A look at the health reform law in Wisconsin
By: By Dinesh Ramde, Associated Press, Superior Telegram
MILWAUKEE — Some questions and answers about the Affordable Care Act in Wisconsin, as enrollment in the state's federally run exchange is about to begin on Tuesday:
DO I HAVE TO GET NEW HEALTH INSURANCE?
Not if you already have it. President Barack Obama has said you'll be able to keep your doctor and your plan under the Patient Protection and Affordable Care Act.
If you don't already have health insurance, you will need to get it by the end of 2014 or face a $95 penalty when you pay that year's income taxes. The penalty increases each year after that.
WHAT ARE MY INSURANCE OPTIONS?
In Wisconsin, people who earn less than the federal poverty level will be able to get coverage through Medicaid. But about 92,000 residents who were previously covered by the program won't be after Dec. 31 because the rules are changing and they earn more than the federal poverty level.
Those residents and others will be able to buy insurance through an online marketplace, or exchange, that allows comparison shopping for health plans, much as Travelocity does for airline tickets. Wisconsin's exchange is being run by the federal government because the state opted not to set up its own.
The exchange can be found at healthcare.gov.
About 700,000 people in Wisconsin are expected to be eligible to sign up for coverage through the federal exchange when enrollment begins Tuesday.
DOES THE EXCHANGE GIVE ME MANY OPTIONS?
Thirteen insurance companies have said they'll offer individual plans to Wisconsin residents through the exchange, according to the state. Nine also intend to offer coverage to small businesses with fewer than 50 employees.
In most counties, at least two companies are offering plans, and under federal law, all companies have to offer at least two plans. That means everyone will have more than one option on the exchange. On average, Wisconsin residents will be able to pick from 97 plans, according to information provided by the federal government.
HOW MUCH WILL IT COST?
A mid-range benchmark insurance plan for a person in Wisconsin will average about $361 a month, according to figures released by the federal government last week. But premiums will vary with a person's circumstances, including where they live, the level of plan picked, family size, age, income and tobacco use. A mid-range benchmark plan, for example, can cost a person less than $200 per month in some areas.
The cost also can be reduced by subsidies available to those who earn too much to qualify for Medicaid but less than 400 percent of the poverty level — $45,000 for an individual and $94,000 for a family of four.
TELL ME MORE ABOUT THESE SUBSIDIES.
The federal subsidies come in the form of tax credits. There is an online tool to help individuals and families figure out how much of a subsidy, if any, that they qualify for: http://kff.org/interactive/subsidy-calculator
Enrollment in the plans begins Tuesday, with health care coverage starting Jan. 1 for those who sign up by Dec. 15.
I HAVE INSURANCE THROUGH MY EMPLOYER. SHOULD I EXPECT ANY CHANGES?
Most people who have health insurance through their employer aren't expected to see much difference, according to the Kaiser Family Foundation. Some people might see their costs go down because the law puts a cap on out-of-pocket expenses and mandates free preventive care.
But some larger companies, those with 50 or more employees, are already looking for ways to cut costs and avoid getting hit with a new tax scheduled to take effect in 2018 on insurance plans valued at $10,200 or more for individual coverage and $27,500 for family policies. United Parcel Service, for example, informed its white collar employees that it will no longer cover spouses if they can get coverage through their own employers.
I WORK FOR A SMALL BUSINESS. WILL IT GIVE ME HEALTH INSURANCE NOW?
The Affordable Care Act defines a small business as one with two to 50 employees. It does not require them to provide workers with health insurance benefits, although they may choose to. Companies also don't have to provide coverage for part-time employees.
THIS IS ALL SO COMPLICATED. CAN'T I JUST SIT DOWN WITH SOMEONE WHO CAN WALK ME THROUGH IT?
Yes, there are a number of free services, starting with so-called navigators, who are trained to help people choose and sign up for the best insurance plan on the exchange for them. Here's a list of six groups in Wisconsin who received federal money to provide navigator services: http://oci.wi.gov/healthcare_ref/grant_recipients.pdf
Other groups have "certified application counselors," who are like navigators but aren't expected to make referrals. The best way to find one of them is to check with local hospitals, nonprofit groups or city officials.
IS THERE ANYWHERE ELSE TO GET HELP?
The Wisconsin Department of Health Services (http://www.dhs.wisconsin.gov ) and the state insurance commissioner's office (http://oci.wi.gov ) have information on their websites.
Independent groups also have created tutorials and online videos to help explain the Affordable Care Act. They include the Kaiser Family Foundation (http://kff.org ) and the Robert Wood Johnson Foundation (http://www.rwjf.org ).