Wisconsin has one of the lowest rates of uninsured citizens in the whole country – but that doesn’t mean people still don’t need help choosing the right health care coverage for themselves. If you’re currently struggling with that decision, you’re in the right place. Our insurance experts will explain the differences between things like major medical, health share plans, short-term health insurance, and more right here in this article. By the time you finish reading, you’ll practically be an expert yourself. And if you’re still confused, we don’t blame you – but our experts are always standing by to take questions.
Major Medical Insurance in Wisconsin
Wisconsin does not have its own state exchange, so if you want major medical coverage through the ACA, you will have to visit HealthCare.gov in order to fill out an application. It’s a fairly quick and simple process which gives you your results that same day. Most people who apply will qualify for a subsidy, which can make or break your healthcare budget.
Most people must wait until Open Enrollment comes around in order to apply via HealthCare.gov. Open Enrollment starts on November 1st and can run until December 15th or longer depending on the demand for that particular year. If you have a qualifying life event, such as a job change, job loss, or a new child (among other things), you might be able to qualify for a special enrollment period that lets you sign up for insurance coverage outside of this narrow window. You should definitely contact someone via HealthCare.gov if you think you might qualify but have questions about special enrollment periods.
Now let’s discuss why someone would want to start by shopping for insurance via the Health Insurance Marketplace. The first reason people argue that this insurance coverage is superior is because of its guaranteed-issue status. Even if you have a pre-existing condition, you cannot be rejected for coverage nor can you be charged higher premiums because of that condition. There are only four things which your insurance company is allowed to use as a justification for charging you a higher rate. And they are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
The second reason many people prefer ACA major medical coverage to other forms of insurance are due to the guaranteed benefits. There are 10 Essential Health Benefits which are guaranteed with every policy sold via the Exchange. These benefits even include more expensive forms of coverage that your average, run-of-the-mill insurance company doesn’t want to sell because it is less profitable for them to do so. Those benefits are:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
If you’re thinking that the guaranteed issue status and the generous list of guaranteed benefits would make these insurance policies prohibitively expensive, your logic isn’t wrong. But many people get around this by qualifying for a federal subsidy. These subsidies, if you make at least 138% of the federal poverty limit, will make direct payments to your insurance provider and substantially lower your monthly premiums. This can save hard-working households and families hundreds of dollars a month – and thousands of dollars a year – while also giving them access to the type of affordable health care that they need to stay healthy and well.
|Household Size||Annual Income (138% of FPL)|
There’s an interesting situation going on in Wisconsin with regard to Medicaid and the ACA. There was a Medicaid expansion program which came bundled when the legislation that originally passed several years ago; however, some states chose to reject the federal funds necessary to properly implement Medicaid expansion. For most of the states that rejected the funds, it created a gap in which people making more than 100% but less than 138% of the federal poverty limit were neither eligible for a federal subsidy through the ACA nor state Medicaid. interestingly enough, although Wisconsin did reject Medicaid expansion funds, there is no such gap within the state. This is because the qualifying income limits for BadgerCare have always been much higher then they are in other states. So if you don’t qualify for a federal subsidy because your income is too low, you can always go to the BadgerCare website and apply for Medicaid. For more information on BadgerCare or to apply, you should visit the Wisconsin Department of Health Services ForwardHealth Website.
Short Term Health Insurance in Wisconsin
Wisconsin has slightly different rules when it comes to short-term health insurance. If you actually need it for its intended purpose of being short-term, then this might not matter as much to you, personally. Wisconsin rules state that the maximum a short-term health insurance plan can be sold for is 12 months; and if that plan is renewable, the initial coverage duration plus renewal duration cannot exceed 18 months. This means that you will only have a year-and-a-half in order to find other, qualifying coverage. That may be plenty of time for some people, but for others, that may be extremely limiting.
In addition to limited plan duration, there are other pros and cons you should know with regard to short-term health insurance. For one, they require medical underwriting (which is basically the opposite of guaranteed issue). This means your insurance company will want to evaluate your current health status before they cover you, and use that information – along with any pre-existing conditions you may have – to decide whether they can afford it to ensure you, and how much you charge you for your monthly premiums. There will also be limits on your annual and lifetime benefits, but no caps on your total out-of-pocket costs. Many short-term health insurance claims also come with a substantially high deductible, so you should be prepared to budget for that.
