Understanding the Affordable Care Act
and the Health Insurance Marketplace
The Affordable Care Act
The Patient Protection and Affordable Care Act (also known as ACA, health care reform and Obamacare) was signed into law in 2010. The ACA is designed to expand access to medical care, increase the value of health care, and support wellness and healthy living. The law impacts both people who have health insurance and people who do not. Some of the changes resulting from the law have already gone into effect. Many significant insurance changes take effect this year.
Elimination of any pre-existing condition limitations for children up to age 19
Removal of lifetime dollar limits on benefits
Extension of dependent coverage of adult children up to age 26
Coverage of preventive care without cost-sharing, such as co-pays,
co-insurance and deductibles
In addition, health insurers are now required to provide easy-to-understand summaries to subscribers outlining a health plan’s benefits and coverage.
Beginning March 31, 2014, most individuals will be required to have health insurance. Those who don’t may be required to pay a tax penalty. Individuals and families with lower incomes may qualify for state-funded plans or financial assistance to help pay for insurance benefits.
The Health Insurance Marketplace (HealthCare.gov) is often called an insurance exchange. It is designed to make it easier to shop for affordable health care insurance. It includes a website and call center where you can shop and apply for private health insurance plans that meet federal and state standards.
The Marketplace offers insurance choices for individuals under age 65 who do not have insurance through an employer and in the past may not have been able to buy insurance on their own. A number of plans are available, and it’s easy to compare benefits and cost so you can select and purchase the best option for your health care needs. The exchange allows you to obtain coverage now or consider options if you are looking to change insurers.
All plans available on the Marketplace cover basic essential health benefits. They differ in several ways:
When you shop through the Marketplace, you can take advantage of potential savings if your household qualifies for subsidized coverage or tax credits. Households with yearly incomes up to about $46,000 for individuals or $94,000 for a family of four will qualify for lower costs.
The Health Insurance Marketplace automatically determines whether you qualify for subsidies. For more information about the Health Insurance Marketplace, tax credits or subsidies, visit HealthCare.gov. If you do not qualify for savings, you can buy insurance directly through a broker or insurance company, if you prefer.
Individuals who have insurance through an employer or who purchased insurance through a broker can remain on their current plan or can access the Marketplace to compare their options.
To get started, visit HealthCare.gov and fill out an application. Be ready to provide information about your household size and income. You can immediately determine whether you can get lower costs on your monthly premiums for private insurance plans or whether you qualify for lower out-of-pocket costs. The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP) through Dec. 31. Beginning Jan. 1, individuals in Wisconsin must visit Access.Wisconsin.gov to determine whether coverage is available through state-funded programs..
This video, produced by the Centers for Medicare & Medicaid Services, may help you better understand tradeoffs between the cost of getting care and monthly premiums.
Once you have entered all of the necessary information, you can view and compare available plans in your area. You’ll find catastrophic, bronze, silver, gold and platinum plans. The plans vary by providers, cost and coverage. Check the details of each plan carefully. Make sure your physician and hospital are part of the plan you purchase.
Apply by mail, online, by phone or in person
There are four ways to apply for health insurance coverage once you have compared plans and made a selection:
Download an application form and instructions at HealthCare.gov and submit by mail
Apply online 24/7 by visiting HealthCare.gov (help is available via online chat)
Call 1-800-318-2596 to apply by phone
Apply in person with the help of a Navigator or other qualified helper
In Waukesha County, certified application counselors are available to assist you through:
Department of Health and Human Services
Economic Support Division
262-548-7280 or 888-446-1239
Waukesha Community Health Center