Health Care & Insurance Resources

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The American Rescue Plan Act of 2021 makes major improvements in access to and affordability of health coverage through the Marketplace by increasing eligibility for financial assistance to help pay for Marketplace coverage. Under the new law, many Wisconsinites who buy their own health insurance directly through the Marketplace will become eligible to receive increased tax credits to reduce their premiums.

Starting April 1, 2021, consumers enrolling in Marketplace coverage through HealthCare.gov will be able to take advantage of these increased savings and lower costs.

When will the extra tax credits be available on HealthCare.gov?

Increased premium tax credits based on the lower income contribution percentage along with expanding tax credit access to consumers with household incomes above 400%, will be available through HealthCare.gov starting on April 1. This means that new consumers and current enrollees who submit an application and select a plan on or after April 1 will receive the increased premium tax credits for 2021 Marketplace coverage. 

Extra tax credits for consumers receiving unemployment compensation will be available starting this summer. 

If I’m currently enrolled in a Marketplace plan, how do I receive the additional tax credits/lower premiums?

Current enrollees, including those who recently enrolled through the 2021 Special Enrollment Period, can update their applications and enrollments in order to get new eligibility results starting April 1. You will need to reselect your current plan in order for the changes to take effect to reduce your premiums for the remainder of the year.

While the 2021 Special Enrollment Period opportunity is available through May 15, 2021, current enrollees can decide during the SEP opportunity if they may want to change to a new plan for the rest of the year. You should consider how much you’ve already paid toward your deductible when deciding whether or not a change in plan makes sense for you.  When you change plans, the amount you’ve paid already towards meeting your prior plan’s deductible may be reset to zero, and you would need to start over paying out of pocket expenses to reach the deductible on your new plan.  If you have made significant payments toward your deductible, check with your insurance company to see how it might impact you and what options are available to keep credit toward what you have already paid.

If I’m currently enrolled through the Marketplace, what will happen if I don’t come back in?

Consumers who enrolled in Marketplace plans prior to April 1, 2021 have the choice of waiting until they file their taxes next year in 2022 to receive the additional premium tax credit amount when they file and reconcile their 2021 taxes. However, we recommend all enrollees come in, update their application, and review their plan options during the 2021 Special Enrollment Period through May 15, 2021 because you may be able to choose a plan with lower out of pocket costs for the same price or less than what you are currently paying. 

If I don’t have coverage, when should I apply?

Consumers who need coverage starting April 1, 2021 should still apply and select a plan by the end of March through the Special Enrollment Period (SEP) so coverage can start April 1.  Then to get the added benefits, you should come back after April 1, submit your application again, and reselect your plan to have increased tax credits applied to your coverage for May 1 forward. 

If I am already paying a very low premium, or no premium, should I take any action?

Consumers who are already paying low or no premiums may find plans with more generous cost-sharing and lower out of pocket costs, and benefit from changing plans. Premiums after tax credits will decrease, on average, by $50 per person per month. Four out of five enrollees will be able to find a plan for $10 or less/month with premium tax credits, and over 50% will be able to find a Silver plan for $10 or less with tax credits. 

Meaning, you may be able to find plans with lower out of pocket expenses and lower deductibles for a similar premium to what you’re currently paying.  

If I’m receiving unemployment compensation, should I wait to apply?

You should apply and select a plan by the end of March in order to enroll in coverage starting April 1, 2021.  After April 1, you can come back in to update your application and confirm your current plan with the updated tax credits. Later this year, you may be able to receive another increase in the premium tax credits available to you. HealthCare.gov will have more information available in the summer once these additional savings are available for consumers who have received unemployment compensation during 2021.  At that time, you can come back to HealthCare.gov to update your application and current plan with more tax credits to reduce your premiums for the remainder of the year.  

Will HealthCare.gov automatically update premium tax credits on behalf of current enrollees?

If consumers don’t take action, they’ll still receive the additional benefit as part of their premium tax credit when filing their federal income tax return next year.  Beginning on April 1, 2021, consumers must come back to HealthCare.gov to update their application in order to receive these increased tax credits this year. However, we are also exploring whether tax credits can be updated on behalf of consumers during 2021.

The American Rescue Plan Act of 2021 includes premium assistance of 100 percent for COBRA continuation coverage for eligible individuals and families from April 1, 2021 through September 31, 2021.  This will allow individuals who lost their job-based health insurance to keep their insurance and receive federal funding to pay for the full COBRA premium. 

COBRA coverage lets people who have job-based health coverage keep it for a period after they lose their jobs, have a reduction in hours, or are furloughed. Usually, people have to pay the full cost of the premium on their own.

