Obamacare Open Enrollment Begins: What You Need To Know In WI

WISCONSIN — Open enrollment for the Affordable Care Act, the health reform law sometimes called Obamacare, began Tuesday in Wisconsin.

To sign up, go to HealthCare.gov. In most states, open enrollment continues through Jan. 15, but to get coverage that begins Jan. 1, enrollment generally must occur by Dec. 15.

In Wisconsin, residents can purchase insurance directly from the federal marketplace.

Here are five things to know about Affordable Care Act open enrollment:

1. You May Qualify For Help

The White House estimates about 1 million people can get help with more affordable insurance under a recently finalized Treasury Department rule.

The change addressing the “family glitch” expands the number of families who can opt out of employer-sponsored coverage and qualify for subsidies to help them get Obamacare coverage instead.

Before the change, eligibility for subsidies was based on an IRS threshold based on the cost of employer-based coverage. It took into account the employee’s share of the costs, but not the cost of adding family members to the plan, which often is more expensive than individual-only coverage.

“For the first time, a lot of families will have a real choice between an offer of employer-sponsored coverage and a marketplace plan with subsidies,” Sabrina Corlette, a researcher and co-director at Georgetown University's Center on Health Insurance Reforms, told Kaiser Health News.

2. Coverage Will Cost More

Health insurance premiums are increasing across the board, and the ACA is no exception.

People who get subsidies won’t feel much pain, according to Kaiser Health News, because the financial relief is tied to the second-cheapest marketplace plans, the so-called “silver” plans.

Subsidies for those plans are rising with the premium hikes. Also, the subsidies Americans have received under legislation tied to the COVID-19 pandemic will remain in place under guarantees in the Inflation Reduction Act.

Individuals who make $20,385 and couples who earn $27,465 or less can get ACA plans with no monthly premiums.

Individuals with earnings of $54,360 and couples with earnings of up to $73,240 are eligible for sliding-scale subsidies to help pay premiums.

Wealthier people will pay no more than 8.5 percent of their household income for insurance premiums, according to the ACA rules.

3. Shop Around For The Best Deal

Even if you’ve received Obamacare coverage before, experts advise shopping around.

New rules this year make that easier. All insurance providers are required to offer plans with specific, standardized benefits, such as the same deductibles, copays and other cost-sharing services.

Also new this year, insurers are required to offer more coverage before the patient starts paying toward the deductible. Insurers offering non-standard plans must also offer standardized plans, according to the new rules.

Plans sold on the federal marketplace have already adopted standardization, making it easier for comparison shopping. Some states are offering standardized plans.

4. Abortions May Not Be Covered

The Supreme Court repudiation of Roe v. Wade in June could change how abortion services are covered under the Affordable Care Act. Seven states — California, Illinois, Maine, Maryland, New York, Oregon and Washington — require abortion coverage in both ACA marketplace and private insurance plans, according to Kaiser Family Foundation.

In other states, health insurance carriers determine whether their plans will offer coverage. In Wisconsin, abortion is subject to Medicaid and marketplace limitations.

5. No Copay For Preventive Health Care

Getting a cancer screening, tests or other preventive care is still covered without a copay under a provision written into the ACA that bars copays on a range of preventive services, drugs and vaccines.

There is some confusion, though, after a ruling in September by U.S. District Judge Reed O’Connor that declared unconstitutional one of the methods the government uses to determine what preventive treatments are covered without cost sharing.

O’Connor held that for religious reasons, Braidwood Management could not be required to pay for a highly effective preventive treatment for HIV and AIDS through its employer health plan.

The ruling is likely to be appealed, and the 2023 coverage year isn’t expected to be affected by the ruling.