Wisconsin Affordable Care Act Comprehensive Guide
In this article, you will learn about the Affordable Care Act health care reform laws in Wisconsin. You will get an understanding of how the health care law impacts you as a citizen of the state. Learn how to sign-up for the Affordable Care Act, learn about the Affordable Care Act penalty and subsidies, and much more.
Contents
What is Wisconsin Affordable Care Act?
Affordable Care Act, also known as Obama Care, was signed into law in March 2010. The goal of the Affordable Care Act is to provide US citizens with affordable health insurance and to reduce the cost of health care spending for families and in America.
The Key Points of the Affordable Care Act / Wisconsin Obamacare:
- Improving Quality and Lowering Health Care Cost
- Access to Affordable Health Care
- New Consumer Protections
- Individual Mandate | Employer Mandate
- Minimum Essential Coverage for each Health Insurance Plans
How to Apply for Wisconsin Affordable Care Act?
Wisconsin Affordable Care Act marketplace is run by the Federal government. Click on HealthCare.gov to access Wisconsin Affordable Care Marketplace. You can preview the different insurance plans and see participating doctors before selecting the final health insurance plan.
| State | Federal or State Marketplace | Website | Medicaid Expansion? |
|---|---|---|---|
| Wisconsin | Federal | www.HealthCare.gov | No |
When can I apply for Wisconsin Affordable Care Act (Wisconsin ACA)?
Wisconsin Affordable Care Act’s Open Enrollment starts on November 1 and ends on December 15. To have health insurance coverage beginning in the following year, you must apply before the December 15 deadline.
In order to qualify for Tax Credit or Premium Tax Subsidies, you must purchase health insurance from the Affordable Care Act Marketplace during the Open Enrollment period.
If you qualify for Wisconsin Medicaid health insurance, then you can sign-up for Medicaid any time of the year.
When is the deadline for Wisconsin Affordable Care Act (WI ACA)?
Important dates for Wisconsin Affordable Care Act deadlines: The absolute last day to purchase health insurance from the Marketplace is December 15.
- November 1: First day to enroll in or change plans for new insurance
- December 15: Last day to enroll in or change plans for new coverage to start the new year
How much is Wisconsin Affordable Care Act?
There are four different plans within the Wisconsin Affordable Care Act. The metal plans represent the various levels of coverage you receive and what the plan pays on average. The plan levels DO NOT represent the quality of the health coverage/doctors you receive.
- Bronze Plan: The plan pays 60% of the cost, you pay 40% of the cost
- Silver Plan: The plan pays 70% of the cost, you pay 30% of the cost
- Gold Plan: The plan pays 80% of the cost, you pay 20% of the cost
- Platinum Plan: The plan pays 90% of the cost, you pay 10% of the cost
The cost of the Affordable Care Act in Wisconsin depends on the metal plan you choose and the number of people in the household. Platinum plans have the highest insurance premiums (monthly cost) and Bronze plans have the lowest insurance premiums.
What are the Wisconsin Affordable Care Act Eligibility Requirements?
In order to get Wisconsin Affordable Care Act, you must meet the following requirements:
- Must live in Wisconsin
- Must be a US citizen, national, or lawfully present, immigrant
- Cannot be currently incarcerated (be in jailed)
- Have a valid Social Security Number
- and few other requirements
Do I need to get Wisconsin Affordable Care Act?
Yes, every individual in Wisconsin needs to have health insurance. The Individual Mandate of Affordable Care Act health care law requires US citizens to enroll in a health insurance plan or pay a penalty. If you have Medicaid or company-sponsored health insurance, you have met the insurance coverage requirement.
You can choose not to have health insurance, but you have to pay the penalty in addition to the hospitals/doctor’s medical fee if you do get sick.
How much is the Affordable Care Act Penalty in Wisconsin?
The penalty (or also called individual shared responsibility payment) is calculated in two ways.
Starting in the 2019 tax year, there is no longer a penalty for not having health insurance.