The bill also provides for an extended election period to allow individuals who previously experienced a qualifying event to enroll in subsidized COBRA coverage. Additionally, it  establishes an expedited review process for workers who are denied premium assistance for COBRA.  Please speak with your employer and health plan if you think you may be eligible for COBRA premium assistance.

The U.S. Department of Labor has issued guidance implementing the American Rescue Plan’s Continuation of Health Coverage premium assistance provisions to provide full COBRA premium assistance to certain individuals who have experienced a reduction in hours or involuntary termination of employment.

The guidance from the department’s Employee Benefits Security Administration includes documents – prepared in consultation with the Departments of the Treasury and Health and Human Services – to implement these provisions, such as frequently asked questions, model notices and a Federal Register Notice.

If I have private insurance, will I have to pay for a coronavirus test?

The Families First Coronavirus Act required that all private insurance plans cover coronavirus testing without deductibles, coinsurance, or co-pays. That bill also prohibited plans from using tools like prior authorization to limit access to testing. Insurers also have to cover fees for visits to the ER, an urgent care center, or a doctor’s office associated with getting a test without cost sharing.

For more information on how to get tested in the state of Wisconsin, please visit the Wisconsin Department of Health Services’ website.

If I have private insurance, will I have to pay for treatment for the coronavirus?

If you have private insurance and are diagnosed with COVID-19, you should contact your health insurance company to find out more information. On March 19, 2020 Senator Baldwin wrote to the CEOs of several health insurance companies urging them to cover all COVID-19 related treatment and services without cost sharing requirements and allowing Americans to get tested, assessed and treated without the fear of unexpected medical bills. In response, a number of major health insurance companies have announced that they will cover certain costs associated with treatment of COVID-19. However, every plan is different. To understand your coverage options, please contact your insurance company directly.

If I have private insurance, how does this bill affect the cost of a vaccine when one becomes available?

The Affordable Care Act required that preventive services and vaccines be covered by private insurance without cost-sharing. Normally, these services and vaccines are covered starting on the first day of the plan year beginning after they get a favorable rating or recommendation from the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices. This section requires that coverage without cost sharing begin fifteen days after getting a favorable rating or recommendation.

I lost my job due to the outbreak of COVID-19. How can I sign up for comprehensive health care coverage?

Being laid off from a job is a traumatic event that affects not only the worker, but families and the community at large. If you have lost your job due to the outbreak of COVID-19, you have options. First, if you lose your employer-based insurance, you can sign up for a Marketplace plan. Losing employer-based coverage, even if you quit or get fired, qualifies you for a Special Enrollment Period. This means you can buy insurance outside the yearly Open Enrollment Period. For more information on signing up for a Marketplace plan after losing your job-based coverage, please visit: Second, you can also sign up for COBRA coverage. COBRA coverage lets people who have job-based health coverage keep it for a period after they lose their jobs, have a reduction in hours, or are furloughed. Usually, people have to pay the full cost of the premium on their own.

The American Rescue Plan Act of 2021 includes premium assistance of 100 percent for COBRA continuation coverage for eligible individuals and families from April 1, 2021 through September 31, 2021.  This will allow individuals who lost their job-based health insurance to keep their insurance and receive federal funding to pay for the full COBRA premium. 

Finally, depending on your income, you may be able to qualify for Medicaid, or BadgerCare Plus, which is a health care coverage program for low-income Wisconsinites. You can determine if you are eligible by visiting the Wisconsin Department of Health Services' website.

Vaccines and testing are essential to slow the spread of COVID-19. The American Rescue Plan Act of 2021 contains billions in funding to get vaccines into Americans’ arms more quickly and provide crucial supplies, testing, and staffing to stop the spread of COVID-19. The bill includes: 

Between March and September 2020, as many as 3 million Americans lost their employer-sponsored health insurance. Americans must have affordable health insurance and access to care during and after this unprecedented public health crisis. 

The American Rescue Plan Act of 2021 will ensure access to health coverage by: 

The American Rescue Plan Act of 2021 will work to address systemic inequities through a $25.2 billion investment in underserved communities and communities of color, including: 

The COVID-19 pandemic has taken a toll on the mental health of many Americans, further straining mental and behavioral health and substance use disorder services that have been historically underfunded. The American Rescue Plan Act of 2021 aims to increase access to mental health and substance use disorder services, treatment, and prevention with $4 billion in funding, including: 

For general information and resources about coronavirus for Wisconsinites, please click here.

For more information about the American Rescue Plan Act of 2021, please click here.

Disclaimer: The information provided on this webpage does not, and is not intended to, constitute health care treatment, legal or tax preparation advice from Senator Baldwin. All information, content, and materials available on this page are for general informational purposes only.