Help with open enrollment is available

Health Insurance coverage is an issue that should be on everyone’s mind. It is that time of year when open enrollment occurs throughout the country. Yes, it is a big deal. Yes, it can be overwhelming. However, we have a few tips and hints to help.

So let’s talk about getting covered. What is this Affordable Care Act, “ACA,” “Obama Care,” or “Marketplace Insurance”?

It is private health insurance with savings based on your income. Health Insurance Plans cover essential health benefits, pre-existing conditions, and preventive care. Most people who apply through the marketplace qualify for premium tax credits and an out-of-pocket cost savings based on household size and income.

The only difference between plans sold inside versus outside the “marketplace” is tax credits/subsidies. To get lower costs on your monthly premium you must go through a marketplace plan. Eligibility to receive federal tax credits is based on income and household size, anyone below 400 percent of the federal poverty level may be eligible. Those who may not qualify for tax credits have an estimated income above $46,680.00 for one person or $95,400 for a family of 4.

The Affordable Care Act open enrollment began Nov. 15. Coverage could start as early as Jan. 1 if you apply, pick a plan, and pay the first month’s premium by Dec. 15. The deadline to enroll is Feb. 15. The only way to become eligible for enrollment after this period is through a special enrollment period due to a qualifying life event.

There are four ways to apply: on-line, paper application, over the phone assistance, or through a local in-person assister.

Be prepared to provide the following information for each person applying: home/mailing address, Social Security numbers, employers and income information, and policy numbers, plan ID, and notices for any current health insurance plans.

There are five steps to getting covered: explore, prepare, compare, choose, enroll. You will create an account, fill out an application, get eligibility results, choose a plan and enroll.

If you are already covered through the marketplace visit by logging in and use these five steps to stay covered: review, update, compare, choose, enroll.

This is your only chance to review your information, insurance plans and choose coverage that best fits your needs. Staying covered is important, so please review your information, even if nothing has changed you may be eligible for additional tax credits.

Wisconsin State Medicaid/BadgerCare is open year round. Eligibility for BadgerCare includes all adults at below 100 percent of the federal poverty level, all children and pregnant women up to 300 percent of the poverty level.

You can enroll for BadgerCare on-line at, if you meet the financial eligibility. However, if you are not sure that you meet the criteria, enroll through for determination of eligibility.

The ACA Task Force of Sheboygan County has several events planned throughout the county, in-person assisters (navigators and/or certified application counselors) are available Wednesdays from 1 to 5 p.m. at the Mead Public Library. View the list of enrollment events, fairs, and contact information at or visit us on Lakeshore Community Health Care’s Facebook page.

 Kristin Blanchard is chief executive officer of Lakeshore Community Health Center and a member of the HSC2020 Steering Committee.