When Brianna Mason gets sick, she goes to a free health clinic on Saturdays on the city’s North Side.
That’s because the 19-year-old, who lives with her grandmother in a one-bedroom apartment on the South Side and works two part-time jobs, has no health insurance.
Things may change for Mason in the coming months as she decides whether to purchase insurance offered through the Affordable Care Act, also known as Obamacare. Enrollment begins Tuesday, Oct. 1, for insurance plans offered through the online healthcare marketplace.
“I’m worried about being fined for not having insurance,” Mason said during a town hall meeting about the Affordable Care Act held at Milwaukee Area Technical College.
Mason attended the meeting hoping to learn how the Affordable Care Act will affect her. Among other things, she found out that she would not incur a penalty unless she is uninsured for three months after the open enrollment period ends on March 31, 2014.
Honyeh Moye, 36, lost his job because of a health problem that required surgery. Moye, a South Side resident, said he was concerned about being denied coverage because of a pre-existing condition. However, beginning Jan. 1 the Affordable Care Act requires all insurers to provide coverage to everyone who applies, regardless of health status.
Others at the meeting said they were concerned that they will no longer be eligible for BadgerCare Plus, the joint federal/state Medicaid program in Wisconsin. People now covered by BadgerCare whose income is at the federal poverty level or below will remain in the program. Individuals on the waiting list now will be able to enroll in BadgerCare if they meet the same income requirement. However, those with income above the poverty line will need to obtain health insurance through the marketplace (see graphic).
The state expects 142,000 Milwaukee County residents to purchase insurance through the marketplace by the end of 2014.
J.P. Wieske, a spokesman for the Wisconsin Office of the Commissioner of Insurance, explained that if people have insurance through their employer, they should compare the cost and services of their current coverage with the plans offered through the marketplace and by providers outside of the marketplace.
“You need to shop around,” Wieske said.
Consumers should keep in mind that while enrollment begins Oct. 1, the effective date for the marketplace insurance plans is Jan. 1, 2014, so they have some time to do their research, Wieske added. Another date to keep in mind is Dec. 15, the deadline for consumers to enroll for coverage to begin on Jan. 1.
Mason and others who are uninsured can decide to forgo insurance, but they will have to pay a penalty the first year of $95, or 1 percent of their income, whichever is more. In 2014, the penalty goes up to $325 per adult; and in 2016 and beyond, it is $695.
In addition to the penalties, there are risks to being uninsured. Health care costs are the leading cause of bankruptcies. In addition people without insurance are less likely to see a doctor regularly and less healthy.
Individuals who participate in the marketplace must decide what percent of their healthcare costs they want the insurer to cover. The bronze tier covers 60 percent of costs; silver, 70 percent; gold, 80 percent; and platinum, 90 percent. In general, the higher the percentage of coverage, the higher the premium.
Other factors that affect premiums are income, age, tobacco use and whether people are signing up for individual or family coverage.
According to the federal government, a Milwaukee family of four making $50,000 a year that chooses the silver plan would pay about $282 a month after tax credits; the same family would pay about $70 a month after tax credits under the bronze plan. The dollar amount of the tax credits is based on plans at the silver level in the place a person lives.
Insurers in the marketplace are required to offer “essential health benefits” in at least 10 categories, including emergency services, hospitalization, and maternity and newborn care. But the exact services they cover will differ, leaving it up to consumers to decide what plan is best for them.
Where to get help
Beginning Tuesday, consumers will be able to enroll for insurance and have their questions answered by experts online at www.healthcare.gov.
A collaborative of local health care organizations and providers has set up a website at www.mkehcp.org, where individuals can learn about the Affordable Care Act and resources throughout the Milwaukee area.
Individuals interested in the marketplace or who have general questions can call (800) 318-2596.