HMP provider copay obligations
The Centers for Medicare and Medicaid Services requires that all providers treating Healthy Michigan Plan (HMP) members discuss copays with HMP members at the time of service.
Please note: Dentists treating HMP members should not collect copays from HMP members. Instead, HMP members receive a quarterly statement for their MI Health Account outlining their copay obligations. Members make their copays to their MI Health Account rather than to providers. If members have questions about these statements, they should call the Beneficiary Helpline at (800) 642-3195 for assistance.
Even though providers who treat HMP members do not collect copays, providers are required to discuss copays with HMP members at the time of service. Dental offices treating HMP members should share the following information with HMP members:
- A copay of $3 is required for each dental visit for HMP members ages 21 or older. Native American Indians, Alaska Natives and pregnant women are exempt from copays.
- When more than one covered service is provided during a visit, only one copay will be charged. If several visits are required to complete a dental service, only one copay will be charged.
All HMP providers should verify a patient’s HMP eligibility before providing dental services at every appointment, as coverage may have changed. Dental services provided to an ineligible member will not be reimbursed.
Delta Dental of Michigan, Ohio, and Indiana