Wisconsin Obamacare

Wisconsin Obamacare Home Page


What Wisconsin Residents Need to Know About Obamacare

On this website, you'll find clear and accurate information about getting health insurance under the Affordable Care Act (ACA), including:

  • whether or not you must get health insurance
  • what the available plans cover
  • how much coverage will cost
  • how to sign up for a plan, and
  • how to get help if you need it.

To begin, keep in mind these key points about health insurance in Wisconsin:

1. Obamacare, officially known as the Affordable Care Act, has not been repealed.

The Affordable Care Act is still U.S. law. On May 4, 2017, House Republicans passed a bill to repeal and replace the ACA, called the American Health Care Act. That bill will become law only if the Senate also approves it. Unless and until that happens, the Affordable Care Act is the law of the land.

2. You are legally required to have health insurance unless you qualify for an exemption.

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Republicans’ Obamacare Replacement Plan: The American Health Care Act

On May 4, 2017, House Republicans passed a bill called the American Health Care Act (AHCA). The law is designed to repeal and replace the Affordable Care Act (ACA), also known as Obamacare. The bill will now move on to the Senate for consideration. Only if the Senate passes the bill will it become U.S. law.

Here are some important things to know about how the current version of the AHCA would work.

The tax penalty for going without health insurance would disappear, but you’ll pay more if you let your coverage drop. The AHCA does away with Obamacare’s controversial “individual mandate,” which requires most Americans to get health insurance or pay a penalty. Instead, you would be required to maintain “continuous coverage.” If your health insurance lapses for more than 63 days, insurers can add a 30% surcharge when you next seek coverage. The boosted price would stay in effect for a full year before dropping to the standard rate.

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How Much Does Obamacare Cost in Wisconsin?

This article explains the costs of health care plans offered under Obamacare (the Affordable Care Act) for individuals or families who are currently uninsured or not covered by a job-based health plan.

What you'll pay for an Obamacare plan depends on five things:

  1. The level of coverage you choose
  2. Whether you qualify for a subsidy
  3. Where you live in Wisconsin
  4. Your age
  5. Whether you smoke

Read on to learn more about each of these factors. 

1. The Level of Coverage You Choose

Obamacare insurance plans offer four levels of coverage, commonly called "metal levels":

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How Do I Sign Up for Obamacare in Wisconsin?

The easiest way to sign up for a health plan under the Affordable Care Act is to go to the online health insurance marketplace for Wisconsin. If you're not ready to enroll right now, you can get more information online, over the phone, or in person.

Where's the Wisconsin Health Care Exchange?

You can find the health insurance exchange for Wisconsin at HealthCare.gov. This is where you can learn about the various health insurance options available to you under Obamacare. If you see a plan you like, you'll be guided through the enrollment process online.

You might not see any mention of Obamacare or the Affordable Care Act when you visit the exchange website, but rest assured you’ve landed in the right place. The exchange was established solely for the purpose of informing consumers about the Affordable Care Act and providing plans under the law.

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What Happens If I Missed the Wisconsin Obamacare Enrollment Deadline for 2017?

For 2017, open enrollment for health insurance under the Affordable Care Act ended on January 31. That means it’s too late for most people to use a health insurance exchange to get coverage for 2017.

If you let the ACA deadline pass you by this year, here are some things to know.

You Can Still Enroll If You Qualify for a “Special Enrollment” Period

Certain life events make you eligible to sign up for health insurance outside of open enrolllment. The circumstances under which you may qualify for special enrollment include:

  • moving to a new state
  • having a baby or adopting a child
  • getting married or divorced
  • leaving a job and losing your insurance
  • losing coverage under your parents’ plan
  • losing coverage because someone on your plan has died
  • losing other types of health insurance
  • gaining status as a member of an Indian tribe
  • becoming an American citizen, or
  • getting out of prison.

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What to Do If You're Frustrated or Fed Up With Applying for Wisconsin Obamacare Through HealthCare.gov

As Obamacare enters its fourth open-enrollment period, one would hope the health insurance application process would be as simple and fast as it was originally intended to be. But, for many, streamlined health plan enrollment and renewal -- not to mention truly affordable coverage -- still seems like a faraway goal.