Despite these downsides, there are some benefits to short-term health insurance. Short-term health insurance works very similarly to how major medical does, including the monthly premiums, doctor networks, copay, coinsurance, and the like. But short-term health insurance can be potentially 1/3 less expensive than unsubsidized ACA coverage when it comes to your monthly premiums – so you’ll have that to look forward to if you are trying to get affordable health care on a tight budget.
Christian Health Plans/Health Share Plans in Wisconsin
Due to the limited time duration of short-term health insurance in Wisconsin, you might be considering a health share plan instead. This is fair, since you won’t have to worry about duration limits with a Christian health plan. Another thing you won’t have to worry about is a tax penalty due to the individual mandate. You won’t have to worry about one anyway because the individual mandate is no longer federal law; but some states are passing statewide individual mandate laws in order to get more of their citizens insured. Wisconsin is not on that list of states yet, and it is uncertain if it will ever pass such a law. But if it does, you should know that a Christian health plan would give you an exemption and alleviate your tax burden.
How do Christian health plans work? In some ways, they’re very similar to short-term health insurance. Just take a look at all the things they have in common:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include all of the guaranteed Essential Health Benefits
- Their monthly payments can be up to 33% less expensive than unsubsidized ACA health insurance premiums
Still, just because they have so much in common doesn’t mean they’re the same. For starters, Christian health plans use different language with regard to their payment structure. Monthly premiums are replaced by monthly share amounts, and things like copays, deductibles, and coinsurance are paid for with “personal responsibility” or “unshared” amounts. Then there are the participation guidelines to consider. For some, this could be as mild as committing to attend a specific church a certain number of times per year; it could also include declaring a specific faith, or changing the way you use alcohol/tobacco for health reasons. And any disputes you get into over claims can only be settled between you and your health share plan provider. These are religious institutions, so the government can’t step in and regulate how they do business. You won’t be able to take them to court the way you would a regular insurance company if your benefits are unjustly denied.
Fixed Indemnity Plans in Wisconsin
Fixed indemnity plans can be a great supplement to any major medical, short-term health insurance, or health share plan. This is especially true if you have one with a really high deductible and no other way to pay for those first few thousands of dollars in out-of-pocket costs. Fixed indemnity plans are also good because they allow you to go out of network in order to get the care you need – albeit they probably won’t cover as much of the bill as major medical would. Still, you won’t be restricted to an HMO or a PPO provider if nobody in your network can give you the care you need. Fixed indemnity plans pay out their claims on a per day, week, month, per visit, or per incident basis. And if you’re lucky, you can find a flexible plan that’ll let you put together hospital, doctor, and even dental benefits on the same plan.
But here’s where indemnity plans fall short for some people: they do not work as a replacement for major medical, or even short-term health insurance or a health share plan. The former options pay out at least some fixed percentage of your total medical costs – fixed indemnity plans, on the other hand, only pay out of fixed amount. After all, would you rather have your insurance company pay 60% of your $250 doctor bill, or $60? That’s the basic difference between normal insurance and fixed indemnity. At the same time, you’ll at least have money coming in and some sort of financial help while you work towards fulfilling your deductible so that you can get your claims honored by your insurance company. Just be careful not to abuse your benefits, because there are lifetime and annual benefit caps with fixed indemnity plans, as well as medical underwriting.
Discount Cards in Wisconsin
Did you know you could supplement your out-of-pocket medical costs with a medical discount card? The only catch is that you have to be careful with these. It’s easy to fall for scams, especially from companies that claimed that their medical discount card is the same thing as major medical insurance, or a viable replacement for it. This simply isn’t true. All a medical discount card can do it’s offer you a small discount on common medical products and services when you check out at the register. You won’t be filing any claims, and you won’t be receiving any reimbursements, either. And the discounts they offer are usually much, much less than the fixed percentage of costs that major medical insurance will agree to pay out per claim.
Basically, you use a medical discount card the way you would use your AAA or AARP membership: you pay a membership fee, receive a card in the mail, and then make sure you use it whenever you purchase medical products or services at a qualifying provider. Some states also have free programs like GoodRx and other prescription discount cards you can get without paying a dime or filling out an application. But if you decide to go with one that requires a fee, do your homework. Make sure that the discounts they offer, and the providers they claim to work with, are genuine. Then do a little math and make sure that the cost of the membership is equal to or less than the amount of money you could save with the discounts. If you can find a good deal and the math checks out, then adding a medical discount card to the coverage you already have is a smart idea.