Health Care & Insurance Resources

This page will be updated as more information becomes available

Note: The special enrollment period for 2021 Marketplace health plans is open now through August 15, 2021 and assistance is available online or by calling 211.

Congress has passed several rounds of financial assistance and relief in response to the COVID-19 pandemic, including most recently the American Rescue Plan Act of 2021, which was signed into law on March 11, 2021.  

Health Care and Insurance Resources for Wisconsinites

Mental Health and Trauma Resources for Wisconsinites

New Tax Credits for Health Insurance Premiums for Wisconsinites with Marketplace Coverage

FAQs: New Tax Credits for Health Insurance Premiums for Wisconsinites with Marketplace Coverage 

New Premium Assistance for COBRA Coverage

FAQs: Insurance Coverage, Testing, and Treatment for Wisconsinites

The American Rescue Plan Act of 2021: Vaccines and Testing

The American Rescue Plan Act of 2021: Health Coverage During the Pandemic and Beyond

The American Rescue Plan Act of 2021: Health Equity

The American Rescue Plan Act of 2021: Behavioral Health 


Health Care and Insurance Resources for Wisconsinites 

  • For information on how to enroll in comprehensive and affordable health insurance coverage, please visit: https://wiscovered.com
    • The special enrollment period for 2021 Marketplace health plans is open now through August 15, 2021 and assistance is available online or by calling 211.

  • For coronavirus information and resources from the Wisconsin Department of Health Services, please visit: https://www.dhs.wisconsin.gov/covid-19/index.htm

New Tax Credits for Health Insurance Premiums for Wisconsinites with Marketplace Coverage 

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.

Background: How These Premium Tax Credits Work

  • For consumers who are eligible for premium tax credits to help purchase a Marketplace plan, an individual or a family’s tax credit amount is calculated based on the following factors:
    • Household’s total expected income for the year
    • Total number of people in the household that file taxes together
    • The premium amount of the second-lowest cost Silver plan in the consumer’s area in the Marketplace. This is the “benchmark” plan cost used to calculate premium tax credits.  It’s not related to which plan a consumer actually chooses to enroll in.
  • The tax credit calculation uses a percentage of the household’s income that they need to contribute (spend) on monthly health insurance premiums. This amount is limited based on how their household income compares to federal poverty levels (FPL).  
  • Prior to the American Rescue Plan Act of 2021, households had to contribute up to 9.83% of their income to pay for health insurance premiums to be eligible for tax credits based on the cost of the benchmark plan. Consumers can choose to enroll in plans that cost more or cost less than the benchmark plan, but the amount of their tax credit is based on this percentage of their income and the cost of the benchmark plan’s monthly premium. Households with incomes greater than 400% FPL weren’t eligible for tax credits to help reduce the cost of purchasing a Marketplace plan.
  • After the coverage year, consumers who had a Marketplace plan with premium tax credits during the year will need to file their federal income tax return for that year and reconcile the amount of tax credits they received in advance with the final premium tax credit calculation as a part of their tax return. If their house income turns out to be higher than what they estimated on their Marketplace application, the household may need to pay back some or all of the excess premium tax credit they received in advance as a part of filing their tax return.  Depending on the circumstances the amount owed back may be capped.