Below are a couple strategies to keep your application moving forward and get your health insurance needs met.

Common Complaints from Health Insurance Applicants

The list of complaints from those caught in the health exchange bureaucracy is long, commonly including:

  • exchange websites are still buggy or broken
  • phone and chat hold times are unreasonable, and representatives often don’t have helpful answers to questions
  • applicants can’t easily compare health plan benefits and costs
  • applicants can’t figure out whether their current health care providers are included in the plan they’re considering
  • applicants choose plans only to discover later that they can’t afford them
  • application information isn’t recorded properly (or protected from privacy violations) by the health care exchange
  • exchanges are slow to respond to problems with applications, premium payments, or tax forms, and
  • health insurance plans are sometimes canceled or changed without notice.

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Obamacare and Taxes: What You Need to Know Before You File

Do you have to worry about IRS Forms 1095, 8965, or 8962? The Affordable Care Act, aka Obamacare, requires you to do one of the following three things when you file their taxes this year:

  • confirm they had health insurance coverage for 2016
  • claim an exemption from health coverage, or
  • pay a penalty when they file their return.

This remains true even though the Trump administration has issued an executive order allowing the IRS to accept tax without health insurance disclosures. Under the Affordable Care Act, you are still required to pay any Obamacare tax penalty you owe, and the IRS may question you if you fail to report your health insurance status on your tax return. The new rule does, however, imply that the Trump administration may not aggressively pursue people who don't pay their penalties.

Here’s what you should know about filing your taxes in this confusing era of health insurance reform.

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Understanding Obamacare's Preventive Health Care Benefits

Get a colonoscopy, mammogram, vaccinations, and other essential services for free

The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through HealthCare.gov, the health care marketplace for Wisconsin. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.

Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges

Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.

Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.

Know the difference between “preventive” and “diagnostic.” Doctors can use screening tests for either preventive or diagnostic reasons. For example, having a routine mammogram every year or two is preventive care for women over 40. But if you schedule a mammogram because you feel a lump or have breast pain, that’s diagnostic. Likewise, a routine colonoscopy is recommended for adults over 50, but if your doctor schedules a colonoscopy to investigate a problem like blood in your stool, it becomes a diagnostic procedure. Preventative services are free; diagnostic procedures are not. (If the timing is right -- say, you go to the doctor because you find a lump in your breast but you also happen to be due for an annual mammogram -- your doctor may bill the diagnostic procedure as preventive, but that’s not something you can count on.)

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Medicaid Expansion: Can I Use Medicaid to Satisfy the Health Insurance Requirement in Wisconsin?

One way to satisfy the Obamacare requirement that you have health insurance is to obtain coverage under Medicaid. If you qualify for Medicaid and enroll in Wisconsin's Medicaid program, you do not have to sign up for another insurance plan.

Wisconsin Has Not Expanded Medicaid

The Affordable Care Act expanded Medicaid eligibility to cover more people who can’t afford health insurance. The U.S. Supreme Court later decided that it was up to individual states to decide whether or not to expand Medicaid.

Wisconsin rejected federal funding to expand Medicaid under Obamacare, but the state is unique in that its Medicaid program -- called BadgerCare -- covers all state residents with incomes that do not exceed 100% of the federal poverty level. That makes Wisconsin the only non-Medicaid-expansion state that does not have a coverage gap. If you are a low-income Wisconsin resident, you should either qualify for BadgerCare or be eligible for subsidies to help you purchase health insurance at HealthCare.gov.

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Obamacare for Self-Employed Wisconsin Residents

Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest hassles they face. But this may change for the better under Obamacare, which provides new coverage options for the self-employed.

Are You Self-Employed or an Employer? 

Before you start evaluating your options for health coverage, you need understand whether you are in fact considered self-employed under Obamacare.

The law says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) Self-employed people can use the new health care marketplace to purchase individual health insurance plans.

If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace.

If you aren’t sure whether the people who work for you are independent contractors or employees, read "Independent Contractor (Self-Employed) or Employee?" on the IRS website.

