Individual & Family Coverage

Individuals and families can purchase health insurance from the “Marketplace,” and the government will provide an Advanced Premium Tax Credit (APTC) to assist with the monthly premium for your health insurance plan. The amount of this tax credit is based upon your projected income for the year, your age and where you live. Other names for the Marketplace include the Affordable Care Act (ACA), Obamacare, and the Health Insurance Exchange.

The deductible is the dollar amount you pay for covered healthcare services before your plan benefits begin covering costs. Often, a plan will have both an individual deductible and a family deductible. Many companies offer plans with no medical deductible.

The max out-of-pocket is the maximum amount that you will pay for covered medical services in a calendar year. If your plan has copayments and/or coinsurance, these amounts will be put towards your max out-of-pocket.

For some plan types, the deductible and max out-of-pocket are the same amount. This means that you pay full price for covered medical services, and once you have met the amount of the deductible and max out-of-pocket, you pay nothing for covered services for the remainder of the calendar year.

In most cases, no, you will not qualify for an Advanced Premium Tax Credit (APTC) if you are offered coverage by your employer. However, you can still enroll in a Marketplace plan at full cost during an enrollment period, even if you don’t qualify for APTC.

If you have a low household income, it is likely that you will qualify for a tax credit that will cover most or all of your monthly health insurance premium, or you may qualify for Medicaid/Badgercare.

Anyone who is eligible can enroll in Marketplace coverage during the Open Enrollment Period from November 1st to December 15th into a plan that will be effective for January 1st. You can also enroll in a plan from December 15th to January 15th that will be effective for February 1st.

You may also qualify for a Special Enrollment Period during the year if you have a qualifying event. Some of these events may include: retirement, marriage, divorce, birth, adoption, loss of employer coverage, loss of Medicaid / Badgercare coverage, or you move out of your plan's service area.

A Health Savings Account is savings account that allows you to deposit money tax-free and use it to pay for medical expenses including deductibles, copayments, and coinsurance. These accounts are offered by banks, credit unions, and other financial institutions. Any interest or other earnings from your HSA plan are not taxable.

You must have an HSA-eligible plan in order to contribute to an HSA account. These plans are sometimes referred to as HDHPs (High Deductible Health Plans). Most HDHPs only cover preventive services prior to paying the deductible amount.

If you did not receive your 1095a form from the Marketplace, we can help you access it! CONTACT US for assistance.