Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and officially enforced in 2014. The intent of Obamacare was to increase access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient health insurance options, and requiring all U.S. citizens to have minimum health insurance coverage.
Obamacare’s Effect on Wisconsin Health Insurance
While Wisconsin is a state that did not support Medicaid expansion, they utilized the Affordable Care Act as a catalyst to restructure their Medicaid program. As a result, a large group of individuals now have access to affordable care. Because of their innovative approach, the uninsured rate in Wisconsin has dropped from 11.6% to 5.6%, which is well below the national average.
What Wisconsin Residents Should Know About Obamacare in Wisconsin
The Pros and Cons of Wisconsin Obamacare
Through an innovative approach to Medicaid, Wisconsin Obamacare has made health insurance coverage available to many that could not previously afford it. Instead of expanding Medicaid coverage, Wisconsin actually reduced coverage to a smaller qualifying poverty limit that matched the amount of subsidies that would be covered on the federal exchange. This shifted the expense from being on the Medicaid program to the federal government subsidies.
There have been criticisms of Obamacare in Wisconsin that while access to health insurance coverage has increased, the Wisconsin middle class has actually suffered significantly due to the increase in high deductible plans. In addition, there is a notable struggle in getting re-enrollments, especially for the healthy young adult population who would rather pay the fine for not having coverage than be responsible for monthly health insurance premiums they cannot afford. This can be seen by the number of enrollees that initially roll in a plan, only to then drop their coverage a few months later.
Obamacare Health Plan Categories and How Much You Will Pay
When shopping in the Wisconsin Obamacare Marketplace, there are four primary health plan categories you can choose from: bronze, silver, gold, and platinum. These categories determine the percentage of healthcare costs that the plan will pay during the span of an insurance year. The remaining percentage of your medical cost is what you will be expected to pay.
These percentage differences between plans will greatly impact how much you pay for care each year. For example, if the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay for the remaining 40%. While this plan will cost you less each month, it leaves you financially responsible for a larger dollar amount of your healthcare cost than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average percentage each plan pays for:
- Bronze plan - 60%
- Silver plan - 70%
- Gold plan - 80%
- Platinum plan - 90%
How do I sign up for Obamacare in Wisconsin?
The Wisconsin Obamacare Marketplace and exchange can be accessed through the federal government website or by calling (800) 318-2596.
What are the Obamacare Marketplace and exchange?
The Marketplace is a central location to shop for insurance options and enroll for selected coverage. In the case of Obamacare, Wisconsin utilizes a Federally-Facilitated Marketplace (FFM), which means that the U.S. Department of Health and Human Services operates and manages the Marketplace where public health insurance plans are offered.
Do I need to use an exchange?
To access public health insurance (Obamacare), you will need to go through the government exchange. The only exception to personally using the exchange to sign up for Obamacare in Wisconsin is if you are able to seek help from a Wisconsin certified counselor or a private insurance agent who can discuss your options and select a plan on your behalf, through the exchange.
How do I use an exchange?
You can use the exchange in one of four ways:
- Visit healthcare.gov
- Use the telephone support assistance available by calling (800) 318-2596
- Find a locally certified counselor
- Seek help from a private insurance agent
What does it mean to be on-exchange or off-exchange?
On-exchange generally refers to purchasing health insurance coverage from the Obamacare Wisconsin Marketplace while off-exchange normally refers to purchasing health insurance coverage from a private company. When you purchase off the exchange you forfeit your ability to qualify for government subsidies.
When is the Obamacare enrollment deadline and what do I do if I missed it?
The Obamacare open enrollment period for 2017 in Wisconsin is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short term individual private insurance to avoid a penalty.
What is the Obamacare penalty if I don’t buy health insurance?
If you do not buy Obamacare or other qualifying health coverage (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty.
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 years of age with a maximum of $2,085. You will pay whichever of the two options is higher.
The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
What if I cannot afford Obamacare?
If you cannot afford to pay for Obamacare coverage, you may be able to qualify for a government subsidy. For more information on government subsidies visit the HealthCare.gov website.
What are the alternatives to Obamacare?
