4 things to know about health care en­roll­ment

Open en­roll­ment pe­riod will be end­ing Dec. 15

Milwaukee Journal Sentinel - - Business - Guy Boul­ton Mil­wau­kee Jour­nal Sen­tinel USA TO­DAY NET­WORK - WIS­CON­SIN

The sixth open en­roll­ment pe­riod for health plans sold di­rectly to in­di­vid­u­als and fam­i­lies ends Dec. 15.

And although buy­ing health in­sur­ance can be con­fus­ing, help is avail­able. You also may be el­i­gi­ble for fed­eral sub­si­dies through the Af­ford­able Care Act to lower the cost. Here are four key things to keep in mind as you en­roll:

First, those with in­comes be­tween 100 per­cent and 400 per­cent of the fed­eral poverty thresh­old in Wis­con­sin are el­i­gi­ble for fed­eral sub­si­dies to help off­set the cost of health in­sur­ance. That works out to $12,140 to $48,560 in in­come for an in­di­vid­ual and $25,100 to $100,400 for a fam­ily of four.

The sub­si­dies vary based on in­come. To re­ceive them, you have to buy a health plan through health­care.gov.

In­di­vid­u­als and fam­i­lies with house­hold in­comes be­low the thresh­old are el­i­gi­ble for BadgerCare Plus, the state’s largest Med­i­caid pro­gram. The thresh­old is higher for chil­dren: Chil­dren in fam­i­lies with in­comes up to 300 per­cent of the fed­eral poverty level — $75,300 for a fam­ily of four — are el­i­gi­ble for BadgerCare Plus.

Se­cond, you can shop for a health plan on health­care.gov. There usu­ally are three tiers of plans — bronze, sil­ver and gold — that vary based on the cov­er­age pro­vided. Bronze plans cost less, for in­stance, but have higher de­ductibles and pro­vide less cov­er­age.

In­sur­ance bro­kers can help you pick a plan, and draw­ing their ex­per­tise can be wise.

Here are places to get help and other in­for­ma­tion:

❚ The fed­eral gov­ern­ment’s toll-free 24-hour hot­line at (800) 318-2596 (TTY: (855) 889-4325).

❚ To find in-per­son help, go to the Find Lo­cal Help tool on health­care.gov.

You also can find in­for­ma­tion on agents and bro­kers in your area at the site.

❚ Cov­er­ing Wis­con­sin has in­for­ma­tion on its web­site in­clud­ing on where to get help.

❚ The Kaiser Fam­ily Foun­da­tion also has a sec­tion of its web­site ti­tled “Un­der­stand­ing Health In­sur­ance.” It in­cludes 300 fre­quently asked ques­tions about health cov­er­age. With luck, you won’t have that many.

Third, you must keep two things in mind:

❚ What mat­ters is the cost af­ter tak­ing into the ac­count the fed­eral sub­sidy, if you are el­i­gi­ble for one, not the pre­mium.

❚ If your in­come is be­low 250 per­cent of the fed­eral poverty thresh­old — $30,350 for one per­son and $62,750 for a fam­ily of four — you are el­i­gi­ble for ad­di­tional sub­si­dies to off­set de­ductibles and other out-of-pocket ex­penses. But you must buy a health plan in the sil­ver tier to re­ceive the ad­di­tional sub­sidy. This is im­por­tant. Some peo­ple who are el­i­gi­ble for the ad­di­tional sub­sidy opt for plans in the bronze tier be­cause pre­mi­ums are lower and end up pay­ing more than they should.

Fourth, the health plans typ­i­cally have dif­fer­ent net­works of hos­pi­tals and physi­cians and dif­fer­ent pre­scrip­tion drug cov­er­ages.

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