Why is UM Health Plan exiting the market for plan year 2026? 

UM Health Plan, which operates Michigan Care and Michigan Care Advantage, has experienced significant financial losses over the past few years. After a thorough business and financial assessment, Michigan Medicine has decided to discontinue the plan. The plan will continue to serve all members and process all members’ claims for services provided through Dec. 31, 2025.   

How does this impact my current medical and pharmacy benefits?  

There is no impact on current-year or 2025 medical benefits. Likewise, there is no impact on pharmacy benefits, which are administered by Prime Therapeutics.

I just enrolled/re-enrolled in Michigan Care (or Michigan Care Advantage) for plan year 2025. How does this impact my 2025 benefits?

There is no impact on your 2025 coverage. The plan will continue to cover medically necessary services through Dec. 31, 2025, as stated in your plan documents.

If I just enrolled in Michigan Care (or Michigan Care Advantage) during Open Enrollment for coverage in 2025, can I change my choice?

Open enrollment elections for 2025 can not be changed. You will be covered by Michigan Care (or Michigan Care Advantage) throughout 2025, and you should select a new plan during the next Open Enrollment period (October 2025) for coverage that will be effective on Jan. 1, 2026. Since the UM Health Plan will be operating for 2025, the announcement that the plan is being discontinued for 2026 does not qualify as an event that would allow for switching plans under IRS regulations.

 Will my provider accept Michigan Care (or Michigan Care Advantage) in 2025? 

The plan is not eliminating any current providers. However, primary care physicians (PCPs), specialists and hospitals may choose to begin or end participation with health plans at various times. As always, you may choose another participating PCP if yours were to exit the plan or at any time you wish.  

If UM Health Plan is winding down operations Dec. 31, 2025, and I receive services on Dec. 31, 2025, will my claims be paid in 2026?   

Yes, your claim(s) for covered services received in 2025 will be paid in 2026. Please refer to your plan documents for more information. If you pay for health care services out of your pocket, you must submit your claim for reimbursement 90 days from the date you receive the health service.

Questions?

If you have additional questions, please contact UM Health Plan’s Customer Service team at 800-832-9186, 8:30 a.m. to 5:30 p.m. Monday through Friday, excluding holidays.

11/25/2024