Affordable Care ActOpen enrollment November 15, 2014-February 15, 2015
Basic information on ACA:
To enroll on your own:
Certified Application Counselors (CACs) are individuals who must complete state and/or federal training, must be working on behalf of an organization that is certified by the Center for Medicare & Medicaid Services (CMS), and CANNOT give advice on insurance plans
Navigators are organizations that are funded through CMS for outreach & enrollment, individuals must complete federal/state training and CANNOT give advice on insurance plans
Agents & Brokers are individuals who complete state and federal training and CAN give advice on insurance plans.
What to bring with:
Marketplace Application Checklist
If you want to talk to someone:
- Federal: 1-800-318-2596
- Local Resources: Great Rivers 2-1-1, simply dial 211
How can I get coverage outside of open enrollment?
Outside open enrollment, you can enroll in Marketplace insurance only if you have certain life events that give you a special enrollment period. You can apply for Medicaid or the Children's Health Insurance Program (CHIP) any time. If you're qualified you can enroll right away.
Buying a Marketplace Plan outside of open enrollment:
In order to buy a Marketplace health insurance plan outside the open enrollment period, you must have a qualifying life event. Qualifying life events that create a special enrollment period include:
Special Enrollment Periods
- Getting married
- Having, adopting, or placement of a child
- Permanently moving to a new area that offers different health plan options
- Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP or BadgerCare, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.)
- For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions
If you have a qualifying life event, you get a special enrollment period. This means you can enroll in or change your health insurance plan outside the open enrollment period. Most special enrollment periods last 60 days from the date of the qualifying life event. Open enrollment for Marketplace coverage ends February 15, 2015. The next open enrollment period is November 1, 2015-January 31, 2016.
On Friday, February 20, 2015 CMS announced a Special Enrollment Period for Tax Season. The Centers for Medicare & Medicaid Services (CMS) announced a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or "shared responsibility payment" when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn't understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM.
For those who were unaware or didn't understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30. If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes.
Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace and:
The special enrollment period announced today will begin on March 15, 2015 and end at 11:59 pm E.S.T. on April 30, 2015. If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.
- Currently are not enrolled in coverage through the FFM for 2015,
- Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
- Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.
This year's tax season is the first time individuals and families will be asked to provide basic information regarding their health coverage on their tax returns. Individuals who could not afford coverage or met other conditions may be eligible to receive an exemption for 2014. To help consumers who did not have insurance last year determine if they qualify for an exemption, CMS also launched a health coverage tax exemption tool on HealthCare.gov and CuidadodeSalud.gov.
Most taxpayers, about three quarters, will only need to check a box when they file their taxes to indicate that they had health coverage in 2014 through their employer, Medicare, Medicaid, veterans care or other qualified health coverage that qualifies as "minimum essential coverage." The remaining taxpayers - about one-quarter - will take different steps. It is expected that 10 to 20 percent of taxpayers who were uninsured for all or part of 2014 will qualify for an exemption from the requirement to have coverage. A much smaller fraction of taxpayers, an estimated 2 to 4 percent, will pay a fee because they made a choice to not obtain coverage and are not eligible for an exemption.
Americans who do not qualify for an exemption and went without health coverage in 2014 will have to pay a fee – $95 per adult or 1 percent of their income, whichever is greater – when they file their taxes this year. The fee increases to $325 per adult or 2% of income for 2015. Individuals taking advantage of this special enrollment period will still owe a fee for the months they were uninsured and did not receive an exemption in 2014 and 2015. This special enrollment period is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015.
The US Department of Health & Human Services is committed to providing the information and tools tax filers need to understand the new requirements. Part of this outreach effort involves coordinating efforts with nonprofit organizations and tax preparers who provide resources to consumers and offer on the ground support. If consumers have questions about their taxes, need to download forms, or want to learn more about the fee for not having insurance, they can find information and resources at www.HealthCare.gov/Taxes or www.IRS.gov. Consumers can also call the Marketplace Call Center at 1-800-318-2596. Consumers who need assistance filing their taxes can visit IRS.gov/VITA or IRS.gov/freefile.
