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:
Annual special enrollment circumstances include, but are not limited to:
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.
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.
up to $285.00/Family
up to $975/Family
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|
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.
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
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.