Upper Peninsula Health Plan: Eligibility, Costs, and Coverage

The Upper Peninsula Health Plan is a nonprofit HMO that covers residents of Michigan’s Upper Peninsula through government programs: Medicaid, the Healthy Michigan Plan, MIChild for children, Medicare Advantage, and MI Coordinated Health for people who qualify for both Medicare and Medicaid. As of 2026, its network includes more than 4,200 providers across all 15 U.P. counties, with some access extending into Lower Michigan, Wisconsin, and Minnesota.¹ Which plan you qualify for depends on your age, income, and whether you already have Medicare.

Which UPHP Plan You Qualify For

Medicaid and the Healthy Michigan Plan

The Healthy Michigan Plan covers adults 19 to 64 who live in Michigan and have household income at or below 133 percent of the federal poverty level. For 2026, that works out to roughly $21,227 for a single person and $43,890 for a family of four.²³ You can’t be enrolled in Medicare or another Medicaid program, and you can’t be pregnant at the time you apply.

MIChild

MIChild is Medicaid coverage for uninsured children under 19 whose families earn too much for regular Medicaid but still need affordable coverage. Children must live in the Upper Peninsula to enroll with UPHP.⁴

Medicare Advantage

UPHP’s Medicare Advantage plans are for people 65 or older, or under 65 with a qualifying disability, who live in the UPHP service area and are enrolled in both Medicare Part A and Part B. You can enroll during the Annual Enrollment Period from October 15 through December 7, or during a Special Enrollment Period if you move, lose other coverage, or have another qualifying life change.⁵

MI Coordinated Health (Dual-Eligible)

If you have both Medicare and full Medicaid, MI Coordinated Health is a Dual Special Needs Plan that combines the two into a single program with coordinated care management. You must be 21 or older, live in an eligible Michigan county (every U.P. county qualifies), and be enrolled in both Medicare and Medicaid.⁶

How to Enroll

Medicaid, Healthy Michigan, and MIChild enrollment all go through the Michigan Department of Health and Human Services. Apply online at michigan.gov/mibridges, call 1-855-789-5610, or visit a local MDHHS office. Once approved, you can select UPHP as your managed care plan.² For Medicare Advantage or MI Coordinated Health, enroll through UPHP directly during the applicable enrollment period.

What Each Plan Costs

UPHP does not charge copays or other out-of-pocket costs for covered Medicaid or Healthy Michigan services when you use an in-network provider.⁷ Healthy Michigan members with incomes between 100 and 133 percent of the federal poverty level do have some cost sharing, capped at 2 percent of annual income. Total cost sharing across all services cannot exceed 5 percent of household income, and you can reduce these amounts by completing a health risk assessment and healthy behavior activities.⁸

MI Coordinated Health charges no monthly premium (including your Part B premium), no deductible, and $0 out-of-pocket for medical services in 2026.⁹

Standard Medicare Advantage plans bundle Part A, Part B, and usually Part D drug coverage. Some plans have $0 monthly premiums, and many include supplemental dental, vision, hearing, telehealth, and gym benefits. The federal maximum out-of-pocket limit for 2026 Medicare Advantage plans is $9,250, though individual UPHP plans may set lower ceilings. Premiums and cost-sharing details vary by plan and change annually, so check the current Summary of Benefits before enrolling.

What’s Covered

Covered services under MI Coordinated Health include inpatient and outpatient hospital care, specialist visits, dental, vision, hearing aids, behavioral health, home health, and long-term supports and services. Specific benefit limits worth knowing:

Dental: one exam every six months; dentures and crowns every five years; sealants every three years.
Vision: one routine eye exam every two years and one pair of glasses every two years, with replacements available yearly if lost or broken beyond repair.
Hearing aids: covered once every five years.
Over-the-counter items: $42 per month loaded onto a NationsBenefits debit card, with unused amounts rolling over monthly through December 31, 2026.⁹

Prescription Drug Coverage

Drug coverage under MI Coordinated Health carries no deductible. Medicare Part D copays are tiered by your level of Extra Help: generic drugs run $0 to $5.10 for a 30-day supply, and brand-name drugs run $0 to $12.65. Once total drug spending on your behalf reaches $2,100, you enter catastrophic coverage and pay $0 for the rest of the year.⁹

Some medications need prior authorization before UPHP will cover them. That applies to drugs not on the formulary, prescriptions that exceed quantity or age limits, drugs where step therapy applies (meaning you have to try a preferred drug first), and brand-name prescriptions when a generic exists.¹⁰ Your doctor’s office usually handles the request. To see whether a specific drug is covered, use the formulary lookup on the UPHP website.

