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Confused About Health Insurance? Let's Clear Things Up.

Posted 10 October 2013 12:00 AM by TCAuthor3

By Greg Long, Senior Vice President Systems of Care &  CMO

The many providers and staff at ThedaCare are compassionate about improving the quality of care for our patients in northeast Wisconsin – we want to make sure we’re helping our patients enjoy every moment of their lives.

I hear questions from people who are confused about the new health insurance requirements. I’d like to take a few moments and answer some of the common questions people are asking about healthcare reform and insurance.

If you don’t have health insurance, the new world of the Affordable Care Act could change things quite a bit for you and your family in 2014. In the next few weeks, you’re going to see tons of information about the new law because new components take place beginning in January 2014, which is when all Americans must carry health insurance or pay a fee. If you’re uninsured, for example, and if you are between 26 and 45, you will face a penalty of $95/person or 1 percent of your household income.

If you’re already covered through your employer, Medicare, Medicaid (Badgercare in Wisconsin) or the Veterans’ Administration, you’re probably good to go, though there may be some changes in coverage. For instance, Medicare currently includes annual wellness visits at no cost to you – that won’t change. If you have Part D prescription drug coverage and fall into the “donut hole” gap in coverage, your out-of-pocket cost will shrink as the hole gradually (and finally) disappears.

For uninsured Americans, the new health insurance exchange is online – you can review and compare insurance plans in the comfort of your home. Wisconsin’s exchange is at UnitedHealthcare: Choice Plus Definity HAS Plan is considered the benchmark plan for Wisconsinites. There are many different benefit levels – starting from more affordable premiums and higher deductibles to plans with more expensive premiums and low deductibles. Check them out to see which one is right for you.

If you have the Medicare Advantage plan instead of traditional Medicare, there will be some changes. Plans must earn 3 out of 5 stars to receive bonus payments for providing you with quality care. There are also new requirements for how they use their bonuses, what they can charge for some services, and how much they can spend on administrative fees. Your plan may also drop coverage for some services like eyeglasses or gym memberships. Be sure to check the details to make sure there are no surprises in your care.

BadgerCare is also an option if you earn approximately $14,000/year (as an individual) or $29,000 (for a family). To learn more about Wisconsin’s Medical Assistance program, visit

One more thing you should consider when exploring your options is to look to your employer. If you work for a company with more than 50 people, your employer must provide you with insurance starting in 2015, or they must pay a fee. Employers are also eligible to purchase health insurance at reasonable rates through the exchange. Be sure to check with your employer about what options they’re providing for employees.

The bottom line for you is that you need to take time to really understand your insurance options, your plan benefits, how they work, and what limits the plan places on your choice of doctors, hospitals and other health care services.