Wisconsin Affordable Care Act Facts 2020

The Affordable Care Act, also known as Obamacare, has not been struck down or repealed.

As of January 2020, the ongoing federal court case challenging the ACA is still moving through the courts. The penalty for being uninsured has been struck down but the rest of the law remains in effect.

This website provides information about getting health insurance under the Affordable Care Act (ACA), including:

• whether you must get health insurance
• what the available plans cover
• how much coverage will cost
• how to sign up for a plan
• how to get help if you need it.

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

1. Open enrollment has ended for 2020 health care plans, but you can still get health insurance if you qualify for a special enrollment period.

In Wisconsin, the ACA open enrollment period ended on December 18, 2019. This means that, unless you qualify for an exception, you won't be able obtain health insurance through HealthCare.gov until the 2021 open enrollment period begins in the fall of 2020.

To learn whether you qualify for an exception that will let you get covered, see What Happens If I Missed the Wisconsin Obamacare Enrollment Deadline?

2. You won’t face a tax penalty for going without health insurance in 2020—but there are big downsides to being uninsured.

Obamacare’s tax penalty went away in 2019. That means that if you didn’t have health insurance coverage in 2019, you won’t have to pay a penalty when you file your taxes in this year.

Even though there's no more tax penalty, think hard about whether it makes sense to forego health insurance. A medical crisis could knock the financial wind from your sails and do more damage than the penalty would. (A study published in 2019 showed that a lapse in health insurance coverage can double a person's chances of ending up in bankruptcy.) Even if you've missed open enrollment for 2020, special circumstances may allow you to obtain coverage.

3. Your health insurance marketplace is located at HealthCare.gov.

During open enrollment, or whenever you qualify for an exception, you can use the website HealthCare.gov to choose your health insurance plan, apply for cost-saving tax credits, and get other help you need.

To learn more about enrollment, see How Do I Sign Up for Obamacare in Wisconsin?

4. More insurers have joined the marketplace and premium rates are stabilizing.

It may surprise you to learn that, after a couple years of bad news about insurers bailing out of the marketplace, many insurers are coming back and new providers are signing up. What may be even better, monthly premiums are stabilizing.

A deep dive into 2020 health insurance rates shows the national average premium cost remaining flat:

The biggest story surrounding 2020 ACA premium changes is that there’s literally no story of crazy rate changes, at least nationally. While there are wide variances from state to state and carrier to carrier as happens every year, when you average them all together nationally, unsubsidized 2020 premiums are expected to be FLAT compared to 2019 pricing. — Charles Gaba, HealthInsurance.org

5. Premium subsidies are available to save you money.

Several forms of financial assistance can help you lower your health insurance premiums.

Fedral tax credits. The federal government provides help with premium payments for those whose incomes fall between 100% and 400% of the federal poverty level. For 2020, for example, a family of four earning as much as $103,000 can qualify for subsidies, as can an individual who earns up to $49,960. Though the subsidies are tax credits, they are automatically deducted from the cost of your premiums each month, as long as you purchase your plan through HealthCare.gov.

Cost sharing reductions. More than half of the people who purchase coverage through a health insurance exchange receive "cost-sharing reductions" (CSRs). Originally, these were payments the federal government made to insurance companies that allowed them to reduce deductibles and co-payments for lower-income Americans. In 2017, the Trump administration stopped paying for CSRs, but insurers and many state regulators found a creative way keep the program alive—adding the costs to silver marketplace plans through a practice called “silver loading”—so CSR benefits remain available for 2020 insurance plans.

Keep in mind that cost-sharing subsidies are available only on silver plans. They will automatically reduce your premium if your income as no more than 250% of the federal poverty level. (For 2020, that means a family of four can't earn more than $64,375 and an individual not more than $24,980.) If you think you may qualify, look carefully at costs for the silver plans available at HealthCare.gov while you are shopping for coverage.

Medicaid. If your income is very low, you may qualify for free or low-cost coverage through Medicaid in Wisconsin.

For more information, see Ways to Save Money on Obamacare in Wisconsin.

6. Beware insurance plans that don’t comply with the ACA!

In 2018, the Trump administration made it easier to purchase "short-term insurance plans" and a federal court recently upheld this move. Short term plans don’t have to cover preexisting conditions or the essential health benefits provided by Obamacare plans. In the past, short-term plans were allowed to last only three months but under new rules you can purchase a non-ACA compliant “short term” plan that lasts as long as three years.

If you’re genuinely caught without health insurance and need it for a few months to cover a new health condition, you might want to consider a true short-term plan to get you through to the next open enrollment period. Otherwise, be careful of plans that don’t meet the requirements of the Affordable Care Act and shop around to look for coverage that truly meets your needs.

Remember, if your income is very low, you may qualify for free or low-cost coverage through Medicaid in Wisconsin.

7. You can get help signing up if you need it.

A couple years back, the Trump administration drastically cut funding for  programs that provide help with health insurance enrollment. It also killed the budget for promoting the federal health insurance exchange. But that doesn't mean you have to fend for yourself when finding and signing up for health insurance.

An insurance agent or broker may be the best bet for sorting out your options. To find one or to learn about other support resources available to you, see How To Sign Up for Obamacare in Wisconsin.