~The Productivity Advisor~

The New Health Care Law – Part 3 on the Affordable Care Act


We are now several days into the first open enrollment period for the Affordable Care Act (ACA).  The stories we hear are those of frustration, delay, inability to log on to the ‘marketplace’ and so on.  But, we have to remember that this enrollment period will last until March 31, 2014.  If you want coverage to be effective on January 1, 2014, you must’ve completed enrollment by December 14, 2013.

Wisconsin’s Health Insurance Risk Sharing Pool (HIRSP) has created an enrollment checklist for its current members since they’ll be migrating to the new marketplace on January 1st.  That checklist is found at http://www.hirsp.org/pdfs/2013gettingreadytoshopmarketplace.pdf.  This is a very well-constructed worksheet and will be of value to anyone planning to access the marketplace to seek health care coverage.

Remember that Wisconsin is using a federally facilitated exchange (FFE) so the logon for that marketplace will be http://www.healthcare.gov .  Once on that site, you’ll be guided through the process.

The Kaiser Family Foundation has also loaded the Silver plan 2 (the second lowest priced Silver plan in the state) for each state on its website that provides estimates of premium cost and tax credits that may be available.  You can logon to http://kff.org/interactive/subsidy-calculator/   and find the link to Wisconsin and the form to be completed to obtain the estimated net cost of that particular plan.  Remember that the Silver plans in the marketplace is one that pays 70% of actuarial value for the benefits you obtain leaving you with responsibility for the remaining 30% of expenses.  This will at least give you an idea of what, if any, tax credit you may expect to see to help offset part of the premium.

A final thought that is very important is this, check the provider directory for the insurance plan you are considering to be certain that your physician is in the network for that plan, and to be sure that he or she accepts the reimbursements negotiated for this plan.  If you have any doubt, note the name of the plan you are considering and telephone your provider to verify that he or she is participating in that plan.

It is most important that you be prepared to be very patient as you sit down to access the state marketplace.  Remember the reports of delays, lost connections, overloaded websites, etc.  You may be among the lucky ones that make it through the system the first time you sit down at your computer…or you may have to try multiple times to access the site.  Think of the tens of millions of people who will be using this site, and that may help to lower your heart rate.  🙂

Al Campbell Pic