Plan A, also called the Adult Benefits Waiver (ABW) program or the Adult Medical Program (AMP) was implemented November 1, 2001.

Eligibility Requirements

• Age 19-64
• Meet the income guidelines (see below)
• Kent County resident
• Have no children
• Do not have any health insurance or any other health benefits
• Not eligible for Medicaid, Medicare, MIChild or Healthy Kids

Income Guidelines

NOTE: These amounts refer to net income (income after deductions)

• Household of 1 = $304* per month (or less)
• Household of 2 = $413* per month (or less)

*Because DHS may apply certain income deductions, those making up to $580/mo (single) or $716/mo (couple) may qualify.  Therefore, we recommend you apply if your income is under these limits.

Things to know about this program include:

• Eligible members will receive a green “mihealth" card from the State of Michigan and a white card from Kent Health Plan.
• Members must receive all primary care services at the primary care practice they are assigned to.
• If a member goes to a non-participating doctor, they will be responsible for the bill. 
• Specialty care referrals must be ordered by the Kent Health Plan provider at the assigned practice.
• Prescriptions must be written for medications on an approved list.
• In some cases, Plan A members may need to have a prescription authorized by their doctor before they can receive the medication.
• Members must get medications at one of the participating pharmacies.

Covered services and Copays:

• There is no fee for enrollment or membership in this program.
• There is a small copay for some services.
• If you are a member of this program and have questions about your coverage, please call Kent Health Plan at (616) 726-8204. 
• If you are a provider and have questions, please call Kent Health Plan at (616) 726-8204. 
• Covered services, required copayments and the card the member must present when receiving services are as follows:

• To view the list of medications covered by Kent Health Plan, Plan A, click here.  Some medications require prior authorization before being filled.  They will be  marked ‘PA.’  To request prescription authorization, please call Kent Health Plan at (616) 726-8204.

• Some medications may have certain restrictions, such as limited quantities.

• Kent Health Plan has made some changes to the list of medications covered by Plan A.  Most brand name medications will now be covered under the following:
• An application will be made to the Pharmacy Assistance Program (PAP) for that medication.
• A medication will be covered through the Community Medical Fund (CMF) for up to 90 days until a member begins to receive their medication from the Pharmacy Assistance Program.
• Medications marked ‘PAP’ will require a prior authorization in order to obtain a 90-day supply through the Community Medical Fund
• Medications marked ‘PAP-E’ are available through the Community Medical Fund for 90 days without a prior authorization

Members will need to contact their doctor’s office to complete an application for the Pharmaceutical Assistance Program.  If a doctor’s office is unable to help with this process, the member may contact Kent Health Plan (726-8204) for assistance in completing the application.

• For all other medication inquiries, please call or email Jan at Kent Health Plan: (616) 726-8204, ext. 33 or JHronek@kenthealthplan.org.

• Services NOT COVERED by Plan A include inpatient hospitalization, organ transplants, transfusions, chiropractic care, experimental treatment, speech or occupational therapy, hearing aids and related services, durable medical equipment, prosthetics and orthotics, weight loss programs, cosmetic surgery, home health services, services related to sex change, vision screening, eyeglasses, contact lenses, and dental care of any kind. Also not covered is any condition that can be paid for under another public or private health care program or insurance, medical services to prisoners, hospice care, any service not authorized by a KHP provider, travel shots, and sports physicals.

Enrollment

Plan A is not currently accepting applications. 

Please ask your clinic or doctor’s office if other help is available.  For prescription assistance you can also call 1-888-477-2669.  For more resources, you can call United Way at 2-1-1 or 459-2255.