From 2016-2018, the ACA penalty is as follows:
- By percentage of income (2.5% of household income or a maximum of National Average Bronze plan premium)
- By number of people in the household ($695 per adult, $347.50 per child, or maximum $2085)
You’ll pay whichever penalty is higher.
How much are Wisconsin ACA Subsidies? What are the requirements?
Affordable Care Act Subsidies are also called, “Premium Tax Credits.”
ACA subsidy lowers your premium – the amount you pay each month to your insurance plan. The amount of your ACA Subsidy depends on the estimated household income that you put on your ACA Marketplace application.
In order to qualify for the Affordable Care Act Subsidy, your income must be between 100% to 400% of the Federal Poverty Level.
| Federal Poverty Level | Insurance Premium After PTC Subsidy |
|---|---|
| Up to 133% FPL | 2% of income |
| 133-150% FPL | 3%-4% of income |
| 150-2000% FPL | 4%-6.3% of income |
| 200-250% FPL | 6.3%-8.05% of income |
| 250-300% FPL | 8.05%-9.5% of income |
| 300-400% FPL | 9.5 of income |
| Over 400% FPL | No Government Subsidy |
Medicaid Expansion under the Affordable Care Act
With the new health care reform, the Federal government offered incentives for states to expand the Medicaid program. 30 states out of the 50 states plus Washington DC expanded Medicaid program while 20 states decided not to expand Medicaid due to expected future cut back funding from the Federal government.
Wisconsin did not expand the Medicaid program under the Affordable Care Act Health Care Reform as of 2015/2016.
| State | Medicaid Expansion |
|---|---|
| Wisconsin | No |
Insurance Companies that offer Affordable Care Act Health Insurance Plans in Wisconsin:
The following insurance companies are offering Affordable Care Act Plans in the Marketplace.
- All Savers Insurance Company (UnitedHealth Group)-2015
Arise (WPS Health Plan, Inc.),
Common Ground Healthcare Cooperative (CO-OP)
Compcare Health Services Insurance Corp
Dean Health Plan, Inc.
Group Health Cooperative of South Central Wisc.
Gundersen Health Plan, Inc.
Health Tradition Health Plan
Managed Health Services Insurance Corp
Medica Health Plans of Wisconsin
MercyCare HMO, Inc.
Molina Healthcare of Wisconsin, Inc.
Physicians Plus
Security Health Plan of Wisconsin, Inc.
Frequently Asked Questions (FAQ) on Wisconsin Affordable Care Act:
- Who runs the Wisconsin Affordable Care Act? Federal
- Where can I sign up for Wisconsin Affordable Care Act? Click here
- Do I need to get health insurance or the Affordable Care Act? Yes, if not, you have to pay a penalty.
- How much is Wisconsin Affordable Care Act? Click here for the average ACA premium
- Did Wisconsin expand Medicaid under the Affordable Care Act? No
Click here for more Frequently Asked Questions on Obamacare / Affordable Care Act.
For more information on Wisconsin Obamacare / Affordable Care Act:
Federal HealthCare.Gov Marketplace
Toll-Free: 1-800-318-2596
Website: HealthCare.gov
Wisconsin Office of the Commissioner of Insurance
125 South Webster Street
Madison, WI 53703
Toll-Free: (800) 236-8517
TDD: Dial 711 and ask for (608) 266-3586
http://oci.wi.gov/consinfo.htm
ocicomplaints@wisconsin.gov
If you have a hard time affording health coverage and have questions about Medicaid eligibility or benefits, go to:
Wisconsin Department of Health Services
1 West Wilson Street
Madison, WI 53703
Toll-Free: (800) 362-3002
TTY: 888-701-1251
http://www.dhs.wisconsin.gov/medicaid/
Wisconsin’s five largest cities in terms of population: Milwaukee, Madison, Green Bay, Kenosha, and Racine. You can apply for Affordable Care Act Health Insurance in any city in Wisconsin.