Marketplace Coverage for Individuals & Families

 

Your Options now that Open Enrollment is Over

Open Enrollment is now over and you only have a couple of options for getting health insurance prior to January 1, 2016.


1. Apply with a Special Enrollment Period (SEP) -

The latest SEP will allow consumers to purchase a qualified health plan from March, 15th - April, 30 2015.  View the press release here.

 To qualify for this SEP you must:

  • Reside in a state with a federally facilitated Marketplace (like WI)

  • Not be enrolled in coverage through the Marketplace for 2015

  • Attest you paid the penalty for not having a health plan in 2014

  • Attest that you first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment on Feb. 15, 2015, in connection with preparing your 2014 taxes.

  • Annual special enrollment circumstances include, but are not limited to:

  • Marriage

  • Having a baby

  • Adoption

  • Foster Care Placement

  • Gaining citizenship

  • Leaving incarceration

  • Gaining status as member of an Indian tribe.

  • Moving outside your coverage area

  • Losing other health coverage due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP.

  • For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

  • IMPORTANT: Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.  From the date of the special circumstance you will only have 60 days to take advantage of your SEP and enroll in coverage.

    2. Apply for Medicaid and CHIP – There is no specific enrollment period for these programs so if you qualify you can apply at any time.  To find your local office please click here.

    3. If you are member of a federally recognized tribe or Alaskan Native shareholder, you can enroll at any time of the year.

    4. Contact your team at Wisconsin Benefit Planning for other options including Short Term Health Plans.

     

    Penalty Fees


    As part of the Affordable Care Act, if you do not have minimum essential coverage you must either pay a fee or have an exemption from paying the fee. The following table illustrates the costs that you will be required to pay when you file your tax returns.  Reasons for possible exemptions from paying these fees can be found by contacting us at 715-356-2300 or visiting www.healthcare.gov.

    2014

    2015

    2016

    $95.00/Adult
    $47.50/Child
    up to $285.00/Family
    $325.00/Adult
    $162.50/Child
    up to $975/Family
    $695.00/Person

     OR 1.0% of family income whichever is greater

    OR 2.0% of family income whichever is greater
    OR 2.5% of family income whichever is greater


    ** If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you’re uninsured for less than 3 months, you don’t have to make a payment.

    It's important to note that even if you pay the penalty fee you are NOT covered with health insurance and are responsible for 100% of your medical costs.

    There are some exemptions that will allow you to not  have to pay the fine.  Visit www.healthcare.gov for more information.

     

    2016 Open Enrollment 

    The 2016 Open Enrollment period will begin on November 1, 2015 and will end on January 31st, 2016.  Please note that the earliest you can receive coverage will be January 1st, 2016.  The chart below lists the days you need to enroll for specific start dates.

     Requested Coverage Start Date  Time Frame to Enroll
    January 1st, 2016 11/01/2015 - 12/15/2015
    February 1st, 2016 12/16/2015 - 01/15/2016

    Source: www.healthcare.gov

     

     

    The Marketplace Basics   

    What is a Health Insurance Marketplace?  A Health Insurance Marketplace (also known as an Exchange) does not provide insurance, rather they make sure the insurance carriers provide plans that meet Federally mandated requirements.  They also allow consumers to pay for their insurance based on their income.  Each state determines if they will have their own Exchange or if they will use the Federal Facilitated Marketplace, otherwise known as the FFM.  In Wisconsin our Marketplace is part of the FFM.

    Who can buy coverage through a Health Insurance Marketplace?  Everyone can however there are exceptions on who can receive the tax credits or subsidies.   

    You only need to use the Health Insurance Marketplace if you expect to qualify for a tax credit (“subsidy”) to reduce your premium. If you don’t qualify for a subsidy, we can help you buy coverage directly from the insurance company of your choice (during open enrollment or if you qualify for a Special Enrollment Period). Remember that you are guaranteed coverage, whether you buy a plan on the Marketplace or off, and that you cannot be charged more because of a pre-existing condition.

     

    Income Guidelines

    Savings depend on 2015 income and family size - If your 2015 income falls within the following ranges you'll generally qualify for a premium tax credit.  The lower your income within these ranges, the bigger your credit. If your income falls below the range you will more than likely be asked to apply for the State Medicaid Program (commonly referred to as BadgerCare).

     

     Family Size

    Family MAGI Income (Modified Adjusted Gross Income)


     1  $11,670 - $46,680
     2  $15,730 - $62,920
     3  $19,790 - $79,160
     4  $23,850 - $95,400
     5  $27,910 - $111,640
     6  $31,970 - $127,880
     7  $36,030 - $144,120
     8  $40,090 - $160,360

     

     

     

    Things to consider:

    Start looking at plans available in your area to learn more about your coverage options. There are a number of ways to do this:

     

    Ø Visit the “Plan Preview” section of the Marketplace website 

           (www.healthcare.gov). 

    Ø Visit the websites of the insurance companies in your area and browse 2015

           plans for detailed information.

    Ø Contact us to help you understand what is available and help you enroll.

     

    Remember, as you browse plans, it’s a good idea to study both the provider directories and drug formularies for the insurers you’re considering.

     

     

     

     

     

     

     

     

     

    Marketplace Application

    Marketplace Application Instructions

     

    Click here to see plans & prices available in your area and to enroll direct.