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How Obamacare Affects Unemployed Wisconsin Residents

The difficulties of unemployment are often compounded by the lack or loss of health insurance. But millions of Americans who are currently without both a job and health coverage may find relief under Obamacare. That's because new coverage options are now available through HealthCare.gov, the health insurance marketplace serving Wisconsin.

All plans available through the marketplace offer essential medical benefits, including preventive care, emergency services, and prescription drug coverage. You can't be turned away if you have a pre-existing medical condition and, as an unemployed person, you probably qualify for significant cost-saving subsidies.

When you sign up for a marketplace health plan, your coverage can start within a few weeks. Usually, you must sign up during an open enrollment period. (For 2016, open enrollment ends on January 31.) But leaving your job and losing job-based health insurance makes you eligible for a special enrollment period. That means you'll have 60 days to sign up for a new health plan. 

Here's an overview of your options for health insurance if you are unemployed, plus more information about what might happen if you don't get health coverage. (And if you're looking for information about applying or eligibility for unemployment, see our articles on Wisconsin unemployment benefits.)

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What Domestic Partners Need to Know About Applying for Health Insurance Under Obamacare

When registered domestic partners or civil union partners apply for coverage in the new health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes, or must we include all the income we make as a couple?

The answer depends on the state where you live.

States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)

California, Nevada, or Washington. In these states, which extend community property laws to registered domestic partners, domestic partners must usually apply using half of the partners’ combined incomes. (We confirmed this with the legal department at Covered California after repeatedly receiving conflicting information from representatives staffing the exchange’s customer service phone line.) This is because IRS rules require that domestic partners registered in these community property states report half of their combined community income on their federal taxes each year.

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Wisconsin Health Care Subsidies Upheld By U.S. Supreme Court: King v. Burwell

Updated June 25, 2015

The U.S. Supreme Court has upheld health care subsidies for residents of Wisconsin and other states that rely on HealthCare.gov, the federal government’s health insurance exchange. As described below, King v. Burwell could have ended tax-credit subsidies for states that use the federal marketplace to facilitate the purchase of health insurance plans under Obamacare.

The 6-3 ruling means that almost 6.5 million Americans will continue to receive the financial assistance that helps them afford health insurance.

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Can I Use a Paper Application to Get Obamacare?

When Obamacare launched, the federal and state health insurance marketplaces (also called “exchanges”) were plagued by technical troubles. Many people who tried to sign up for new health insurance plans online in the early days were unable to complete their applications.

Because of these difficulties, some individuals and application assistants turned to the old-fashioned way of getting health insurance -- paper applications.

Applying on Paper May Not Be Better or Faster

When facing a slow or broken online health insurance exchange, using a paper application may seem tempting -- at least it would provide the feeling of getting something done. However, paper forms may not speed up the process at all. On the contrary, they could slow down your application even more.

The worker who reviews your paper application must manually enter the information from your forms into the same system you would use online at your state’s exchange. It won’t work any faster for them than it does for you. Plus, using a paper application opens up more opportunity for error by putting more people between you and your goal of getting insurance.

It’s still best to apply online if you can. That said, if you feel that you’re unlikely to come back and apply for health insurance later, you may want to go ahead and complete a paper application now. Follow these steps to apply on paper.

How to Get a Paper Application for Obamacare

If you want to use a paper application to apply for coverage under the Affordable Care Act, you have a couple of options:

  • If you live in a state that uses the federal health insurance marketplace -- or in a state that operates its own exchange and provides a link to a downloadable paper form -- you can get the forms right now.
  • In any state, you can call the health insurance exchange customer service center or contact an in-person assister -- such as a navigator, certified application counselor, or certified agent or broker -- to get a paper application and help filling it out.

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About This Website

We built this website to get people the answers they need about the Affordable Care Act (Obamacare). Our goal is to guide you to reliable, local information about your new health insurance options.

When you choose your state or enter your zip code above, you will quickly learn:

  • whether or not you're required to get health insurance

  • what the available plans cover

  • how much coverage will cost, and

  • how to sign up in your state.

For those concerned about cost, we show you how to determine whether you qualify for subsidies. We also explain the rules about expanded Medicaid eligibility.

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