King V. Burwell Decision: ACA Tax Credits Are Here To Stay In Wisconsin

Image credited to Huffington Post Sam Stein

Image credited to HuffPost Sam Stein

Today, June 25, 2015, the Supreme Court of the United States ruled on the court case King V. Burwell in favor of Burwell. The outcome of this case confirms the use of advance premium tax credits for consumers using a state exchange or the federal Health Insurance Marketplace ( The Supreme Court decided that Congress’ intention was to make financial assistance available to all consumers regardless of the state they live in, or whether their state made the decision to create their own Marketplace.

This decision allows over 166,000 Wisconsin residents to continue receiving their federal financial subsidies for their health insurance through the Marketplace and continues to provide the access to future tax credits and financial assistance to people who may still be uninsured.

Consumers can dial 2-1-1 to find a local enrollment assister, and also contact the Marketplace Call Center at 1-800-318-2596 to enroll in coverage. There are many Navigator and Certified Application Counselors across the state that are ready to answer questions and help people access health insurance.  Consumers in the Milwaukee area can call 414-270-4677 and 608-261-1455 in the Madison area to speak with a local Navigator.

School is Out, but Health Insurance is Always In!

Children all over Wisconsin are crouched in their seats, counting down the final seconds until 3:00, spring-loaded to dash out the door for the last time until fall. For many, the last day of school signals the beginning of summer and several months largely free of responsibility.

After taking a few moments to reminisce about care-free memories such as these, many adults reawaken to the reality that summer means employment change, and a laundry list of budget items to attend to. Remember that employment changes often affect health insurance. As summer begins and many readjust their budgets, remind your friends and family to keep their insurance up to date!

The end of school alone has far reaching effects on employment. As children wake up to cartoons and camps instead of last-minute dashes to the curb, many bus drivers switch jobs or begin receiving unemployment insurance for the summer months. Sick teachers no longer require substitutes, and kitchen staff abandon lunch rooms, now eerily quiet in the absence of rambunctious, ravenous youngsters.

Many people who do not work in schools also face employment changes in the summertime. As children run off to summer camps and public pools, park staff and camp counselors may switch from part- to full-time employment or drop supplemental positions. Construction workers, plumbers, and electricians may find seasonal work renovating school facilities while the halls are empty. Gardeners and landscapers may find their services suddenly in high-demand.

Regardless of the specifics, any income or job change can affect a person’s health insurance options, especially for those insured through the Health Insurance Marketplace ( or Badgercare Plus. People experiencing an income change should remember to update their information on their Marketplace or Access application, since changing income will affect subsidy amounts and, potentially, eligibility for Badgercare Plus.

Those who transition between full- and part-time employment may gain or lose an offer of employer health coverage. These offers can also affect eligibility for the premium tax credit and should be reported as soon as possible. It is important for consumers to remember their responsibility to keep marketplace application information accurate and current.

Of course, health insurance may take low priority in planning a budget, especially in light of more pressing budget items like food and utility bills. Without a doubt, it can be annoying to have to report changes to the Marketplace throughout the year. But especially for seasonal workers whose incomes change regularly, a single meeting with a Navigator or other enrollment assister can help consumers plan to stay covered for the whole year. A Navigator can help consumers determine what (and whose) income to report, estimate a yearly total, and develop a plan to stay covered all year. Consumers can dial 2-1-1 to find a local enrollment assister, and also contact the Marketplace Call Center at 1-800-318-2596 to make changes or ask questions.

By accurately reporting their financial situation for the whole year, seasonal workers can remove one concern from an often too-full plate during times of transition. Encourage those you know to plan ahead now to stay insured for the rest of the year. That way, when August rolls around and children are fretting over their back-to-school preparations, these hard-working adults can enjoy a turn to feel care-free.

Dial 2-1-1 to find local enrollment assistance, the Marketplace Call Center at 1-800-318-2596, or contact Covering Kids and Families for a Navigator:

Milwaukee: 414-270-4677

Racine/Kenosha: 262-637-8377

Rock/Walworth: 262-902-8572

Dane: 608-261-1455

Understand your health insurance… and be prepared for next year!

