Who Must Get Obama Care (the Affordable Care Act or ACA) in Wisconsin

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Do I Have to Get Obamacare in Wisconsin?

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Do I Have to Get Obamacare in Wisconsin?

Despite what you may have heard, you can’t be arrested or thrown in jail if you don’t have health insurance in Wisconsin. You may, however, be forced to pay a tax penalty if you aren't enrolled in a health insurance plan that meets the requirements of the Affordable Care Act.

To avoid the penalty, you must either obtain qualified health coverage or prove your eligibility for an exemption.

What Qualifies as Coverage?

If you have any of the following types of health coverage, you won’t have to pay a penalty:

  • an individual insurance plan, whether purchased on your own or through HealthCare.gov, the exchange serving Wisconsin
  • a plan (including COBRA or a retiree plan) provided by your employer
  • Medicare, Medicaid, or coverage under the Children’s Health Insurance Program (CHIP) 
  • TRICARE (coverage from the U.S. military)
  • coverage under a veterans health care program 
  • coverage through the Peace Corps

If you aren’t sure whether your current plan qualifies, talk to the plan provider.

What Doesn’t Qualify as Coverage?

Some types of health plans don’t meet the requirements for coverage under the Affordable Care Act (Obamacare). These include vision insurance, dental insurance, workers’ compensation, coverage that is limited to a specific condition, and plans that offer only discounted medical services.

Are You Exempt From the Obamacare Penalty?

Even if you don’t have insurance, you won’t have to pay the penalty if you qualify for one of the following exemptions:

  • You are uninsured for fewer than three months of the year.
  • You prove that you can’t afford coverage -- that is, premiums for a "bronze" policy cost more than 8% of your earnings.
  • You don’t have to file a federal income tax return because your income is too low.
  • You qualify for Medicaid under the new income limits established by the Affordable Care Act but, because Wisconsin has not expanded Medicaid eligibility, you cannot take advantage of these rules.
  • You are a member of a federally recognized Indian tribe.
  • You are a member of a health care sharing ministry.
  • You are a member of a recognized religion that objects to health insurance.
  • You are in the United States illegally.
  • You are incarcerated.

You may be eligible for an exemption under other circumstances, as well -- for instance, if you can show that obtaining coverage would subject you to serious financial hardship. Qualifying financial difficulties may include homelessness, eviction, domestic violence, death of a loved one, a medical emergency, or a natural disaster. 

You can apply for a financial hardship exemption at HealthCare.gov.

In addition to determining eligibility for a hardship exemption, HealthCare.gov can certify other exemptions listed above, such as incarceration or membership in a qualifying group. However, several of the exemptions listed above may be claimed only at the time you file your taxes. These exemptions are lack of affordable coverage, income below the tax filing limit, unlawful presence in the United States, or a coverage gap of less than three months.

You can apply for more than one exemption at the same time.

Learn More

For information about how the Obamacare tax penalty works and how much you may owe if you're not insured, see How Much Is the Obamacare Tax Penalty?

To find out how to obtain coverage, see How to Sign Up for Obamacare in Wisconsin.

For information about costs, see How Much Does Obamacare Cost in Wisconsin?

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