Health Insurance: Big Changes Happening | WisCommunity

Health Insurance: Big Changes Happening

“What am I going to do about health insurance?” the woman at the picnic recently asked me. She had no health insurance and had several health problems.

In the next several weeks big changes are happening related to health insurance. Open enrollment will begin October 1st for a new competitive Health Insurance Marketplace for small businesses and those who buy insurance on their own. Health plans will go into effect in January 2014.

Those who have insurance through HIRSP, the state’s high risk pool, will be required to transition to private coverage through the Marketplace. 

The recently passed state budget made changes to the state’s BadgerCare program.  Under those changes parents, currently covered by BadgerCare that make over $15,500 for a couple, will receive a letter soon telling them they will lose coverage through the state and must sign up for a private plan through the Marketplace.

About 90,000 people are expected to lose BadgerCare coverage by the end of this year. In the counties that make up the 31st Senate District over 4000 people are affected by this change.

But, for the woman I met at the picnic, the news is good. Beginning in January people making less than $11,500 a year will be eligible for the state’s BadgerCare program. These folks should contact their local county health department to receive instructions on how to sign up. Local consortiums (counties working together) are staffing up to prepare for over 80,000 people who will be eligible for BadgerCare beginning next year.

All other individuals who will be purchasing insurance through the Health Insurance Marketplace can go to for information. There is also a toll-free call center available to help answer questions 24 hours a day, seven days a week. The toll-free number is 1-800-318-2596.

I’ve spoken with many local agents and brokers who are preparing for the expected influx of new customers in October. “We’ve hired new agents,” one firm told me. “We are also planning many information meetings to help answer questions.” He shared that folks really like the personal service they receive from an agent. In addition, those without internet access find it much easier to work with a local agent.

In addition to insurance agents and brokers, there will be specially trained and certified individuals who to help people apply for health insurance through the Marketplace. These Certified Application Counselors and licensed Navigators will not only help individuals but can assist small business people find health insurance plans that fit their needs.

I recently spoke with a former business owner in Trempealeau County. He always provided health insurance to his employees but found premiums very expensive. “I was at a competitive disadvantage because my big box competitors did not provide coverage for their employees,” he said.

The Small Business Heath Option Program (SHOP) will give small employers some of the advantages large employers have today.  Small businesses may be able to qualify for health insurance tax credits. If a business has fewer than 25 full-time equivalent employees with an average salary of $50,000 or less the business can qualify for up to 50% of the premium paid for employees’ insurance. In addition, these businesses are now able to buy less expensive insurance through the new competitive Marketplace.

Small employers can go to or call the special SHOP phone number 1-800-706-7893. To find out if they qualify for the Small business Health Care Tax credit, employers can visit for more information and resources.

As October 1st approaches, people will see more education and outreach efforts in their counties and communities.  I will have updated information in my Senate Office. People can reach my office by calling 877-763-6636. I will also be putting updated information on my Senate website at; font-family: Calibri;">

The Affordable Care Act is already making it easier for people to get, keep and afford health care benefits. It helps protect consumers from discriminatory insurance practices, allows children up at age 26 stay on their parents’ health insurance, provides free wellness and prevention care, and strengthens coverage for those on Medicare. And the new Marketplace will give Wisconsinites answers to their questions about affordable coverage.


September 4, 2013 - 5:37pm