Since the Health Insurance Marketplace went online, much work has been devoted to getting people without insurance enrolled in a plan. But once you have new health insurance, it is equally important to make sure you stay insured and are considering your full range of options. If you enrolled in Marketplace coverage for 2015, keep the following questions in mind throughout the year:

Has my household’s income changed since I filled out my Marketplace application?

If you have Marketplace health insurance and are receiving tax credits to help pay your monthly premium, remember that the amount you are receiving is based on your estimate of your 2015 yearly income. This is the amount that you reported on your Marketplace application.

It is important to log on to and report changes whenever you experience an income or household change. Changes that need to be reported include an increase or decrease in how much you get paid or how many dependents you have, as well as a change in marital status. Updating your information on will allow any financial assistance you receive to be corrected for your next month’s premium, which can help prevent you from having to pay back tax credits when you file your taxes next spring.

Is my current plan helping me meet my health needs affordably?

Keep in mind that the Marketplace, as well as many employers, offers a variety of insurance options each year. If you suspect that your current coverage may not be the best fit for you, reach out to a navigator or other in-person assister about exploring other options. Unless you have an income or household change, you usually cannot switch your insurance plan mid-year, but most insurance providers (including Marketplace, Medicare, and many employer options) WILL allow you to switch plans each fall.

How long will my current insurance plan continue?

If you have Marketplace insurance, your current plan will continue until the end of the year (December 31, 2015). At that point, the insurance company may decide to change your plan’s costs or benefits, or your plan may stay the same. Your insurance company will send you a letter this fall about any changes that will go into effect on January 1st.

Keep in mind that other plans may change as well, and entirely new plans may be offered. It benefits you to re-examine options in the Marketplace each year. If you have employer coverage and think it may be unaffordable, the Marketplace may be an option for you as well. Beginning on November 1st, you can check out the Marketplace options for the coming year. If you decide to switch, make sure to enroll by December 15th for your new coverage to begin on January 1st. You will have the entire open enrollment period (November 1, 2015 – January 31, 2016) to change plans, though.

I know someone who still does not have any health insurance. When can they apply?

The best time of year to apply is in the fall, when most insurance options have open enrollment periods. But someone who needs insurance now may have other options. People who experience a qualifying life change may qualify for a Special Enrollment Period, and if your income makes you eligible for BadgerCare Plus, you can sign up at any time through the state website. See below for a summary of when to apply through the Marketplace.

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**Apply for BadgerCare Plus at any time**

If you have any questions about your eligibility, reporting changes, or making sure you are considering all your options, call one of the Navigator agencies below to get free, local help:

Madison: Covering Kids & Families – 608-261-1455
Milwaukee: Covering Kids & Families – 414-270-4677 and Gerald Ignace Tribal Health Center – 414-383-9526
Racine & Kenosha: Racine Kenosha Community Action Agency – 262-637-8377
Janesville: First Choice Women’s Health Center – 262-902-8572
Dial 2-1-1 anywhere in Wisconsin to find in-person enrollment help in your area.

Say “I do” to Health Insurance Coverage!

The beginning of May brings flowers, warmer weather, and the kick off to wedding season.  Do you know anyone getting married this summer?  In addition to picking out a present on their registry, why not also share the gift of health insurance?

Although the Health Insurance Marketplace’s Open Enrollment period closed in February, there are a number of special qualifying events that allow people a chance to enroll or change their coverage throughout the year – and marriage is one of them.  As your friends and family members are planning their vows and heading to their county clerks’ offices for their marriage certificates, remind them to add applying for health insurance to their list of to-dos.

Because marriage is considered a qualifying event, lucky couples will have 60 days from their I-do’s to apply, which is still plenty of time for a honeymoon! The process for changing or applying for new coverage is fairly straightforward, so don’t worry about causing the newlyweds any stress.  The couple can apply online at, call the Health Insurance Marketplace 1-800-318-2596, or contact a local Navigator or enrollment assister to talk through their options face-to-face.

Now the newlyweds may be concerned about cost, especially after paying for all of the other expenses that go along with getting married.  So remind them that in Wisconsin last year, over 80% of people were eligible for coverage costing less than $100 per month.  That coverage includes doctors’ visits, prescription drugs, hospital services and all the other major benefits needed “in sickness and in health.”