Any health insurance coverage that meets the minimum essential coverage, as set forth in the Affordable Care Act, can be used, whether this coverage is received through an employer, private insurance company, or purchased through a private exchange.
There are several alternatives available when selecting coverage. You can select one of the available alternatives on the Marketplace, purchase one of the many options available on the private exchange, or see if you are eligible for subsidized programs through Wisconsin’s Medicaid program.
Obamacare Health Insurance FAQs
How Much Does Obamacare Cost in Wisconsin?
This is dependent on your income level, the type of coverage selected, age, and if you smoke.
Is there a way to decrease my Obamacare cost?
Your cost is impacted by the level of coverage that you select.
What if I can’t afford Obamacare? Is there Cost assistance?
Yes. If you are unable to pay for the cost of Obamacare coverage, you may find that you qualify for government subsidies. Subsidies depend on income and the number of family members in the household.
Does Wisconsin Obamacare cover pre-existing conditions like maternity, IVF, diseases or illnesses?
Yes, under the Affordable Care Act, it is illegal for health insurance companies to deny coverage due to pre-existing conditions.
Do I need to buy additional or supplemental insurance on Obamacare?
This depends on the level of desired coverage. You may want to pursue supplemental insurance for specific health scenarios.
Obamacare Health Insurance Plans vs COBRA
COBRA allows you to continue to utilize your previous employer's insurance plan regardless of your employment status for a designated period of time by paying the entire premium. This is generally not cost effective and a similar option can be purchased at a smaller dollar amount via the Federal Exchange.
I’m on Medicare, how does that impact me with Obamacare?
If you are on Medicare A, you are considered covered and do not need to seek additional coverage. Medicare B is not considered sufficient and additional coverage would need to be obtained.
How do I qualify for an Obamacare exemption?
There are a few exemptions available due to significant hardships. You can apply for exceptions status through the Federal exchange.
Obamacare, The Affordable Care Act FAQs
- What is Obamacare or the Affordable Care Act?
The Affordable Care Act was signed into law by President Barack Obama on March 23, 2010. The Affordable Care Act, often referred to as Obamacare, was intended to broaden affordable healthcare access to a larger population base and includes regulations that require all U.S. citizens to have minimum qualifying health insurance coverage as of 2014.
- Do I have to have Obamacare if I live in Wisconsin?
Since the enforcement of Obamacare, the Affordable Care Act, all U.S. Citizens are required to have a qualified health plan (includes minimum viable coverage) to avoid a tax penalty. This health insurance coverage can be purchased through a variety of vendors in a private or federal Marketplace.
- Where do I find the Obamacare plan options for Wisconsin?
The Federal Health Insurance Marketplace will contain the options for Wisconsin.
- How much does Obamacare cost in Wisconsin?
The cost of your Obamacare health insurance plan will depend on the tier of coverage you select. You can choose between the Bronze Plan (plan pays 60% of healthcare costs, you pay 40%); Silver Plan (plan pays 70% of healthcare costs; you pay 30%); Gold Plan (plan pays 80% of healthcare costs; you pay 20%), and Platinum Plan (plan pays 90% of your healthcare costs; you pay 10%). See more on the various tiers of Obamacare coverage here.
- What are government insurance subsidies and how do I qualify for them?
People that fit into the middle- or low-income tax bracket are eligible for government subsidies. These subsidies come in the form of tax credits. The amount of subsidy you are eligible to receive will be based on your income, the amount of people in your household, and the cost of the benchmark Silver Obamacare Marketplace plan in your region.
- What is the penalty for not having health insurance in Wisconsin?
The Obamacare penalty for not having health insurance coverage in 2016 is $695 per adult ($347.50 per child) or 2.5% of annual income claimed on a tax return without health insurance (whichever is larger). The health insurance penalty for 2017 will be similar, however the $695 flat fee will be adjusted for inflation.
- What if I missed the Obamacare Enrollment Deadline?
If you miss the Obamacare Enrollment Deadline, you will need to wait until the next Open Enrollment period or you may qualify for a Special Enrollment Period if you experience or have experienced a qualifying life event.
