Frequently asked questions

Below are frequently asked questions to help you:

General

Am I approved for Medicaid?

If you applied for Medicaid benefits, the State of Michigan will tell you if you've been approved. Once you're approved for Medicaid, you'll get a plastic mihealth card in the mail along with a welcome letter. Check the card to make sure all of your personal information is correct.

Next, you'll need to select a health plan to help manage your care. Call Michigan Enrolls at 888.367.6557 (TTY users call 711) to select a health plan. If you selected Priority Health Choice, Inc., we will send you a member ID card. Show this card and your mihealth card when you need any care.

When can I change plans?

You have 90 days to switch plans once you're enrolled in a Medicaid health plan. To change to a different health plan, call Michigan Enrolls at 888.367.6557 (TTY users call 711). They can help you choose a new plan.

If you've been enrolled in a Medicaid plan for more than 90 days, you can change health plans once you've reached your open enrollment month, which is 12 months from when you enrolled in the plan. The State will send you a notice when you're allowed to change health plans.

If you change plans and start using Medicare or one offered by your employer, notify your Michigan Department of Health and Human Services case worker and they will make the change to your file.

Who can I contact with questions?

For questions related to eligibility, what services are covered, providers to use or how to get a replacement card, contact a case worker by calling your local Michigan Department of Health and Human Services office.

If you're already a Priority Health member and have questions about your plan and how it works, or have an update that may affect your coverage, call our Customer Service at the phone number on the back of your member ID card.

Do you have a member app?

Yes! Get easy access to your health plan information when you download the MyHealth app from the App Store or Google Play. Register your MyHealth account. You'll need your member ID card and your contract ID number, found on your member ID card.

How can I find an in-network pharmacy?

To find in-network pharmacies, use our Find a Doctor tool. Select "Medicaid/Priority Health Choice MDC" or "Healthy Michigan Plan/Priority Health Choice HMI" in the "Choose a plan" drop down menu to see covered locations. You may also call our Customer Service at the phone number on the back of your member ID card and a representative can help you.

How can I find a doctor/PCP in my area?

Need help finding a doctor? Use our Find a Doctor tool to find in-network doctors. Select "Medicaid/Priority Health Choice MDC" or "Healthy Michigan Plan/Priority Health Choice HMI" in the "Choose a plan" drop down menu to see Medicaid and MIChild providers. You may also call our Customer Service at the phone number on the back of your member ID card and a representative can help you. You can also request a printed list of providers be sent to you.

It's important to build a good relationship with your doctor, known as a primary care physician, or PCP, so you can stay ahead of any health issues before they arise. Your PCP will know your health history, can provide care, order lab tests, prescribe medicine and help you plan a hospital visit if you need one. If you don't choose a PCP, one will be chosen for you.

How do I change my PCP?

You may make a change to your PCP by calling our Customer Service department at the phone number on the back of your member ID card.

Do I need a referral to see a specialist?

Your PCP works with you to keep you healthy. Sometimes you may need care or special tests from another provider. Your doctor will help you find a specialist who is a Priority Health Choice, Inc. participating provider. Don't see a specialist without your PCP's approval. You need approval from both your PCP and from Priority Health before you see an out-of-network specialist.

How can I find a hospital/urgent care center in-network?

The emergency room is for problems that can seriously harm your health or that are a matter of life and death. If you have a medical emergency, go to the emergency room or call 911 right away. You do not need to call your PCP before getting care.

If you need care right away, but it's not life-threatening, such as sprains and strains or X-rays and lab tests, an urgent care center may be the best place for you to go. You should call your PCP first and your PCP will tell you if you need to go to an urgent care center, or give you other instructions.

After an emergency room or urgent care visit, be sure to call your PCP for any follow-up care. To find in-network doctors, hospitals, urgent care centers and pharmacies, use our Find a Doctor tool. Select "Medicaid/Priority Health Choice MDC" or "Healthy Michigan Plan/Priority Health Choice HMI" in the "Choose a plan" drop down menu to see covered providers and locations.

Do you provide interpretation services?

Priority Health provides free language services to people whose primary language is not English, such as qualified interpreters and some information written in other languages. If you need these services, contact our Customer Service by calling the phone number on the back of your member ID card.

Who can I contact if I need a replacement Medicaid card?

