parallax background

Individual + Family Plans

Lower premiums available!
Find out if you qualify

How Obamacare Impacts Your Individual Health Insurance Wisconsin

PLEASE NOTE! The Health Insurance Marketplace Open Enrollment period for 2020 coverage ended December 15th, 2019. If you do not have a qualifying life event, you are unable to purchase an Obamacare ACA plan after that date. However, Short Term Health Plans have become the primary product in the market, providing insurance coverage until the next Open Enrollment period.

The Affordable Care Act (commonly referred to as Obamacare) has introduced a number of changes to the health insurance market that you need to be aware of. Due to problems with Obamacare, such as website issues and uncertainty about options and rates, meaning there is still significant confusion that can prevent you from finding individual health insurance Wisconsin plans that meet your health care needs and budget. Read on to discover critical Obamacare information that affects your health care.

Many individuals are still asking “how does Obamacare work?” Under Obamacare, nearly everyone must have health insurance or pay a tax penalty. For individuals, there are a lot of changes introduced in health insurance you should be aware of:
  • Mandatory Coverage: You are now required to obtain health insurance coverage or pay a tax penalty. It used to be that many individual policies were either expensive or did not offer the breadth of coverage available in most group health insurance plans. Today, a variety of insurance plans exist to provide you the coverage you need at an affordable rate.
  • Prescription Drug Coverage: Health plans now offer various prescription drug coverage options to make medications more affordable for individuals.
  • Pre-existing Conditions: Individuals with a pre-existing conditions or disabilities can no longer be denied health insurance or be charged more for coverage than others who are in the same age area without such conditions.
  • Preventive Services: Preventive services and tests are free in most health plans (no deductibles or copayments) under the Affordable Care Act. The covered preventive services include mammograms, various cancer screenings, tests for diabetes and heart disease, and more.
  • Making Coverage Affordable: Individuals who cannot afford health care insurance may qualify for subsidies where the federal government pays part of the premium. If you are self-employed, there are tax credits available to help with the cost of insurance.
  • Tax Penalties: Most adults who go without health insurance will now pay a tax penalty. In 2016, the penalties continue to increase. Those who did not obtain coverage will pay either 2.5 percent of their household income or $695 per adult and $347.50 per child (with a maximum of $2,085 per family), depending on which is higher. For tax year 2017 and beyond, the percentage option will remain at 2.5%, but the flat fee will be adjusted for inflation.
  • Payment Limits: Health insurers can no longer establish dollar limits, whether per year or over a lifetime, on the coverage for essential benefits. In the past, they would set limits on the total amounts they would pay. They can still put limits, however, on how many times you obtain certain services in a given year.
  • Health Savings Accounts (HSAs): Obamacare did not create health savings accounts, but it did lead to their becoming increasingly popular as employers and individuals look for lower premium options that provide tax advantages. HSAs are offered with a high-deductible health plan and offer premium reductions of 25 to 40 percent. The savings account portion gives the insured a pool of money to control and budget as they see fit, while paying for medical, vision and dental care before the deductible is met.
  • Health Insurance Marketplaces: The Affordable Care Act established state health insurance marketplaces (also known as exchanges) where individuals, families and small businesses can shop health insurance and get possible income-based subsidies. With the subsidies and choices offered, some are better off buying Obamacare plans from the healthcare marketplace (if their state has one). For others, however, purchasing coverage on the health insurance  marketplace is a better choice. Contact us today to get a variety of policy/price proposals to compare and see which option best meets your budget and specific needs.
  • Enrollment Period: Now, health insurance can only be purchased at specific times, called Open Enrollment periods. When the Open Enrollment period is closed, you can still purchase an individual plan if you have a Qualifying Life Event. Otherwise, contact us today to get a Short Term Health Plan to provide health insurance coverage until the next Open Enrollment period.

This Affordable Care Act information should help you make a more informed decision about your health care plan. For many individuals, Obamacare health insurance will be more expensive than open market plans. To get started searching for health care, use our quote engine below:

While Open Enrollment has closed, there are still several Qualifying Life Events that can enable you to get an individual health insurance Wisconsin plan. If you do not qualify during the special election period, a Short Term Health Plan will get you the coverage you need until the next Open Enrollment period. Either way, contact us today to get started with individual health insurance!

Learn More About Your Options

What Should You Consider When Choosing a Health Plan?
There are a number of important factors you should consider before you buy family health insurance. Milz Health Group is here to answer any questions you have and to help you make the right choices about your health care coverage.

Before selecting a health insurance plan for yourself, or your family, we recommend that you carefully review the following information and speak with one of our friendly, licensed insurance specialists.

