Welcome to The Consumer’s Companion - Open Enrollment 2021 Edition!
Let this be your quick reference for rights & responsibilities under the federal health reform law. Learn about health insurance Marketplaces, BadgerCare Plus, and additional resources to help you understand health coverage and health reform. The Consumer’s Companion is a publication of HealthWatch Wisconsin, Inc.
Download The Consumer's Companion as a PDF & Download the FAQ as a PDF
Eligibility | Enrollment Period | Assitance Eligibility | Consumer Resources | Calculate FPL
Health Reform Explained
Health Reform became the law of the land in 2010, making sweeping changes to health coverage options, consumer protections (especially for those with pre-existing conditions), and the cost of private health insurance. Reform also created new ways to buy insurance, with the health insurance Marketplace and new financial assistance opportunities that helped make insurance accessible and affordable for many previously uninsured people.
Information You Can Use!
How to enroll in an insurance plan can be complicated & time consuming. The information on this page will help you: Understand eligibility for the Marketplace, Cost Savings, & BadgerCare Plus, Find Resources, Local Help, & Calculating FPL, And even answer a few “Frequently Asked Questions”
Why is Health Insurance Important?
Comprehensive health care coverage can get you to the health care you need and deserve. If you don’t enroll in coverage, whether it be through work, the Marketplace, or public programs like BadgerCare Plus, you may be surprised by a large hospital bill! If you miss the Open Enrollment Period, you could have a coverage gap!
Generally, if you don’t have insurance, through your job or a program like BadgerCare Plus, you can sign up to buy private insurance right from Health Reform’s Insurance Marketplace: Healthcare.Gov To determine if you’re eligible for Marketplace Coverage, consider:
1. Am I eligible to enroll in a Marketplace Insurance Plan? Almost everyone is eligible to enroll in a Marketplace Plan, except those who are eligible or enrolled in Medicare or those who are not lawfully present in the US.
2. And am I eligible for Financial Assistance to help pay for the Marketplace Plan? Eligibility for assistance, like Advance Premium Tax Credits or Cost Sharing Reduction, is based on your household income and your access to insurance. See more on “Marketplace Assistance Eligibility” below.
3. How do I know if I should apply for BadgerCare Plus or a Marketplace Plan? If you apply for health coverage through the Marketplace at HealthCare.Gov, it will generally assess whether you are instead eligible for a Medicaid program, and direct your application to your County Human Services agency. But this isn’t foolproof. If you are close to the edges of eligibility or have income that varies from month to month, consult with a Navigator or helper.
Generally, consumers may apply for health insurance using the Marketplace Healthcare.gov during “Open Enrollment Periods,” where you can shop for health plans in your area. Open Enrollment for health coverage starting January 1, 2021 is:
November 1 - December 15, 2020
There are four ways to apply for Marketplace coverage:
Online: Healthcare.gov | Phone: 1-800-318-2596 | Mail: Send in a paper application! In Person: Find help near you in Wisconsin: https://wiscovered.com/ Other Local Help https://localhelp.healthcare.gov/
When you apply for health coverage at Healthcare.gov, you’ll answer questions about household size and income, learn about premium costs or assistance paying for insurance, or see if you qualify for free or low-cost coverage through a BadgerCare Plus. What if you miss Open Enrollment? Sometimes, certain situations like a move, marriage, or new baby allow you to apply for coverage through a Special Enrollment Period.
Some individuals enrolling in a Marketplace plan may qualify for financial assistance (tax credits or cost sharing.) Household income and access to insurance are relevant factors.
Advance Premium Tax Credit Income Eligibility:
• What are they? Subsidies to reduce your premiums!
• Household income is 100% FPL - 400% FPL, determined at the time of application
• Based on anticipated income during the year, and reconciled against actual income on your tax return
Cost Sharing Reduction Income Eligibility:
• What are they? Savings on out of pocket expenses!
• Household income is 100% FPL - 250% FPL
• Must purchase a silver tier Marketplace Plan
Note: Access to Insurance: Keep in mind, financial assistance is not available if you have access to “Minimum Essential Coverage” that is, insurance that is deemed sufficient, including Medicare, full benefit Medicaid, or “Affordable” employer-sponsored insurance.
Calculate Your FPL
If you apply for a Marketplace plan for 2021, you will follow the 2020 Federal Poverty Level Guidelines. Income will be calculated using Modified Adjusted Gross Income (MAGI). Generally, MAGI is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have. This will be calculated for you when you apply. Use our free FPL calculator at: https://home.mycoverageplan.com/fpl.html