For Consumers

How does the Health Insurance Marketplace work?

  1. There are new, affordable insurance options available for people without insurance.
  2. You can compare insurance plans that serve your area for costs, services, doctors and hospitals to make the best value choice for your situation.
  3. Financial help is available so you can find a plan that fits your budget. Check if you might be eligible for a discount or financial support for your health plan with this calculator from HealthCare.gov.
  4.  All insurance plans must show the costs and what is covered.
  5. Help is available online, by phone, and in person to find the plan that works best for you.
  6. You can buy insurance on the Marketplace during Open Enrollment starting November 1, 2015 through January 31, 2016. You may keep or change your insurance during this time for any reason.
  7. You may also buy insurance on the Marketplace during Special Enrollment Periods that happen when you have “life changes” like getting married or divorced, losing coverage, adding a child, and other events. Learn more at this Webpage at healthcare.gov.

Watch this short video: What is the Health Insurance Marketplace?

Why is it important to have insurance?

  1. If you or a family member gets sick, you won’t have to worry about big medical bills or going into bankruptcy.
  2. When you have insurance for you and your family members, you can be comfortable seeing a doctor when an ache or sickness doesn’t go away or gets worse. You can focus on getting and staying well, not whether you can afford to get care.
  3. Almost everyone will be required to have health insurance starting in 2014 or risk a fine when you file income taxes.
  4. Learn more at this page of the healthcare.gov website.

Here are some things you should know about insurance because of the Affordable Care Act:

  1.  All insurance plans must cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions.
  2. You might be able to get financial help to pay for a health insurance plan, based on your income.
  3. If you have a pre-existing condition, insurance plans cannot deny you coverage.
  4. All insurance plans will have to show the costs and what is covered in simple language with no fine print.

Starting January 1, 2014, everyone (with a few narrow exceptions) must be enrolled in a health insurance plan. The plan can be private, like the ones offered through your employer, or bought on your own on the Health Insurance Marketplace, or the open market. Or, if you are eligible, the insurance plan can be public, like Medicaid, BadgerCare+ or Medicare.

If you have insurance you like now, you may keep it. Or, you can use the Marketplace to research other qualified plans that may offer you coverage or costs that better fit your situation. It doesn’t hurt to shop around!

What insurance plan are available in Wisconsin?
Click to open this table Wisconsin Health Insurance Plans by County to see where the 13 approved health plans will provide service.

Compare Plans
The website healthcare.gov/find-premium-estimates/ provides information about plans, including your out-of-pocket costs, providers, and covered services. 

Enrollment Services for Consumers with Special Needs
HIV Positive and People With AIDS
Targeted enrollment assistance is available for people living with HIV.  Find trained Certified Application Counselors in Wisconsin.