Ask yourself the following the questions to identify which type of health plan makes sense for your finances and needs:
  1. Health Care Needs: The first consideration when selecting a health plan type is what you and your family’s specific needs are. How often do you go to the doctor? Will your needs change in the next year, such as starting a family? Are you receiving on-going treatment? Do individual family members have specific needs not covered under a general family plan?
  2. Hospitals and Doctors: The second consideration is the network of doctors and hospitals in the plan. If you like your doctor, is he or she in the plan? Are the doctors and facilities conveniently located near you? Do you have freedom to see whomever you want?
  3. Costs: The third consideration is the cost of your plan, and what benefits package makes sense based on your finances. Under the Affordable Care Act, many health insurance plans for individuals now have bronze, silver, gold and platinum benefit levels that indicate the level of coverage (and associated costs) the policyholder will have. When considering the options, be sure to see what each plan does or does not cover and what would be your out-of-pocket cost. Before making a decision, consider the various plans’ monthly premiums, deductibles, visit copays and other expenses. Are you eligible for a federal subsidy or tax credit to help pay for the health insurance?
Think Metal When it Comes to Coverage
The Affordable Care Act – more commonly known as Obamacare – has enacted a variety of new family health insurance options. Understanding these changes will help you find the plan that’s right for your family.

There are four main levels of coverage when it comes to health insurance plans: bronze, silver, gold and platinum. Bronze plans are the cheapest policies, but they also mean high out of pocket costs for things like deductibles, copays, and coinsurance. Platinum policies cost the most, but they offer the most coverage.

Bronze pays for an average of 60% of health care expenses, with consumers picking up the rest.

Silver pays 70%, gold 80%, and platinum 90%. But keep in mind that different companies offer differing premiums for the same coverage.
What Types of Family Plans are Available?
There are a number of health insurance options to meet your specific health care needs. The following basic plan types should give you a better idea of what plan makes the most sense for your family:
  • Indemnity (Fee-for-Service, or FFS) Plans: These major medical plans offer the greatest flexibility in choosing your doctors. Indemnity plans often come with a deductible; an amount you must pay for medical benefits before the insurance coverage begins payment on your claims. Typically, after the deductible has been met, the insurance will cover a percentage of expenses.
  • Preferred Provider Organizations (PPOs): These plans contract with a network of hospitals and doctors who furnish services for a specified rate. This means that PPO members have coverage with any health care provider. PPO members can go to doctors or hospitals that are not in the network but will have to pay a higher deductible or co-payment. This is a great plan if you are looking for insurance that is both affordable and flexible.
  • Health Maintenance Organizations (HMOs): With these managed care plans, you will have a primary care physician (PCP) who is responsible for managing all of your health care. If you need to see a specialist or someone else in the network, you need a referral from your PCP. Treatment received outside the network is generally not covered, or is covered at a significantly reduced level.
  • Point of Service (POS) Plans: These medical plans are a combination of the PPO and HMO models. Like an HMO, there is a PCP providing referrals to in-network doctors. Like a PPO, you can see providers outside the network and pay more of the cost.
Do Family Health Plans Qualify for Tax Credits, Too?
If you purchase a family health plan from the federal health insurance marketplace, you may qualify for subsidies to help pay your plan’s premium (i.e., the price tag of your health plan before deductibles and co-payments). The confusion surrounding tax credit eligibility revolves around misunderstandings about which family members qualify as dependents. Household size and household income are two of the most important factors that will decide your eligibility to receive tax credits. Contact us today to determine your family’s eligibility and find a plan that is right for your budget.
What Is Minimum Essential Coverage?
You are always free to choose a family health plan outside of the federal health insurance marketplace. However, these plans vary widely and in some instances may not provide the minimum essential coverage required by the ACA. Depending on the specifics of your family’s health plan, you may have the minimum amount of coverage, but you may have to pay out-of-pocket for dental and prescription drugs. Minimum essential coverage does not include these two common medical expenses for families in some cases. Contact us to determine a plan that is affordable and meets your unique coverage needs.
What Is the Cap on Out-of-Pocket Expenses?
The ACA has many provisions that ideally will lower your family’s health care costs. Out-of-pocket expenses are a topic that comes up frequently to insurance specialists. In 2016, the annual maximum amount of out-of-pocket for an individual health plan is $6,850 and for family health plans on the federal marketplace is $13,700.

Some medical expenses, however, do not count towards this cap (e.g., “out-of-network” visits to the doctor). We can walk you through what to expect from your family health plan’s out-of-pocket expenses and how to save money over the long run.

Do you need a health savings account to help with out-of-pocket expenses? Find out more about your Health Savings Account options here.

Want to learn more?
Click the buttons below to explore.

For more information about Individual & Family Health Insurance,
please call us locally at 262.299.4904 or toll free at 866.575.3313 to speak with an experienced ACA representative.
We are here to help!