- How do I get an Obamacare quote?
The Federal Health Insurance Marketplace will allow you the ability to input your personal information and receive an Obamacare quote. You can access the Marketplace through the healthcare.gov website.
- What is an Obamacare exchange or marketplace, do I need to use it, and how do I use it?
The Wisconsin Obamacare Marketplace or Exchange is a service that allows you to compare and enroll for medical insurance in your state. It can be accessed through different websites (healthcare.gov), calling, or in person. You will need to use the Marketplace to apply for government subsidies.
- How do I know if I'm exempt from Obamacare in Wisconsin?
To be exempt from the Obamacare, or Affordable Care Act penalty in Wisconsin, you will need to fill out a hardship exemption form and file it with the Federal Health Insurance Marketplace. Some hardships that qualify for exemption include: homelessness, eviction or foreclosure, domestic violence, the death of a family member, a natural or human-caused disaster, or filing for bankruptcy. For other qualifying hardships, see the Federal Health Insurance Marketplace hardship exemption page.
- What information and documents should I have when I'm signing up for Obamacare?
To sign up for an Obamacare health insurance plan you will need documents that verify your annual income and United States citizenship.
- Where can I get help with my Obamacare application?
The Federal Health Insurance Marketplace can help you with your health insurance applications. You may also call the government's helpline for assistance at (800) 318-2596.
- What is a Navigator?
A navigator is an individual or organization that is required to be unbiased as they help consumers, small businesses, and their employees explore health insurance options in the Marketplace. Navigator services are free to the public. They are trained to offer guidance in many areas, including how to complete eligibility and enrollment forms.
- What does Obamacare cover in Wisconsin?
Obamacare, or the Affordable Care Act (ACA), states that health insurance companies must cover treatment associated with any and all medical conditions, these are called essential health benefits. Obamacare removes the ability of insurance companies to discriminate or deny coverage for any pre-existing medical condition. Additionally, once you are enrolled in an insurance plan, you cannot be denied coverage for any condition and your rates cannot be increased based upon your health. This coverage applies to pregnancy as well as pre-existing conditions. Learn more about what all Marketplace health insurance plans cover here.
- How can I decrease the cost of my health insurance in Wisconsin?
Your health insurance costs will be dependent on the type of health insurance plan that you select. Health insurance plan costs fluctuate based on monthly premium costs and deductibles. In most cases, if you have a higher monthly premium, your deductible will be lower. Alternatively, if you want a lower monthly premium cost, you can opt for a higher deductible. Learn more about how your deductible affects your monthly premium here.
- How do I find Obamacare plans?
You can find the qualified Affordable Care Act (Obamacare) health insurance options on the Federal Health Insurance Marketplace.
- Are Obamacare health insurance premiums tax deductible?
If you are self-employed, Obamacare health insurance premiums may be tax deductible.
- Do I need Obamcare if I already have other health insurance?
If your existing health insurance plan meets the minimum essential requirements of a qualified health plan, as determined by the Affordable Care Act, you can keep your existing plan and avoid the tax penalty.
- Where do I buy Obamacare if I live or work in two different states?
If you live of work in two different states, it is recommend that you look for multi-state federal health insurance coverage (Obamacare), which is available in the federally regulated Marketplace.
- Will short term insurance help me avoid the Obamacare penalty?
No, short term coverage does not meet the minimum viable coverage of a qualified health plan according to Obamacare, the Affordable Care Act (Obamacare). Without additional health insurance coverage you will be subject to an ACA tax penalty.
- How has Obamacare Affected Health Insurance in Wisconsin?
While Wisconsin is a state that did not support Medicaid expansion, they utilized the Affordable Care Act as a catalyst to restructure their Medicaid program and as a result, did not leave a large gap of individuals without access to affordable care. Because of their innovative approach, the uninsured rate has dropped from 11.64% to 5.6%, well below the National Average.
- Who runs Obamacare marketplace in Wisconsin?
The State of Wisconsin has a Federally-facilitated Marketplace. The Federally-facilitated Marketplace is administered by the federal government, under the Department of Health and Human Services (HHS).