As we kick off the wedding season this month, remember that health insurance coverage could be a very affordable and important addition to a new family!  Call Covering Kids & Families for more information and to apply: Milwaukee: 414-270-4677, Madison and surrounding counties: 608-261-1455, Racine/Kenosha: 262-637-8377, and Rock/Walworth: 262-902-8572.

For other local enrollment assistance sites, dial 2-1-1 or visit

Ready for Health Insurance Enrollment Super Saturday on January 31?

With just 18 days to go before the Affordable Care Act’s Health Insurance Marketplace open enrollment period closes on February 15, community organizations, enrollment assisters, and insurance agents are planning nearly two dozen insurance enrollment events around Wisconsin on Saturday, January 31.

Consumers can drop in at any of these events to ask questions about eligibility for Marketplace or BadgerCare Plus insurance, learn about insurance or enroll.

With a few exceptions, US and legally documented immigrants must now have health insurance or may have to pay a tax fine that goes up every year. On the Marketplace, plans range in costs and services to help fit into your budget and meet your actual health care needs. And, 90% of people in Wisconsin have been able to take advantage of tax credits to reduce the cost of premiums, and some financially eligible households have been able to reduce their out-of-pocket costs to just few dollars per doctor visit. Health insurance is a big decision and it can be complicated. That is why CKF is here to help, on Super Saturday and throughout the year.

The Southern Wisconsin Navigator Collaborative (Covering Kids & Families, Gerald Ignace Tribal Health Center, Southwest Community Action Program and Racine Kenosha Community Action Agency) has 7 events planned on Super Saturday.

Center Street Library
2727 W. Fond du Lac Ave
10 am to 2 pm

Journey House
2110 W. Scott St.
10 am to 1 pm

La Murguia Head Start building
1645 S. 36th St.
Noon to 3 pm

CVS Pharmacy (Molina)
2607 N. Downer Ave.
2 pm to 6 pm
Dial 2-1-1 or 414-270-4677 for details.

Madison (Press Release)
United Way of Dane County
2059 Atwood Ave.
9 am to 6 pm
Dial 2-1-1 or 608-261-1455 for details or to set up an appointment.

Racine County Human Services/Workforce Development Center
1717 Taylor Ave.
Noon to 3 pm
Contact: Jessica Retzlaff

Southwest Technical College Outreach Center Computer Lab (Piggly Wiggly Mall)
316 W. Spring St.
9 am to 1 pm

If your clients, friends and family who need insurance aren’t near these events, learn about a dozen more in the state at the EnrollWI Website

The Affordable Care Act may affect your taxes this year! Be ready to file in ’14 and fix it for ’15.

With the New Year begun and tax season underway, Wisconsinites may be surprised to find a new line on their tax forms asking about their health coverage. As of January 1st, 2014, those who do not have health coverage may have to pay a penalty at tax time. The IRS will assess the first year’s penalties on consumers’ tax returns this spring.

Consumers who have health insurance (like through an employer or a relative) will simply check a box on their taxes this year indicating that they were insured for 2014.

The changes will be more involved for consumers who bought 2014 coverage through the Health Insurance Marketplace and received the Advanced Premium Tax Credit (APTC), and for those who were uninsured last year.

Consumers with Marketplace coverage will need to complete new forms to reconcile the tax credits they received. The tax credits were based on estimated 2014 income, and now they must be corrected to reflect what consumers actually ended up making. These consumers should be on the lookout for Form 1095-A in the mail, a statement of the insurance subsidies they received last year.

Others who remained uninsured last year may have to pay a tax penalty. This year, that penalty is $95 per person ($47.50 for each child) or 1% of household income, whichever is greater. The most a family will pay this first year is $285. Fines will go up next year. Some consumers may be able to avoid the fine by applying for an exemption.

An unfortunate pitfall may await those who remain uninsured and put off filing their taxes this year. The deadline to enroll in 2015 health coverage through the Health Insurance Marketplace is February 15th, two months before the April 15th tax filing deadline. Uninsured individuals who wait until after February 15th to file will have to pay this year’s penalty and will have missed the deadline to apply for 2015 coverage and tax credits. This may lead to a higher penalty on next year’s taxes.

