Obamacare and Wisconsin Health Insurance

Obamacare and Wisconsin Health Insurance

obamacare wisconsin

The Affordable Care Act, better known as Obamacare, is revolutionizing how health insurance is purchased and delivered in Wisconsin. It has resulted in higher coverage rates at reduced costs as well as more people receiving preventive care services.

As part of the Affordable Care Act (ACA), most Wisconsin consumers qualify for premium subsidies when enrolling in Marketplace plans through this state’s marketplace. These subsidies include cost-sharing reductions (CSRs) and advance premium tax credits (APTC).

How the law is affecting Wisconsin

Wisconsin stands out as an important state to monitor, as its uninsured rate in its large cities is particularly high. Thankfully, the Affordable Care Act is helping address this problem.

Many uninsured people are now receiving coverage through the Affordable Care Act Marketplace, with most qualifying for premium tax credits and cost-sharing reductions. Now, with the newly enacted Inflation Reduction Act of 2022 extending these enhanced subsidies through 2025, many more uninsured people could potentially access care – providing another opportunity to further build enrollment gains.

Though health insurance enrollment and access remain key goals in Wisconsin, certain barriers remain that impede enrollment and access. These include policies such as the Affordable Care Act Family Glitch or restrictions related to immigrants as well as various factors which make meeting healthcare needs or affording premiums difficult for some residents.

Wisconsin also features several Consumer Operated and Operated Plans (CO-OPs), health insurance cooperatives that offer low-cost coverage to some individuals and groups who do not have access to coverage through their jobs or another source. About 20% of Wisconsin residents can avail themselves of such coverage.

BadgerCare

BadgerCare is a state-run health insurance program designed to give low-income families with children access to coverage based on income and asset guidelines that comply with federal rules.

As part of the Affordable Care Act, Wisconsin broadened eligibility for BadgerCare coverage to adults whose income falls within 100 percent of the federal poverty level (FPL). Furthermore, parents and caretakers saw their eligibility reduced from 300% FPL to 100% FPL.

Wisconsin created and implemented the ForwardHealth Portal website to assist consumers with understanding their options under the Affordable Care Act (ACA). This resource offers detailed information about health plans available across Wisconsin as well as enrollment assistance resources.

As of March 20, 2019, 212,209 Wisconsin residents had selected health plans through the Marketplace and 88% qualified for premium subsidy assistance.

Marketplace

The Marketplace (also referred to as health insurance exchange) is where individuals and families can shop for and purchase an eligible plan under the Affordable Care Act (ACA). People without access to health coverage through employers, Medicare or Medicaid can shop there for coverage.

The federal government also offers financial assistance in the form of premium tax credits to help people pay their premiums. You can claim these subsidies on your income taxes.

To qualify for Marketplace plans premium tax credits, you must meet income and family size eligibility requirements. Our Premium Tax Credit Change Estimator can help you assess how changing circumstances could impact your premium tax credit amount.

People living in rural Wisconsin value access to Marketplace coverage even more than people elsewhere in Wisconsin; 17 out of the top 20 counties with the highest proportion of Marketplace users are rural counties.

Medicare

Medicare provides healthcare coverage for senior citizens and people living with disabilities. Medicare usually covers most costs associated with doctor visits, hospital stays and other forms of medical assistance.

Obamacare set up Marketplaces as private health plans designed to offer affordable coverage to low-income and uninsured Americans, as well as providing tax credits that will assist individuals in affording it.

Individuals without employer-based coverage can purchase health insurance plans on the Marketplace and those who qualify for special enrollment periods can do so outside of Open Enrollment. Some states also have short-term health insurance markets that provide temporary coverage solutions.

Many Wisconsin residents enrolled in Original Medicare also purchase a Medigap plan to cover out-of-pocket medical costs like copayments, coinsurance and deductibles. As prices can range between hundreds of dollars, it is wise to shop around to find the most cost-effective plan.

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About the Author: Raymond Donovan