Essentials by MESSA
Your Essentials by MESSA plan provides you and your covered dependents with exceptional coverage and MESSA’s unmatched personal service. Your MESSA card connects you with the largest provider network in Michigan, as well as some of the most prestigious hospitals in the world, including Cleveland Clinic, Mayo Clinic and University of Michigan Health System.
If you’re new to your Essentials by MESSA plan, you’ll find some great information here that we hope will simplify your transition.
The basics
Your Essentials by MESSA plan has a deductible, which is a fixed amount you must pay for covered medical services before MESSA starts to pay claims. You’ll pay the full cost of medical services until your deductible is met — which is $375 for an individual or $750 for family coverage.
After you meet your deductible, you’ll be responsible for copays and coinsurance.
- A copay is a fixed amount you pay for a medical visit or prescription.
- Coinsurance is a percentage you pay for a covered service or prescription. Your Essentials by MESSA plan has 20% coinsurance.
Here’s how it all works when you go to an in-network provider:
| BEFORE deductible is met | |
|---|---|
| Preventive care | No cost to you |
| Online, office and specialist visit | Copayment and deductible |
| Urgent care/ER | Copayment and deductible |
| Other medical services | Deductible |
| Prescriptions | Copayment or coinsurance |
| AFTER deductible is met | |
|---|---|
| Preventive care | No cost to you |
| Online, office and specialist visit | Copayment |
| Urgent care/ER | Copayment |
| Other medical services | Coinsurance |
| Prescriptions | Copayment or coinsurance |
Preventive care
With your Essentials by MESSA plan, preventive care is free when you go to an in-network provider. This includes:
Essentials by MESSA prescription coverage
Free preventive drugs
Your Essentials by MESSA plan includes a list of preventive drugs that are covered at no charge — no deductible, no copayment and no coinsurance. This helps you stretch your health care dollars and limit your out-of-pocket costs.
| Up to 34-day supply | 90-day supply | |
|---|---|---|
| Generics | $10 copayment | $30 copayment |
| Preferred brand-name drugs Most brand drugs with no generic equivalent or therapeutic alternative |
20% coinsurance $40 – $80 maximum |
20% coinsurance $120 – $240 maximum |
| Nonpreferred brand-name drugs Brand drugs for which there’s a more cost-effective generic alternative or preferred brand-name drug |
20% coinsurance $60 – $100 maximum |
20% coinsurance $180 – $300 maximum |
Does staying in-network matter?
In a word, yes.
One of the big things to know is that preventive care is free when you go to an in-network provider — you pay no deductible, no copay and no coinsurance. In-network providers accept a lower approved amount as payment in full, meaning you pay less in deductibles, copayments and coinsurance.
Out-of-network services have higher deductibles and coinsurance — for example, your out-of-network coinsurance is 40% instead of 20% when you stay in network — and you can be billed the difference between charges and approved amounts. On top of that, what you pay does not count toward your deductible or out-of-pocket maximum.
Save yourself some money, and stay in-network.
Resources for you
Medical Plan Coverage Booklet
Essentials by MESSA overview
What you should know about referrals
Medical care while traveling in the U.S.
Get the most out of your MESSA benefits
MESSA goes beyond the basics to provide exceptional benefits and unmatched personal service. We want to be sure that you know all that your MESSA health plan has to offer (and it’s a lot).