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ACA Plans

The Patient Protection and Affordable Care Act of 2010 introduced a lot of previously un-insured and under-insured people to the security of medical coverage and preventative care.

Along with the excellent news comes the inevitable frustration that can sometimes result from sweeping changes. You’re not alone – – there are a lot of people that are still left wondering: “What is the Affordable Care Act, exactly?” and “How does the Affordable Care Act affect me?”

We answer these questions on a daily basis at FHK Insurance. Simply click on a state to see questions we’re asked about the most when it comes to ACA health insurance in Wisconsin .

If you have any other questions about your current insurance plan, please don’t hesitate to contact us. We are happy to help!

This chart helps determine if you are eligible for premium tax credits toward your health insurance premium.

2017 Federal Poverty Level (FPL)


Household Size 100% 138% 250% 400%
1 $12,060 $16,643 $30,150 $48,240
2 $16,240 $22,411 $40,600 $64,960
3 $20,420 $28,180 $51,050 $81,680
4 $24,600 $33,948 $61,500 $98,400
5 $28,780 $39,716 $71,950 $115,120
6 $32,960 $45,485 $82,400 $131,840
7 $37,140 $51,253 $92,850 $148,560
8 $41,320 $57,021 $103,300 $165,280

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View Some FAQ’s:

What is the Affordable Care Act?

Now, you might be wondering: “How Will the Affordable Care Act Affect Me?” The main effect this act has on a majority of people is that it requires everyone to have some type of health insurance, otherwise you must pay a penalty for not having any. Although there are certain situations in which you may qualify for an exemption from coverage. If you already have health coverage, you may keep your current plan without changing a thing. However, if you are uninsured or are not offered health insurance by your employer, you have access to health plan choices from the new Health Insurance Marketplace. The new law also states that individuals must be offered health insurance that provides essential health benefits such as:

  • ambulance and emergency services
  • hospitalization
  • newborn and maternity care
  • counseling and behavioral treatments for substance abuse and other mental health disorders
  • prescription drugs
  • rehab devices and services
  • laboratory services
  • preventative health services
  • care for chronic diseases, and pediatric care, (including vision and oral).

In order to be certified and listed as a provider in the new Health Insurance Marketplace, insurance policies must cover all the aforementioned EHBs. Click here to see the cost of not having insurance.

How Will Affordable Care Act affect me?
Now, you might be wondering: “How Will the Affordable Care Act Affect Me?” The main effect this act has on a majority of people is that it requires everyone to have some type of health insurance, otherwise you must pay a penalty for not having any. Although there are certain situations in which you may qualify for an exemption from coverage. If you already have health coverage, you may keep your current plan without changing a thing. However, if you are uninsured or are not offered health insurance by your employer, you have access to health plan choices from the new Health Insurance Marketplace. The new law also states that individuals must be offered health insurance that provides essential health benefits such as:

  • ambulance and emergency services
  • hospitalization
  • newborn and maternity care
  • counseling and behavioral treatments for substance abuse and other mental
  • health disorders
  • prescription drugs
  • rehab devices and services
  • laboratory services
  • preventative health services
  • care for chronic diseases, and
  • pediatric care, (including vision and oral).

 

In order to be certified and listed as a provider in the new Health Insurance Marketplace, insurance policies must cover all the aforementioned EHBs. Click here to see the cost of not having insurance.

How do I sign up for the Affordable Care Act?
Enrollment periods and deadlines are constantly changing for the Affordable Care Act. We are here to offer you advice on how to get Individual and Family plan coverage and how to sign up for the best plan for you and your families needs.

Affordable care plans and options are available through the Health Insurance Marketplace. Individuals can enroll online with a local broker, navigator, or by calling the Marketplace directly at 1-800-318-2596. Alternatively, some employers may offer affordable coverage that is Affordable Care Act compliant. In order to avoid a fee and possibly make a mistake by enrolling in a plan that does not have your doctors in the network, speak with a licensed broker who is certified and can assist you with choosing the right plan.

Some states offer their own on-line marketplaces, or exchanges, to sign up for Affordable Care Plans. In Wisconsin, however, residents can simply sign up for the Affordable Care Act by working with a local insurance agency or by going to www.healthcare.gov. Healthcare.gov also provides a preview of health insurance plan options and prices for 2015.

What are the enrollment periods?
Enrollment periods and deadlines are constantly changing for the Affordable Care Act. We are here to offer you advice on how to get Individual and Family plan coverage and how to sign up for the best plan for you and your families needs.

Affordable care plans and options are available through the Health Insurance Marketplace. Individuals can enroll online with a local broker, navigator, or by calling the Marketplace directly at 1-800-318-2596. Alternatively, some employers may offer affordable coverage that is Affordable Care Act compliant. In order to avoid a fee and possibly make a mistake by enrolling in a plan that does not have your doctors in the network, speak with a licensed broker who is certified and can assist you with choosing the right plan.

