4 things to know about health care enrollment
Open enrollment period will be ending Dec. 15
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.