With the implementation of Healthcare Reform, there are several changes occurring in the medical insurance arena. To familiarize yourself with the changes, please visit healthcare.gov (the Federal website) or call CMS, the agency governing the program, at 1-800-318-2596.
With the changes in 2014, anyone can purchase medical insurance without consideration of pre-existing conditions. For many, coverage may be available through group insurance coverage provided by their employer. For those that are seeking individual coverage, there may be three different general directions available in Wisconsin:
If your modified adjusted gross income falls at or below 100% of the federal poverty line, you may be eligible for Badgercare. Enrollment in Badgercare can be initiated through healthcare.gov. Additional information regarding Badgercare can also be found at the Wiscoinsin Access Webiste, Access.wisconsin.gov.
If your modified adjusted gross income falls between 100% and 400% of the federal poverty line, you may be eligible for premium subsidies. To qualify for the subsidies, you must purchase your coverage through the Marketplace, or Exchange. This can be done online through the healthcare.gov website, through the CMS 800# (1-800-318-2596), or by mail. For an indication of your subsidy eligibility, the calculator below can be used. Once your financial eligibility is established, we can help you with program selection. Leitch Insurance Agency has agents that are licensed and registered to work within the Marketplace/Exchange.
The “Standard Market”
If you are eligible for premium subsidies, you can still go through the Marketplace/Exchange, or you can shop through the standard market. In Pierce & St. Croix Counties, there are only two providers (Health Tradition Health Plan and Medica) available within the Marketplace/Exchange. Medica also provides coverage outside the Exchange. WPS (Wisconsin Physicians Service) also provides competitive programs in the standard marketplace. We can help you compare programs and purchase coverage with these programs.
To help determine whether you would be eligible for a premium subsidy, the calculator below is provided through the Kaiser Family Foundation. Please note that final determination is based on your application through the Exchange.
If the subsidy calculator does not appear below, please follow this link to the Kaiser Family Foundation website.
Please call our office with any additional questions.