Some states offer their own on-line marketplaces, or exchanges, to sign up for Affordable Care Plans. In Wisconsin, however, residents can simply sign up for the Affordable Care Act by working with a local insurance agency or by going to www.healthcare.gov. Healthcare.gov also provides a preview of health insurance plan options and prices for 2015.

When are the enrollment periods?

First step in answering the question, how do I sign up for insurance under the Affordable Care Act? One must know that the 2015 Open Enrollment Period begins November 15th, 2014 and ends February 15th, 2015. In order to have a January 1st, 2015 effective date, you must apply before December 15th 2014.

If you need health coverage outside of the Open Enrollment Period, there are many situations where a Special Enrollment Period entitles you to enroll. This includes but is not limited to an income change, a change of residence, change in employer coverage, certain life changes or hardships, and more. Those who qualify for a Special Enrollment Period will be granted 60 days following the qualified life event to enroll in a health plan of their choice. Contact us today to see if you qualify. For small business owners there is no limited Enrollment Period, as employers can begin offering coverage to their employees at any time during the year, regardless of where you decide to purchase coverage.

Should I take my employer or COBRA coverage?
COBRA CoverageIf your employer provides affordable health coverage, (premium is less than 9.5% of your total income), that meets the 10 Essential Health Benefits (EHBs) that the Affordable Care Act plan requires, you are most likely required to take that coverage if you are eligible for Premium Tax Subsidy (On-Exchange). Check with a licensed agent to help you determine this for you. COBRA is similar; you are required to take it if you are applying On-Exchange. If your income does not provide you with help paying for premium, then you can choose the insurance that is more suitable for you, an individual plan or COBRA.
Am I off or on exchange?

Your status in regards to Off or On-Exchange is based on your expected Modified Adjusted Gross Income (MAGI) for 2015. On-exchange is a marketplace of health insurance plans run by the Government for Wisconsin residents, Healthcare.gov. Off-Exchange is for people with higher income levels and those that can enroll through the insurance company directly. Off-Exchange individuals are above the 400% of the Federal Poverty Level (FPL). If you qualify for On-Exchange or Off-Exchange largely depends on yearly income, and if you’re offered insurance from your Employer. Here is the Federal Poverty Level Chart for Wisconsin.

federal-poverty-level-chart On-Exchange

What is my ACA premium tax credit?

Your ACA premium tax credit is the discount you receive off of your monthly health insurance premiums through the Affordable Care Act. This discount is applied in advance. There are a number of factors that are taken into consideration when deciding what your premium tax credit is.

This online calculator will help you determine what your tax credit is. This tool helps you determine what dollar amount you will receive to help you pay for the plan you select. To figure out which specific plan will work for you contact us today.

Once you enter in your location, simply enter your annual income, number of family members and whether or not insurance is offered through your employer. Then you will receive your estimated discount, along with what your monthly insurance premium will be after this discount. Let us know if you have any questions after using the subsidy calculator and we would be glad to go over your results with you!

Does the Affordable Care Act cover my medications?
Each plan formulary, (also known as a preferred drug list), has their own tier level determinations in regards to prescription medications. The tier level determines the amount of cost and coverage for each prescription medication. All Affordable Care Act plans include prescription coverage as it is one of the 10 Essential Health Benefits (EHBs), however each state sets its own list of covered medications, and depending on which plan is most efficient for you, copays and coinsurance as well. Prescription costs are applied to the total health insurance out-of pocket maximum per the plan selection. To find out whether or not a health plan covers the medicine you take, check the plan’s formulary list for your medicine’s exact name, the dosage you take, and the amount of pills prescribed by your doctor. If you find that your medications aren’t listed on a plan’s formulary, you may also request that coverage or give you access to it. In the event that your request is denied, you have the right to appeal your health plan’s decision.
Does working with an agent cost me more?
No, you will pay the same amount to work with an agent as you would if you were researching and dealing with the application process all on your own or directly with the federal Marketplace or Insurance Company. We offer what they offer, except we have no incentive to sell one plan over another. Consulting with an agent will help you choose the right health plan for your needs, as you consider and compare Marketplace offerings based on their plan categories, monthly premiums, out-of-pocket costs, types of insurance plans and provider networks, and other benefits. Let our friendly and knowledgeable agents at FHK Insurance take the stress out of Affordable Care Act enrollment. Contact us today.
What are the advantages to working with an agent in Wisconsin?
FHK insurance is the oldest and largest insurance agency in Wisconsin. We currently have agents with over 30+ years of experience, who can help you determine what you are eligible for and when. FHK Agents are licensed and certified to make Affordable Care Act plan suggestions and recommendations, unlike the federal Marketplace call center and Navigators, FHK can suggest a plan fit for you. We are devoted to providing a personalized touch only an independent broker can offer. We represent most major health insurance companies; our entire focus is on working with our clients and finding the most efficient plan for them. Find out how we can help you today, click here for no-pressure information from our trained agents that help people like you daily.