketplace and must be purchased directly from McLaren Health Plan.  Large groups are defined as employer groups with 51 or more full-time equivalent employees. McLaren Health Plan offers plans for large groups on the Health Maintenance Organization (HMO), Point-of-Service (POS) and High Deductible platforms with a variety of benefit options.

  • INDIVIDUAL PLANS

Individuals plans are purchased by individuals to cover themselves and their qualified dependents. The individual is responsible for paying the premium.  Tax credit may be available to qualified individuals who purchase their plans on the Marketplace.

McLaren Health Plan offers plans on the Marketplace. You also may purchase Individual plans directly from McLaren Health Plan. There are a number of plans to choose from, with a variety of premiums and benefit options.

 

HEALTHY MICHIGAN

The Healthy Michigan Plan (sometimes referred to as “Medicaid Expansion”) provides health care benefits to qualified Michigan residents aged 19-64 at a low cost so more people can have health care coverage.

McLAREN HEALTH ADVANTAGE (SELF-FUNDED PLANS)

Self-funded plans (also known as Administrative Services Only or ASO plans) are plans in which the employer assumes the financial risk for providing health care benefits to its employees. Rather than paying an insurance company to pay medical, dental and vision claims, the employer is responsible for the cost of the claims, using a third-party administrator to process the claims on its behalf. Companies that decide to offer self-insured plans usually do so for cost savings and to control the plans offered.

McLaren HealthAdvantage is a wholly owned subsidiary of McLaren Health Plan, and is a Michigan third-party administrator (TPA) that administers self-funded products to employer groups with 50 or more employees.

MEDICAID

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.

 

MEDICARE ADVANTAGE HMO

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

  • Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.

  • Medicare Part B (Medical Insurance) 

Part B covers certain doctors' services, outpatient care, medical supplies and preventive services.

  • Medicare Part C (Medicare Advantage Plans)

Part C is a type of Medicare health plan offered by a private company, such as McLaren Health Plan, that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. McLaren Health Plan is a Health Maintenance Organization, or HMO. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. McLaren Health Plan does offer prescription drug coverage.

  • Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.