Commissioner Nickel Reminds Consumers to Shop for Health Insurance
2018 Open Enrollment Starts on November 1 and Ends on December 15, 2017
Madison, WI—With open enrollment beginning on November 1, Commissioner Ted Nickel reminds consumers to shop for health insurance coverage.
Open Enrollment
The Affordable Care Act (ACA) requires insurers to offer coverage on a guaranteed issue basis to all eligible consumers during an annual open enrollment period. Open enrollment allows individuals to re-enroll in their existing health insurance plan or to shop for a new plan. Consumers are encouraged to shop for insurance. If you receive a subsidy through the federal exchange, it is important to understand how the subsidy will impact the cost of your plan. While subsidies are only available through the exchange, consumers shopping for health insurance should consider off-exchange carriers as well.
This year, open enrollment runs from November 1, 2017, until December 15, 2017. Coverage begins on January 1, 2018. Consumers seeking individual coverage should sign up before December 15, 2017, or risk being locked out of the individual insurance market until 2018. Consumers facing a loss of their group coverage or other special situations may be eligible for special enrollment periods.
Advanced Premium Tax Credit (APTC)
The federal government offers consumers a tax credit to help individuals afford health insurance coverage purchased through the federal exchange. APTC is the advance payments of a tax credit that can be used to lower monthly premium costs. When consumers apply for APTC, they estimate their expected income for the year. It is important to report any changes in income during the year to the federal government to ensure consumers do not take more premium tax credit than they are due based on their final income. APTC is the difference between the second lowest cost silver plan for your age and county of residence and your maximum monthly contribution.
APTC is available to individuals and families with incomes between 100 percent and 400 percent of the federal poverty level (FPL) ($24,600.00 for an individual and $98,400.00 for a family of four in 2018). Individuals can use the premium tax credit to buy a bronze, silver, gold or platinum plan on the federal exchange.
Second Lowest Cost Silver Plan in Each County
Information on the chart below is the second lowest cost silver plan rate for a 21-year-old in each county. Consumers should note that all subsidies are based on the cost of the second lowest cost silver plan in their county. The five example scenarios listed below are calculated using these values.
Chart - Second Lowest Cost Silver Plan
Example Federal Subsidy Scenarios
The following five examples are scenarios of individuals who qualify for APTC. It is important to note APTC amounts and maximum contributions may vary based on your family situation and income. For simplicity, we have limited the examples to single coverage. These scenarios are approximations of actual amounts and may differ from those quoted on the federal exchange Web site at
HealthCare.gov.
Example 1: Green Bay (Brown County)
Cindy lives in Green Bay, Wisconsin. She is single, aged 25, and makes $18,090.00 annually.
- Cindy's maximum premium contribution is $61.51 per month in 2018.
- Cindy's APTC will be $566.78 per month in 2018. This amount can be deducted from her monthly premium even if she does not purchase the second lowest cost silver plan.
Example 2: Eau Claire (Eau Claire County)
Jack lives in Eau Claire, Wisconsin. He is single, aged 34, and makes $24,120.00 annually.
- Jack's maximum premium contribution is $129.24 per month in 2018.
- Jack's APTC will be $432.34 per month in 2018. This amount can be deducted from his monthly premium even if he does not purchase the second lowest cost silver plan.
Example 3: Madison, Wisconsin (Dane County)
Sarah lives in Madison, Wisconsin. She is single, aged 40, and makes $45,000.00 annually.
- Sarah's maximum premium contribution is $358.50 per month in 2018.
- Sarah's APTC will be $92.35 per month in 2018. This amount can be deducted from her monthly premium even if she does not purchase the second lowest cost silver plan.
Example 4: Milwaukee, Wisconsin (Milwaukee County)
Linda lives in Milwaukee, Wisconsin. She is single, aged 55, and makes $30,150.00 annually.
- Linda's maximum premium contribution is $206.28 per month in 2018.
- Linda's APTC will be $787.06 per month in 2018. This amount can be deducted from her monthly premium even if she does not purchase the second lowest cost silver plan.
Example 5: Rhinelander, Wisconsin (Oneida County)
Steve lives in Rhinelander, Wisconsin. He is single, aged 61, and makes $36,180.00 annually.
- Steve's maximum premium contribution is $288.23 per month in 2018.
- Steve's APTC will be $890.17 per month in 2018. This amount can be deducted from his monthly premium even if he does not purchase the second lowest cost silver plan.
Alternative Enrollment
In cases where a consumer's current health insurer is exiting the market and the policy was purchased through the federal exchange, the federal government will assign the consumer to a new health insurer if the consumer does not purchase coverage through the exchange. This process is called "alternative enrollment." To avoid alternative enrollment, consumers are encouraged to explore their options and shop around for coverage.
Interactive Coverage Map
OCI provides access to an interactive map showing all carriers available in each Wisconsin county and a link to the company Web site to explore plan options. The Health Insurer Map is a record of health insurance companies' marketing practices as reported to OCI in rate filings. Inclusion on this list is NOT an implicit or explicit endorsement by OCI. For access to the Health Insurer Map please visit
oci.wi.gov/Pages/Consumers/FindHealthInsurer.aspx.
Tips on Shopping for Coverage
When shopping for coverage, remember the cheapest policy may not be the best option. Questions to consider when deciding to change or keep one's current plan include:
- Will the plan allow you to see the providers you want?
- Will your current doctors accept your coverage?
- Will the plan cover the prescription drugs you are currently taking?
- What are the benefits that are excluded?
- What is the total cost to you, including premiums, coinsurance, copayments, deductibles, or other out-of-pocket expenses?
- If you have a specific health condition, is one type of plan better suited to provide the services you need?
Created by the Legislature in 1870, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.