Health & Science
2:15 pm
Mon September 30, 2013

Wisconsin's Health Insurance Exchange: Calculate Your Premium

As Wisconsin people can begin shopping on the new health care insurance exchange on Oct. 1, here are answers to some questions with Jackie Garner of U.S. Centers for Medicaid and Medicare Services.

Q: Who needs to pay attention to this inaugural enrollment period of the Affordable Care Act?

A: “Those individuals and families who are uninsured for whatever reason, either insurance has not been available through their employer or they haven’t been able to afford insurance or perhaps they have a pre-existing condition, they will be able to go to healthcare.gov and they will be able to enroll in healthcare in Wisconsin.”

Q:  People who don’t have insurance will be fined. When will the federal government levy the fine?

A: “Yes, it is part of the law. The Affordable Care Act requires everyone to have coverage in 2014, and when you file your taxes in 2015, that’s when a fee would be levied if you did not purchase insurance, unless, there are a few exemptions, religious exemptions are one, for example, but for the most part, everyone must have insurance. That fee, in 2015 for the 2014 tax year, is about $95 per individual or one-percent of your annual income, about half that for a child, but that fee does go up each year.”

Q: Might it be a better deal for a family to buy individual plans for each member – versus a family plan?

A:  “It could. Individual plans are always an option for families and yet, we have found and would encourage that families who have one family plan, tend to find that a little more manageable.

Q: When people review the list of insurance plans available to them in Wisconsin, should they assume the list of providers will grow or change?

A: “I would not expect that list to change. There are 97 qualified health plan choices in the Wisconsin marketplace, and I think the people in Wisconsin will find that they have some good choices.”

Q: What should a people do, if their employer drops insurance and directs workers to the exchange?

A: “Well first of all, we’re working with employers to encourage them to consider their options in the marketplace because they have been eligible and will continue to be eligible for even more tax reductions and they will find plans more competitive and affordable. However, if an employer should decide to drop their insurance and then an employee (was) to go into the marketplace, they would be eligible for tax credits, if their income met the requirements. If the employer however, was continuing to offer insurance, and it met certain criteria in that it’s affordable and has minimal value, then the individual, if they went into the marketplace to purchase their own insurance, the individual would not be eligible for those tax credits.”

Q: How long do you expect the average individual to need to sift through the health plan choices and enroll?

A:  “In our focus group testing, it took anywhere from 15-minutes to an hour, depending on the complexity. If you have a family that has some special circumstances, it perhaps could take 30 minutes to an hour. But overall, it is a very streamlined application. For those who often use Amazon or a travel web site, it’s a very similar process. You’ll be able to compare side by side, health plans based upon what’s important to them.

Q: Where can people go for assistance in shopping for a health plan?

A:  "There’s the web site, healthcare.gov. There’s a toll-free number: 800-318-2596. People can also contact insurance brokers and agents or contact a community health clinic. Also, some public libraries (staff) have been attending training so that when someone comes into their library, they may have a section of computer reserved. They understand what the marketplace is and can point people in the right direction.”