Health care options available for individuals
Marketplace website modified; plan costs in Wisconsin remain lower than national average

By Katherine Michalets - Freeman Staff

Nov. 3, 2015

WAUKESHA - Since it was launched in 2013, the health exchange website created after the Affordable Care Act went into effect has had a reputation of experiencing technical issues and being a slow process, but was modified in time for the 2015 enrollment period, allowing Americans to assess their options faster. And in Wisconsin, the benchmark health insurance plan offered through the exchange will increase less here than the national average.

Modified marketplace website

Sandy Raasch, sales professional for Platinum Benefits Group, said the expectation for when enrollment began this past Sunday on is that it would run smoother and the renewal process would be faster because of site modifications.

“They should be able to go in, reconcile and reconfirm their policy if they know they want to keep plans; it should take about 10 minutes,” Raasch said.

That’s a dramatic difference from the nightmare that the site was in 2013 and 2014, she said, but navigating the options remains challenging.

“Everyone I talk to and who are highly educated, it still difficult to understand. I don’t know how a person is able to completely do it alone,” Raasch said, adding the hardest part isn’t filling out the application, but determining which network to select.

An agent handling different health insurance policies, like herself, is better able to understand the nuances of the options, she said. One plan may have lower premiums, but the coverage may not be as comprehensive as a more expensive plan.

“I would just encourage (people) to remain optimistic,” Raasch said. “The older people get the bigger tax credits even if their income is the same, it’s worth their time to go in and check.”


The front page of's website.

Doctor networks

One of the most significant changes individuals can expect when selecting health insurance in 2016, Raasch said, is that several companies have exited the market, including Assurant which is discontinuing its health insurance division on Dec. 31, 2015; and Anthem Blue Cross and Blue Shield which will no longer sell ACA-compliant individual health insurance policies in Milwaukee, Racine and Kenosha counties.

She said there are still good health insurance options separate from the marketplace.

Some of the people returning to the health exchange website will be forced to switch plans for 2016 because some health insurance cooperatives have collapsed since they were formed.  Data released Friday showed a choice of 50 plans per county overall, compared to 58 per county in 2014, and an average decline of two plans per insurer.

Tax credits and cost

Raasch said it’s important to maintain documentation for selected health insurance plans, especially if an individual really likes that particular plan. She said representatives for the federal marketplace do not go into an individual’s account to verify that the income and all other information remained the same, so the person could possibly lose her income tax credit as of Jan. 1. So it’s important for an individual to make sure the forms online are reconciled.

Raasch said she has found that health insurance premiums are consistent on and off the marketplace, but deductibles will tend to be lower through

While the Affordable Care Act does make health insurance more affordable for some, that’s not the case for everyone, Raasch said.

“ACA is not affordable for the middle-income person,” she said, citing that some plans come with a $6,800 maximum out-of-pocket.

Last week, the U.S. Health and Human Services Department said the cost of its benchmark plan on would increase less in Wisconsin than the national average. According to an Associated Press report, the silver plan rates will go up 4.7 percent in Wisconsin compared to 7.5 percent nationally. Some states will have rates increasing by double digits while other states will have a decline in rates. Nationally, about eight in 10 returning customers will be able to buy a plan for less than $100 per month after tax credits.

Peter Frittitta, who handles client strategic services for R&R Insurance Services, Inc., said the cost of insurance on the marketplace has stabilized; however, he said pressure is increasing from some employees forced onto the marketplace who found it affordable two years ago, but now witness costs increasing.

Tammy Yager, consultant for T.E. Brennan Company, said individuals should check prices and look for the best value.

The classic example is an MRI, which can cost $750 through a private company and around $2,500 at a hospital.

Scott Fuller, senior vice president of employee benefits practice group leader for Associated Financial Group, LLC, said now that more individuals are paying for their health insurance they are more willing to shop around for the best price for a procedure.

To keep costs down, Fuller also recommends that employees take an active role in their health, including taking “advantage of preventative care which the ACA mandated be covered at 100 percent.”

“The healthier we are the lower the costs will be,” he said.

Kurt Janavitz, CEO of Integrated Health Network based in Brookfield, said he believes there will be more price transparency in the future.

The future

Fuller worries that if health insurance remains such a complicated problem, people will become discouraged.

“I think it’s one of the biggest fears is that if we don’t find a way to simplify it, people may get so frustrated they don’t want to deal with it. It is a challenging and complex problem,” Fuller said.

Janavitz said individuals are determining what they want out of health insurance for what cost.

“People are still trying to figure out what price point is OK to have less choice,” he said. Overwhelmed, people pick health insurance based on cost compared to quality.

“We are going to continue to see more and more options that are attempting to do something different,” Janavitz said.

While some people may want the additional options, he said health insurance will also get more complicated.

“Get counsel and advice,” Janavitz said. “Health insurance is morphing.”


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