If you've lost your Medicaid card or have benefit questions, call the Medicaid Beneficiary Helpline at 800.642.3195 (TTY users call 711).

What if I get a bill?

You shouldn't get a bill for services that you get from your PCP, hospital or pharmacy that your PCP and Priority Health have approved. If you get a bill, please contact us and be sure to have your Medicaid ID number ready.

Healthy Michigan Plan

Healthy Michigan Plan

Who can I contact for questions related to dental coverage?

Healthy Michigan Plan members have dental services included in your plan through our partner, Delta Dental. Call Delta Dental Customer Service at 866.558.0280 (TTY users call 711) from 8 a.m. to 8 p.m. with any questions.

Who can I contact regarding my quarterly statement?

Call the Beneficiary Helpline at 800.642.3195 (TTY users should call 866.501.5656), Monday - Friday, 8 a.m. - 7 p.m. with any questions about your quarterly statement.

Do I qualify for any incentives? What is the health risk assessment incentive?

If you are a Healthy Michigan Plan member, you can lower your out-of-pocket costs when you complete your health risk assessment (HRA) with your primary care provider (PCP). Follow these easy steps:

1. Call your PCP within 60 days of your enrollment or renewal and schedule a visit.

2. See your PCP within 150 days of your enrollment or renewal.

3. Have your PCP fax your completed HRA to Priority Health.

You can qualify for the incentive once every 12 months. HRA forms are available in your welcome packet or online.

Benefits and coverage

Is preventive care covered?

When it comes to preventive care for children, adults and women, we've got you covered for services such as immunizations, screenings, lab tests and more. These services can help prevent illness or find diseases or medical problems before you have symptoms. See our Preventive Health Care Guidelines.

Are my prescriptions covered?

You have prescription drug coverage with Priority Health Choice, Inc. We use a formulary. This is a list of approved drugs. If you would like to know more about the formulary, call our Customer Service at the phone number on the back of your member ID card.

What is virtual care?

Virtual care is a convenient way to get care for a variety of common illnesses, without having to go to the emergency room or urgent care center. For non- emergency issues, you can connect with a doctor 24/7 through your smart phone or computer to receive care where you are, when you need it. You can use virtual care for things like allergies, back pain, bites and stings, cold, cough and flu, fever, pink eye and more. Check with your PCP to see if they offer virtual care, or log in to your MyHealth account and schedule a virtual care visit.

What steps should I take if I become pregnant?

You have lots of options for a healthy pregnancy. Sign up for the Maternal Infant Health Program (MIHP). It is a free pre and postnatal program for Medicaid and Healthy Michigan Plan members, to help you have a healthy pregnancy and baby. To learn more about the MIHP or to locate a provider near you, visit michigan.gov/mihp. Your Medicaid plan covers dental care during pregnancy through our partner, Delta Dental.

How do I get my baby health care coverage?

When you have a baby, or anytime your family size changes, call your MDHHS case worker so your records can be updated. Also call our Customer Service at the phone number on the back of your member ID card to report the change.

Do you offer transportation services?

Yes! Transportation services are handled in-house and are available to Priority Health Choice Inc. Medicaid members to get to and from doctor appointments, to pick up covered medicine from a pharmacy, or to travel for other covered services like physical therapy. Call our Transportation Call Center at 888.975.8102 (TTY users call 711) Monday - Thursday 8:30 a.m. - 5 p.m. and Friday 9 a.m. - 5 p.m. to see if you qualify for transportation services or mileage reimbursement, or to schedule your travel service.

Are mental/behavioral health care services covered?

As a member of a Priority Health Choice Inc. Medicaid plan, we can help you arrange short-term treatment for mental or emotional needs for adults. For more information, call the number on the back of your member ID card.

Treatment for long- term, severe mental conditions, inpatient or intensive outpatient treatment, as well as severe disturbances for children must be arranged through your local Community Mental Health Services Program (CMHSP) agency. If you have questions, we can help. Call our Behavioral Health department at 800.673.8043 (TTY users call 711).

Who can I contact for questions related to vision coverage?

As a member of a Priority Health Choice, Inc. Medicaid plan, you're covered for vision services including routine eye exams, and lenses and frames through participating eye doctors. Call our Customer Service at the phone number on the back of your member ID card to get help finding a location or if you have a question about these services.