Consumers seeking to take advantage of the special enrollment period can find out if they are eligible by visiting https://www.healthcare.gov/get-coverage. Consumers can find local help at: Localhelp.healthcare.gov or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in 150 languages. The call is free.
Walk-in Opportunities for those who qualify for this Special Enrollment Period (SEP)
- Buffalo County event: Thursday, April 16th from 9am-12pm at Buffalo County , 407 S 2nd St –2nd floor conference room, Alma WI
- Clark County event: Friday, April 24th from 10am-3pm at Memorial Medical Center, Neillsville WI
- Jackson County event: Tuesday, April 14th from 1-6pm at Black River Memorial Hospital, 711 W Adams St., Black River Falls, WI
- La Crosse County events: Wednesday, April 22nd from 1-5pm & Wednesday, April 29th from 2-6pm at La Crosse County Health & Human Services Bldg, 300 4th St N, La Crosse (1st floor conference room 1100)
- Monroe County event: Thursday, April 23rd from 10am-6pm at Lugar de Reunion, 620 Industrial Dr, Suite 1, Sparta WI
- Pepin County event: Thursday, April 16th from 2-6pm at Pepin County's County Board Rm #108, 740 7th Ave W, Durand WI
- Trempealeau County event: Monday, April 20th from 12-6pm at Western Technical College, 36084 Walnut St, Independence WI
- Vernon County event: Tuesday, April 21st from 10am-6pm at Vernon County Human Services-Erlandson Office Bldg, 318 Fairlane Dr (1st floor conference room) Viroqua WI
Medicaid and CHIP: Enroll any time
In Wisconsin, the Medicaid & CHIP Program is called BadgerCare. You can enroll at any time—there is no limited enrollment period for these programs. Medicaid and CHIP provide health coverage to millions of families with limited incomes. You can find out if you qualify for Medicaid or CHIP by filling out a Marketplace application, or by visiting or calling your local Medicaid office.
Wisconsin did not expanded Medicaid but you may still be eligible, especially if you have children, are pregnant, or have a disability. Every state's eligibility rules are different. If it looks like you're eligible for Medicaid or CHIP, the Marketplace will pass along your information to your state agency, where you'll be able to enroll.
The Western Region for Economic Assistance is the Medicaid/CHIP/BadgerCare agency for Buffalo, Clark, Jackson, La Crosse, Monroe, Pepin, Trempealeau, and Vernon Counties. To apply you can complete an application on line or by calling their offices Monday-Friday 8:30am-4:00pm 1-888-627-0430 or completing a paper application (available at the county offices or by printing it and mailing it to address listed on the first page). If you live in another county please check the following website to find your local Medicaid office.
The following agencies are part of the Western Region Enrollment Network and will continue to offer Certified Application Counselors (CACs) to help with applying for health insurance through the MarketPlace. If you need assistance please contact one of these local agencies:
Locate an insurance agent that can assist you and enter the county in which you live in the bottom left box to get a list of local agents.
- Black River Memorial Hospital, 715-284-5361
- Gundersen Health System, 1900 South Ave, La Crosse, (800)362-9567 ext 58660
- La Crosse County Human Services, 300 4th St N, La Crosse 608-784-HELP
- Marshfield Clinic, 1000 N Oak Ave, Marshfield 800-782-8581 ext. 94475
- Mayo Clinic, 700 West Ave, La Crosse, 1-866-789-4374
- Memorial Medical Center, Neillsville, 715-743-3101
- Scenic Bluffs Community Health Center, Cashton 608-654-5100
- St. Clare Health Mission, 916 Ferry St., La Crosse 608-392-9546
- Tomah Memorial Hospital, 321 Butts Ave, Tomah 608-374-6699
- Workforce Connections, Wanda Palmer, 608-790-8136
Information needed to enroll:
- Social security numbers (or document numbers for legal immigrants
- Employer and income information for every member of your household who needs coverage (pay stub or W-2, etc)
- Policy numbers for current health insurance plans covering members of your household
- If anyone in your household is eligible for a job-based insurance plan you will need to have their employer complete an employer coverage tool (available on the healthcare.gov website
The Marketplace will remain open after Feb 15, 2015, but depending on individual circumstances, tax credits may not be available.