Lower Costs & Expanded Access Under the American Rescue Plan Act of 2021

  • Individuals and families may be eligible for a temporary increase in premium tax credits for this year, with no one paying more than 8.5% of their household income towards the cost of the benchmark plan or a less expensive plan. Meaning, many consumers will be eligible for higher tax credit amounts to help cover their Marketplace health plan premiums.
    • This new lower cap on the percentage of a family’s household income that goes toward premiums addresses the “subsidy cliff” for those with household incomes above 400% of the federal poverty level (FPL).  Instead of no premium tax credits for individuals and families making more than 400% FPL, the new law will make premium tax credits available to these families and caps how much of a family’s household income the family needs to pay towards their premiums at 8.5%, based on the cost of the benchmark plan.
    • Some consumers making more than 400% FPL may not receive tax credits if the cost of the benchmark plan is less than the 8.5% of their household income that they need to contribute toward the premium.  
    • When consumers enroll, they can choose a plan that is the same, costs more or costs less than the benchmark plan. The 8.5% cap is used to calculate this increase in premium tax credit amounts, but the cost of the plan a consumer chooses to enroll in may be higher or lower than the benchmark plan. 
  • Individuals and families get a temporary boost in their premium tax credits.
    • The law increases premium tax credits for all income brackets for coverage years beginning in 2021 and 2022. For 2021 and 2022, the law applies a new premium percentage owed by individuals and families at all household income levels. 
    • Of note, most people across all household income levels will see lower premiums as a result of receiving more tax credits to reduce plan prices. Many consumers with household incomes from 100% to 150% FPL would have $0 premium plans (after tax credits) available to choose from when considering their options and selecting a plan.  
  • Taxpayers who receive unemployment compensation during any week beginning in 2021 may be eligible to receive premium tax credits to help pay for 2021 Marketplace coverage.

FAQs: New Tax Credits for Health Insurance Premiums for Wisconsinites with Marketplace Coverage

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.


New Premium Assistance for COBRA Coverage

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.

Additional resources:

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.


FAQs: Insurance Coverage, Testing, and Treatment for Wisconsinites

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: https://wiscovered.com

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.


The American Rescue Plan Act of 2021: Vaccines and Testing

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: 

  • $50 billion for testing, genomic sequencing of variants, and contact tracing efforts, as well as manufacturing and procurement of PPE 
  • $20 billion for improving vaccine administration and distribution
  • $10 billion for the Defense Production Act to procure essential PPE and other medical equipment 
  • $8 billion for public health workforce development 

The American Rescue Plan Act of 2021: Health Coverage During the Pandemic and Beyond

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: 

  • Lowering or eliminating health insurance premiums for millions of Americans who buy insurance through the marketplaces through increased tax credits, reducing premiums by potentially thousands of dollars each year 
  • Providing incentives for states to expand Medicaid by increasing federal supports, which could provide health insurance coverage to nearly 4 million Americans, including 640,000 frontline or essential workers, if expanded nationwide 
  • Subsidizing 100% of premiums for COBRA continuation coverage to help people who experienced job loss maintain their health coverage 
  • Providing $8.5 billion in provider relief to help struggling rural health care providers and ensure access to care in rural areas 

The American Rescue Plan Act of 2021: Health Equity 

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: 

  • $7.6 billion for community health centers, Federally Qualified Health Center Look-Alikes, and Native Hawaiian Health Centers 
  • $3.3 billion for the Indian Health Service 
  • $1 billion for emergency assistance for children, families, and workers through the Temporary Assistance for Needy Families program 
  • $500 million for nursing home strike teams to manage COVID-19 outbreaks and another $200 million for infection control in nursing homes 
  • $276 million to protect the elderly and fight elder abuse 
  • $150 million for the Maternal, Infant, and Early Childhood Home Visiting Program 
  • $50 million for the Title X Family Planning Program 
  • Allowing states to provide Medicaid coverage for one year postpartum to address the maternal health crisis disproportionately affecting communities of color 
  • Increased federal support through Medicaid for home- and community-based services 

The American Rescue Plan Act of 2021: Behavioral Health

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: 

  • $3 billion for the Substance Abuse Prevention and Treatment and Community Mental Health Block Grants 
  • $420 million for Certified Community Behavioral Health Clinics 
  • $420 million to the Indian Health Service for behavioral health services 
  • $140 million to develop a program to support providers’ mental health and decrease burnout of providers and public safety officers 
  • $100 million to the Behavioral Health Workforce Education and Training Program to train behavioral health paraprofessionals, such as peer support specialists 
  • $80 million in new grants for community-based and behavioral health organizations 
  • $80 million for the Pediatric Mental Health Care Access Program and an additional $50 million to support youth suicide prevention 
  • $10 million for the National Childhood Traumatic Stress Network 

Additional Information and Resources

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

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

This webpage shares information, email addresses and links to other sites or entities on the Internet that are not maintained by Senator Baldwin. Resources, email addresses and links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Senator Baldwin of any of the products, services or opinions of the entity or organization or individual. Senator Baldwin bears no responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.