Using the Provider Network

Because UPHP is an HMO, you generally need to use in-network providers, and you pick a Primary Care Physician who handles routine care and referrals to specialists. The network covers all 15 U.P. counties plus some providers in Lower Michigan, Wisconsin, and Minnesota.¹ The website has a searchable directory, but availability changes. Before booking with a new provider, call UPHP at 1-800-835-2556 (TTY: 711) to confirm they are in-network and taking new patients.¹¹

If a MI Coordinated Health member is admitted to an out-of-network hospital for an emergency, UPHP requires notification within one business day, and continuing care after the emergency is stabilized needs UPHP’s approval.⁹

Rides to Appointments

Distances in the U.P. can be a real barrier to care, so UPHP offers non-emergency medical transportation to Medicaid and MI Coordinated Health members for covered services.¹² Two options are available:

Mileage reimbursement if you or someone you know can drive. You submit a reimbursement form with proof of the appointment within 12 months. A friend or family driver has to complete an attestation form before UPHP can pay.
Facilitated transport by bus, cab, or volunteer driver if you have no vehicle or driver. Submit requests at least five days ahead through the UPHP website or by calling 1-800-835-2556.¹²

UPHP covers up to 80 miles roundtrip for routine care available in your community. For appointments more than 200 miles away one way, the plan also helps with meal and lodging costs. A parent or guardian must travel with members under 18. For urgent trips with less than five days’ notice, call UPHP right away; they’ll try to arrange a ride and at a minimum will offer mileage reimbursement.¹²

Member Portal and Customer Service

Once enrolled, the UPHP Assist Member Portal is the easiest way to manage your coverage. You’ll need your Member ID (on your card) and date of birth to create an account.¹³ The portal lets you check eligibility, view medical and pharmacy claims, see or change your PCP, and request a replacement ID card.

UPHP Customer Service answers at 1-800-835-2556 (TTY: 711). Medicaid members can also reach a Nurse Advice Line at 1-877-615-2915 for after-hours clinical questions.¹¹

If UPHP Denies Something You Need

If UPHP denies, reduces, or ends a service you believe should be covered, you can appeal. Medicaid members have 60 calendar days from the written denial notice to file.¹⁴ MI Coordinated Health members have 65 calendar days.¹⁵ Standard appeals must be resolved within 30 calendar days. If waiting could seriously harm your health, request an expedited appeal, which UPHP must resolve within 72 hours. Medicaid members who lose their internal appeal can request an independent State Fair Hearing, and you have the right to keep receiving the disputed benefit while your appeal and hearing are pending.

Grievances cover complaints that aren’t about coverage decisions, such as quality of care, long wait times, or poor service. You have 60 calendar days from the incident to file. UPHP generally responds within 30 days, or up to 14 days longer if more information helps you. For a serious health risk, request an expedited grievance, which UPHP must answer within 24 hours.¹⁵ Medicare members can also file directly with Medicare at 1-800-MEDICARE.

1
Upper Peninsula Health Plan. 2026 UPHP Provider Manual
2
State of Michigan. Healthy Michigan Plan – Who Is Eligible
3
Federal Register. Annual Update of the HHS Poverty Guidelines
4
Upper Peninsula Health Plan. Medicaid 101
5
eCFR. 42 CFR Part 422 – Medicare Advantage Program
6
Michigan Department of Health and Human Services. MI Health Link
7
Upper Peninsula Health Plan. Medicaid Member Handbook
8
State of Michigan. Healthy Michigan Plan Frequently Asked Questions – Cost Sharing
9
Upper Peninsula Health Plan. MI Coordinated Health 2026 Summary of Benefits
10
Upper Peninsula Health Plan. Pharmacy Pre-Authorization Process
11
Upper Peninsula Health Plan. Member Resources
12
Upper Peninsula Health Plan. Non-Emergent Medical Transportation Rules
13
Upper Peninsula Health Plan. Member Portal Registration Guide
14
Michigan Department of Health and Human Services. Appeals and Grievances Technical Requirements
15
Upper Peninsula Health Plan. Coverage Decisions, Appeals and Complaints