Help people avoid the penalty for 2015
Encourage consumers to review their 2015 coverage options to get insurance!

Enrollment Answers and Help
Covering Kids & Families, leading the Southern Wisconsin Navigator Collaborative, has licensed Navigators available to help people in southern Wisconsin enroll. Contact any office to get answers to questions or learn about in-person enrollment help.

Madison: Covering Kids & Families – 608-261-1455
Milwaukee: Covering Kids & Families – 414-270-4677 and Gerald Ignace Tribal Health Center (Milwaukee) – 414-383-9526
Platteville: Southwest Community Action Program – 608-348-9766
Racine & Kenosha: Racine Kenosha Community Action Agency – 262-637-8377
Janesville: First Choice Women’s Health Center – 262-902-8572
Dial 2-1-1 anywhere in Wisconsin to find in-person enrollment help in your area.

Tax Help
For more information on taxes and health insurance, check out H&R Block’s ACA Tax Impact page. Individuals with low incomes can get free tax filing assistance at Volunteer Income Tax Assistance (VITA) sites, and people over age 60 with low-incomes can get free assistance at AARP TCE Tax-Aide sites. Check if you are eligible for assistance, then find a free tax assistance site near you.

VITA sites: Call 1-800-906-9887 or visit the IRS Website
AARP TCE sites: Visit AARP’s site finder Website
Dial 2-1-1 for information on all sites in your area.

Open Enrollment for Health Insurance November 15, 2014 – February 15, 2015!

Now is the time for consumers to update information, change plans, renew coverage or enroll for the first time! Visit the Health Insurance Marketplace at, contact the call center 24/7 at 1-800-318-2596 or find a local enrollment assistance counselor to apply. Remember, consumers have until December 15, 2014 to enroll or make changes which would take effect January 1, 2015.

Covering Kids & Families (CKF), in partnership with the Racine Kenosha Community Action Agency (RKCAA), the Southwest Community Action Program (SWCAP) and Gerald L. Ignace Indian Health Center (GLIIHC) are local Navigators who can provide assistance as well.  Our contact information:

CKF Madison: 608-261-1455
CKF Milwaukee: 414-270-4677
RKCAA: 262-637-8377
SWCAP: 608-348-9766
GLIIHC: 414-383-9526

Also, consumers can dial 2-1-1, reference the Wisconsin Enrollment Directory (, or contact other Navigators throughout the state (below) to find local help.


Special Enrollment Period for BadgerCare+ Transitioners Ends November 2

In September, the Centers for Medicare and Medicaid Services (CMS) announced a Special Enrollment Period for people who lost their BadgerCare+ coverage in April due to the eligibility changes made by the Wisconsin Department of Health Services (DHS). That Special Enrollment Period closes November 2nd.

An estimated 62,000 people throughout the state lost BadgerCare+ coverage in April, and approximately 60% of them did not re-enroll into Marketplace coverage, likely remaining uninsured and without access to compensated care.

These individuals will have until November 2nd to sign up for a Marketplace plan this year; otherwise, they must wait until November 15th to sign up for health coverage beginning on January 1st. They may also be subject to a tax penalty for not having health insurance during 2014.

A person who may be eligible for a Special Enrollment Period can start the process of buying insurance by calling the Health Insurance Marketplace at 1-800-318-2596. Please encourage them to do so as soon as possible!

2015 Marketplace Renewals and Re-enrollments

The second Open Enrollment period is coming up quickly! From November 15th, 2014 through February 15th, 2015, the Health Insurance Marketplace will be open for 2015 enrollment.  Those who remain uninsured, as well as anyone interested in learning about the new options, can apply during this time.

Consumers who enrolled last year may be wondering how to re-enroll or change plans for 2015. CMS released final rules on this process several weeks ago. Anyone enrolled in a 2014 Marketplace plan will receive letters from CMS and their insurer containing important information about this process.

The QHP’s letter will provide consumers with the 2015 premium for their current plan and remind them of their 2014 tax credit, which they will continue to receive (in most cases) if they take no action during open enrollment.

Going into open enrollment, it is important to recognize that tax credits will be recalculated.

