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Marketplace Health Insurance - Affordable Care Act

Affordable Care Act or Obamacare - The Call for Repeal

Congress is currently looking at repealing the Affordable Care Act also known as Obamacare. Repealing the Affordable Care Act will impact persons insured under the Marketplace (Affordable Care Act), Medicaid (BadgerCare in Wisconsin) and Medicare. The ADRC is charged with both advocating for older adults, adults with disabilities, and their caregivers as well as empowering you to advocate for yourself. To do this we have compiled information to help you be informed about these possible changes.
Go to the ADRC Advocacy page for this information.
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The ADRC does not have Certified Application Couselors (CACs) to assist persons to enroll in or review existing plans at the Health Insurance Marketplace.

We do, however, want to provide you with the information you need to enroll and find answers to questions. This webpage has links to resources to help you do just that.


BadgerCare Plus vs the Marketplace

If you are a senior age 60 plus or an adult with a disability an ADRC Benefit Specialist can assist with determining if you are eligible for Wisconsin's BadgerCare Plus. Call 920-448-4300 to speak to a Benefit Specialist or click to go to the ADRC Medicaid-BadgerCare Plus page for more information. Or you can print this BadgerCare Plus Information Flyer Or go directly to ACCESS.wi.gov.

Attention those dually enrolled in Marketplace and BadgerCare Plus: Centers for Medicare and Medicaid Services (CMS) announced individuals who are enrolled in both Marketplace coverage with Advance Premium Tax Credits and Medicaid/BadgerCare Plus will be receiving a letter asking them to contact the Marketplace and end their Marketplace coverage, as they can not be dually enrolled. Contact the Marketplace at 800-318-2596.

Medicare vs the Marketplace

If you have Medicare coverage, you are not eligible to use the Marketplace to buy a health or dental plan. ADRC Benefit Specialists can assist you in understanding Medicare. Call (920-448-4300) to speak to a Benefit Specialist, or click to go to the ADRC Medicare page for more information about Medicare and valuable classes you can attend to learn more.

From Marketplace to Medicare - Get answers to frequently asked questions with document produced by the Greater Wisconsin Agency on Aging Resources, Inc. (GWAAR).


Marketplace Health Insurance Information
There are a number of ways to access the Marketplace to get information.

Federal Assistance

Healthcare.gov is a great place to get information about the Marketplace and/or apply on your own. You can:
  • browse coverage options, Answer a few questions to see what coverage you may be eligible for before you apply. Gives you a preview of 2015 plans and estimated prices.
  • get questions answered, Guide for Marketplace with your next steps, income chart to see if you qualify for savings, checklist to gather documents you'll need to apply.
  • keep or change your plan If you already have a Marketplace plan you should review it every year to see if it still fits your healthcare needs and pocketbook. See plans and prices to help you make an informed choice.

Individuals: Premium Tax Credit Fact Sheet - Learn more about the tax credits available for individuals applying in the Marketplace through this IRS website.

State Assistance

EnrollWI.org provides information specifically related to health insurance options and the Marketplace for those assisting Wisconsin residents to enroll in affordable health insurance. Visit this site to also learn about the organizations across the state that will be Navigators for 2016-2019:

County Assistance

Brown County Community Resources for BadgerCare or Marketplace Assistance

The following agencies can help anyone determine eligibility and apply for the Healthcare Marketplace and can assist persons under age 60 with BadgerCare eligiblitiy and applications.

Resources for Badger Care Plus

Bay Lake Consortium
1-888-794-5747 (Toll Free)
Access.wisconsin.gov
*Can request face-to-face assistance

Resources for Marketplace Assistance

Marketplace:
800-318-2596
www.healthcare.gov


N.E.W. Community Clinic
920-437-9773
622 Bodart St., Green Bay, WI
www.newcommunityclinic.org
Click name for flyer

HRS Erase:
www.hrserase.com
800-211-2209
Offices at Bellin, St. Mary's, and St. Vincent hospitals



Affordable Care Act: Key Health Insurance Protections for All Americans
Information Provided by: Centers for Medicare & Medicaid Services (CMS)


The U.S. Deparment of Health and Human Services (HHS) issued a final rule that implements five key consumer protections form the Affordable Care Act, and makes the health insurance market work better for individuals, families, and small businesses. Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans. The five key provisions of the Affordable Care Act that are applicable to non-grandfathered health plans are:
  • Guaranteed Availability
Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
  • Fair Health Insurance Premiums
Health Insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography. Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
  • Guaranteed Renewability
Health insurance companies will no longer refuse to renew coverage because an individual or an employee has become sick. You may renew your coverage at your option.
  • Single Risk Pool
Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single state-wide risk pool for the individual market and single state-wide risk pool for the small group market.
  • Catastrophic Plans
Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventivie services without cost sharing.

Check out the additional links below for more information you can use to check the facts about the Affordable Care Act.

Endorsement is not implied or assured but rather the ADRC of Brown County is following our mission to "promote easy access to reliable, useful information..... and advocate and secure benefits" for the people we serve.


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  • IRS 1095 B Tax Form
    This website answers questions about the IRS 1095-B tax form. Individuals who received minimum essential coverage (ex: BadgerCare Plus, Medicaid) from a state of Wisconsin health care program will get a 1095-B tax form. The Wisconsin Department of Health Services will be sending out the forms.

  • Health Insurance Marketplace- Insurance Options
    Resource listing for BadgerCare Plus and the Marketplace questions and assistance.

  • The Affordable Care Act Facts in Wisconsin
    Fact sheet produced by Covering Kids & Families, Wisconsin (www.ckfwi.org) that outlines how to get health insurance in Wisconsin. Information about the Marketplace and BadgerCare Plus. Helpful easy to read income eligibility chart for both programs.

  • Read the Law
    All 10 Titles of the Affordable Care Act, with amendments to the law called for by the reconciliation process. Divided into sections to make it easier to read.

  • Kaiser Foundation Frequently Asked Questions
    Coverages questions asked about the Affordable Care Act. Has a search feature to quickly find the answers to your questions.
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