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By Susan Fisher, Elder Healthcare Advocate

For the Greater Wisconsin Agency on Aging Resources, Inc.

 

On October 1, 2013, state- and federal- run Marketplaces opened across the United States.  As individuals begin to explore what the Marketplace may offer them, there are several things everyone should know about the Marketplace and the Affordable Care Act (ACA).  Below are ten key facts.

  1. Effective January 1, 2014, all individuals are required to have health insurance unless they qualify for an exemption.
  2. Most individuals who currently have health insurance will not be required to obtain other health insurance.  Examples of sufficient health insurance include the following:

          a. Medicare,
          b. BadgerCare (if eligible in 2014),
          c. Other forms of Medicaid,"
          d. Tricare and those who participate in the Veteran’s Health Program,
          e. Employer provided health insurance, and
          f. State-approved and privately purchased health insurance.

      3.  Individuals may receive an exemption for several reasons which include, if they are a member of a
           federally recognized Indian tribe, qualify for religious conscience exemption, or have no affordable
           insurance is available.

      4.  Those who do not have sufficient health care may purchase health insurance through the Marketplace.  In
           Wisconsin, the Marketplace is the federally-run forum selling qualified health insurance plans to the public.

      5.  All qualified health plans must include the following health care services:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital);
  • Emergency services;
  • Hospitalization (such as surgery);
  • Maternity and newborn care (care before and after your baby is born);
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy);
  • Prescription drugs;
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills);
  • Laboratory services;
  • Preventive and wellness services and chronic disease management; and
  • Pediatric services.

      6.   Individuals may enter the Marketplace in a variety of ways.  They may enter by phone, through the web,
            by mail, or with the help of designated persons allowed to assist with enrollment. While individuals will be
            required to pay for their health premiums and other health care costs, there is no fee to enroll in the
            Marketplace.

       7.  Those wishing to purchase Marketplace insurance must do so from October 1, 2013, to March 31, 2014. 
            To have health insurance on January 1, 2014, health insurance must be purchased by December 15,
            2013.  Once this first enrollment period ends, Marketplace insurance will not be available until October 1,
            2014, unless an individual experiences a qualifying life event like a divorce, death, a birth, or a marriage.

       8.  Several types of financial assistance (or subsidies) are available for those whose incomes fall within
            certain economic guidelines, which may lower one’s premiums, reduce out-of-pocket costs, or limit yearly
            out-of-pocket costs.

       9.  Those who have Medicare will not qualify for the subsidies.  Also, it is prohibited to sell someone with
            Medicare Marketplace insurance.  

      10.  More information may be found at www.healthcare.gov, http://www.dhs.wisconsin.gov/health-
            care/training/index.htm
; and http://oci.wi.gov/healthcare_reform.htm.

If you have questions about the Affordable Care Act, please call 1-800-318-2596.