Common Questions About the Affordable Care Act
Can I and should I sign up for health insurance?
Starting in 2014, most people will need to have health insurance that covers a full range of services, or pay a fee when they file their income taxes.
- U.S. citizens and others who are legally in the U.S. can sign up for health insurance through the Marketplace.
- You do not need to sign up if you are covered by Medicare, Medicaid (disability), BadgerCare, the VA health program, or good and affordable insurance through your job or your spouse’s job.
- You do need to sign up if you have no insurance, or you are losing your coverage, or you are not eligible to be covered under an affordable, quality employer plan.
- Young adults can stay on their parents’ insurance until they turn 26, but they can also go to the Marketplace to see if they can get less expensive insurance or qualify for BadgerCare.
- If your employer offers good and affordable insurance, ask at work about signing up. If you don’t take it, you might not be able to get the federal financial assistance to lower your costs.
What is the Federal Insurance Marketplace?
The Marketplace is a website where you can see and sign up for one of the health insurance plans offered in Wisconsin. There is also a phone line to help you. You will also find out if you are eligible for BadgerCare or federal financial assistance that can lower the cost of your insurance.
Website: www.healthcare.gov Phone: 1-800-318-2596
How good is this insurance?
All of the insurance plans provided by our local health insurance companies through the Marketplace must cover the same full range of services, including doctor visits, hospital care, prescriptions and much more.
Will I be able to afford it?
The plans vary in cost and where you can go, which is explained on the website. There are many options and you can choose the best plan for you and your family. Many people will get a discount and/or a tax credit from the federal government. The amount of financial assistance is calculated when you sign up and it can lower your monthly cost right away.
Can I be turned down?
No. You cannot be turned down because of health problems.
Should I check out other options?
- Lower income people might be eligible for BadgerCare, which is health insurance paid for by the government. You can find out by signing up through the Marketplace, or you can call or go to:
Dane County Department of Human Services - Job Center
Phone: 1-888-794-5556 1819 Aberg Avenue, Madison
- If you are disabled in some way, you may apply for federal disability, though you may need health insurance in the meantime. These organizations will help you:
Social Security Administration office
Phone: 866-770-2262 6011 Odana Road, Madison
Dane County Aging and Disability Resource Center
Phone: 608-240-7400 2865 N. Sherman Avenue, Madison
What information do I need in order to sign up?
- ID information for all members of your family (age, Social Security numbers, or legal permanent resident/green card or visa numbers)
- Income for all family members because you will have to estimate your 2014 family income to get your financial assistance (pay stub or tax forms, or other documents showing income)
- Information about insurance offered through your job or your spouse’s job, even if you don’t take it, including how much it costs for a single plan
- Use the Marketplace Application Checklist to help you gather information.
Important things to remember after you sign up:
- You must pay your premiums every month to keep your coverage.
- Report any changes in family income or number of people in your family by calling the Federal Insurance Marketplace number
- You can appeal a decision that you don’t agree with by calling the Marketplace number
Take notes about your Marketplace account, insurance plan and other important information that you may need later.
What if I already have insurance through my job?
If you have insurance that you like and is affordable through your employer, you don’t have to change anything. Since employers review and may change the insurance they offer each year, it’s a good idea to talk to your employer about their plans for 2014.
If your employer decides not to offer insurance at any time, or it costs you more than 9.5% of your income, you will be able to purchase insurance on the Insurance Marketplace, and may be eligible for a discount on the cost depending on your income.
What if I don't have Insurance coverage by January 1, 2014?
- If someone who can afford health insurance doesn’t have coverage in 2014, they may have to pay a fee.
- People without health coverage will also have to pay the entire cost of all their medical care. They won't be protected from the kind of very high medical bills that can sometimes lead to bankruptcy.
The fee in 2014 and beyond:
- The fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher.
- In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.
- It's important to remember that someone who pays the fee won't get any health insurance coverage. They still will be responsible for 100% of the cost of their medical care.
- After open enrollment ends on March 31, 2014, they won't be able to get health coverage through the Marketplace until the next annual enrollment period, unless they have a qualifying life event.
Minimum essential coverage:
To avoid the fee in 2014 you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following in 2014, you're considered covered and don't have to pay a penalty:
- Any Marketplace plan, or any individual insurance plan you already have
- Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
- The Children's Health Insurance Program (CHIP)
- TRICARE (for current service members and military retirees, their families, and survivors)
Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
- Peace Corps Volunteer plans
Other plans may also qualify. Ask your health coverage provider.
What kinds of health insurance don't qualify as coverage?
Health plans that don't meet minimum essential coverage don't qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include:
- coverage only for vision care or dental care
- workers' compensation
- coverage only for a specific disease or condition
- plans that offer only discounts on medical services