Health Insurance coverage is an issue that should be on everyone’s mind. Yes, it is a big deal. Yes, it can be overwhelming. Enrollment is open until Jan. 31, so you still have time to sign up for a plan. Let’s talk about getting covered. What is this Affordable Care Act, “ACA,” “Obamacare,” or “Marketplace Insurance”?
It’s private health insurance with savings based on your income. Health Insurance Plans cover pre-existing conditions and essential health benefits. Preventive care visits include health and behavioral screenings for adults and children at no additional cost. Most people who apply through the marketplace qualify for premium tax credits and an out-of-pocket cost savings based on household size and income. The only difference between plans sold inside versus outside the “marketplace” is tax credits/ subsidies. To get lower costs on your monthly premium you must go through a marketplace plan. Eligibility to receive federal tax credits is based on income and household size, anyone below 400 percent of the federal poverty level may be eligible. Those who may not qualify for tax credits have an estimated income above $47,080 for one person, or $97,200 for a family of four. There are four ways to apply: online, with a paper application, over the phone assistance, or through local in-person assistance. On Saturday, Jan. 14, Lakeshore Community Health Care will have free, in-person assistance for Marketplace and Medicaid (Badger Care) applications from 10 a.m. to 2 p.m. at Mead Public Library in Sheboygan.
Be prepared to provide the following information for each person applying: home/mailing address, Social Security number, employer and income information, policy numbers, plan ID and notices for any current health insurance plans.
You will create an account, fill out an application, get eligibility results, choose a plan and enroll. If you are already covered through the marketplace, log in to Healthcare. gov to stay covered. This is your only chance to review your information, insurance plans and choose coverage that best fits your needs. Staying covered is important, so please review your information; even if nothing has changed, you may be eligible for additional tax credits.
The Affordable Care Act open enrollment began in November and the deadline to enroll is Jan. 31. The only way to become eligible for enrollment after this period is through a special enrollment period due to a qualifying life event: having a baby, marriage, divorce or losing health coverage.
Wisconsin State Medicaid/ Badger Care is open year round. Eligibility for Badger Care includes all adults at below 100 percent of the federal poverty level, all children and pregnant women up to 300 percent of the poverty level.
The ACA Task Force of Sheboygan County has inperson helpers (navigators and/or certified application counselors) available Wednesdays from 1 to 4:30 p.m. at the Mead Public Library or call (920) 783-6633, extension 207 for help. View the list of enrollment events and contact information at www.lakeshore communityhc.org or visit us on Lakeshore Community Health Care’s Facebook page.
Kristin Blanchard Stearns is the chief executive officer of Lakeshore Community Health Center and a member of the Healthy Sheboygan County 2020 steering committee.