Because of the new 2015 federal poverty level (FPL), and a likely change in the cost of the benchmark plan used to calculate tax credits, the tax credit amount for those with household income at a given percent of FPL will change for 2015. To receive the new 2015 tax credits, consumers must resubmit their application and enroll in a plan, even if they want to re-enroll in the same plan.

Below find answers to some common questions consumers may have about the re-enrollment process:

What are my options going into Open Enrollment?

During the enrollment period, there are several possible courses of action. You could renew your plan; update, switch, or cancel your plan; or take no action. Here’s what happens in each case:

  1. If you choose to simply renew your plan, and you attest that there has been no change in your income or household size, you will be re-enrolled for 2015 with your same 2014 tax credits.
  2. If you have household updates to report, want 2015 tax credits or want to look at the new options, you should update and resubmit last year’s application in order to see your new tax credits and plan options. (Please note that if, on the 2014 application, you claimed that your anticipated income was the same as reported on your 2012 tax return, the specific amount will not be listed on this year’s application either and you will need to refer to you 2012 tax return to determine if that amount is still correct).
  3. If you are currently enrolled in a marketplace plan and take no action during the 2015 enrollment period, you will be re-enrolled and receive your 2014 tax credits unless:
    • Your 2013 tax return indicates your income is over 500% FPL OR
    • You did not give the marketplace access to future tax returns at the end of last year’s application
    • In either of these cases, you will still be re-enrolled, but will not receive any financial assistance (Advance Premium Tax Credits or Cost Sharing Reductions).

If I take no action, in which plan will I be re-enrolled?

  1. If possible, the same QHP as last year.
  2. If your specific QHP is not available, you will be enrolled in a different version of the same product from the same insurer.
    • A plan in the same metal tier if possible
    • Otherwise, a plan that is one metal tier up or down from the old plan.
  3. If no version of last year’s product is available, you will be auto-enrolled in the most similar product available through the same insurer. The same metal tier policy applies as above:
    • A plan in the same metal tier if possible
    • Otherwise, a plan that is one metal tier up or down from the old plan.
  4. If neither of the above options is available, you would be auto-enrolled in the most similar product available through a different insurer.
    • Since none of last year’s marketplace insurers are going off the exchange, we should not have to worry about this case in Wisconsin.

If my household situation or income has changed, how do I report those changes?

Through the website or by phone.

Due to the challenges of following up on incomplete information received by mail, the final rule gives the Federally Facilitated Marketplace the option to reject changes submitted by mail.

After the Open Enrollment period begins, consumers will be able to preview the new options and monthly premium estimates here.

Wisconsin Faces Cuts in FoodShare Funding

Wisconsin is one of only four states nationwide that is enacting cuts to the food stamp (FoodShare) program. The food stamp cuts were passed as part of the massive Federal Farm Bill in February. The intent of the legislation was to save money by clamping down on states that were using certain provisions of a federal heating assistance program to increase food stamp benefits.

The Associated Press found that governors of 12 states have taken steps to avoid the cuts. In some cases, states are using their own money, saying they’re preserving benefits for their most vulnerable residents. The AP review said Wisconsin, Michigan, New Jersey, and New Hampshire are the only ones that did not try to work around the federal cuts.

But how does this affect our work at CKF? FoodShare eligibility is one of the federal benefits that qualifies school-age children for Free and Reduced Lunch as part of the National School Lunch Program. CKF has been working with Wisconsin’s Department of Public Instruction to connect children to free lunch via direct certification since 2011. Cuts to FoodShare mean fewer students are eligible for the healthy, nutritious meals they need to remain productive at school.

The good news is that students that were eligible for FoodShare at the start of this school year will remain eligible for free lunch for the rest of this academic year and the first month of school in 2015, regardless of whether or not they lose their FoodShare eligibility. The bad news is that unless Wisconsin leaders step in to avoid these cuts, untold numbers of kids will not be eligible for FoodShare and free lunch for next year.

For some kids, school is the only place they can get a fulfilling and nutritionally balanced hot meal.

Learn more about CKF’s Direct Certification Project at the webpage Questions about Direct Certification or how FoodShare relates to free lunch? CKF’s Direct Certification Specialists, Nikki and Helena, are happy to answer your questions. Please contact them at