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Small Business Employee Benefits and HR Blog

Wisconsin Health Insurance Exchange Guide

This guide provides an overview of the Wisconsin Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for Wisconsin residents and small businesses.

Wisconsin Health Insurance Exchange IntroductionWisconsin health insurance marketplace

Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces).

Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchange.

All states have three options for setting up a state health insurance exchange for 2014:

  1. Build a state-based exchange
  2. Enter into a state-federal partnership exchange
  3. Default to a federally-facilitated exchange

Wisconsin will default to a federally-facilitated health insurance exchange.

Wisconsin Health Insurance Exchange - History 

Originally, Wisconsin explored setting up a state-based health insurance exchange. In 2010 former Governor Jim Doyle explored IT resources to develop a state-based exchange, held stakeholder meetings, and developed a protocol exchange. In 2011, Governor Scott Walker signed an Executive Order to establish a planning office for an exchange, however closed the planning office a year later. Legislation establishing a state-based exchanged failed to pass the 2012 legislative session and in November 2012, Governor Walker announced that Wisconsin would default to a federally-run health insurance exchange.

According to Governor Walker's announcement: "In Wisconsin, we have been successful in providing health insurance coverage to over 90 percent of state residents without the creation of an exchange and absent federal regulation. We have a long history of being a leader on health reform issues, and with more guidance and greater state flexibility, our competitive market system would have ensured health insurance coverage to the most vulnerable Wisconsinites without federalization of our market. Unfortunately, operating a state exchange would not provide the flexibility to meet our state’s unique needs or to protect our state’s taxpayers." (Click here to read full announcement.)

Wisconsin Health Insurance Exchange - What is It?

The Wisconsin Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. Starting October 1, 2013, Wisconsin residents will be able to access information about all the plans available through the Exchange, shop for plans, and access individual premium tax credits. The SHOP Exchange will be available to small businesses with 100 or fewer employees. Coverage from the Exchange starts January 1, 2014.

According to an estimate by healthcare.gov, nearly 497,400 or 10% of Wisconsin’s non-elderly residents are uninsured, of whom 456,780 (92%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Wisconsin participates in the Medicaid expansion.

More information on the Wisconsin Health Insurance Exchange can be found here.

Wisconsin Health Insurance Exchange - What Plans will be Available?

All plans offered through the Wisconsin Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP), and offer a baseline of coverage. The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%).  

Details on plan carriers and rates will be available by October 1, 2013, although many states will release details sooner.

Wisconsin Health Insurance Exchange - Role of Brokers and Navigators

The Wisconsin Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Wisconsin Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). 

The Wisconsin Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the navigator program in Wisconsin.