Covering Wisconsin in the News
Enrolling in Medicare or other plans? Experts say read the fine print
Medicare open enrollment is underway and it is also the time of year when other public health coverage programs and employer-sponsored plans carry out their sign-ups.
Wisconsinites are being encouraged to weigh their options. Advisers said reducing health care costs involves more than focusing on monthly premiums. You should also compare a plan's copays and deductibles.
Adam VanSpankeren, navigator program manager for Covering Wisconsin, which helps people understand and sign up for publicly available health insurance and similar programs, said reading notifications this time of year is vital because a small, subtle difference could end up being a big shock.
"You might be used to going to your doctor year after year, and then find out that they're actually not covered by your plan anymore," VanSpankeren explained. "That's got to be the most kind of disheartening and surprising thing. And people often discover that when they go to get care."
As for Medicare, original plans do not cover prescription drugs, so what's known as the Part D plan is needed for medications. Starting in 2025, the plan will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan.
Health policy analysts said there can be trade-offs when deciding between a traditional Medicare coverage option and a Medicare Advantage plan.
Dr. Rhonda Randall, chief medical officer and executive vice president of UnitedHealthcare Employer and Individual, noted Advantage plans tend to cost more, but are worth considering for the benefits they provide.
"Things like dental, vision and hearing," Randall outlined. "Many Medicare beneficiaries might be surprised to know that original Medicare doesn't cover most of those things, but many Medicare Advantage plans do. I also recommend people to check for mental health coverage."
About 56% of Wisconsinites signed up for Medicare have advantage plans. Program enrollment runs through Dec. 7. UnitedHealthcare offers an online guide for navigating Medicare. Meanwhile, people with employer-sponsored health plans are also entering their enrollment season and sign-up through the health insurance exchange under the Affordable Care Act begins Nov. 1.
Covering Wisconsin plans to maintain navigators, scale back promotions
The Wisconsin agency that helps people sign up for Affordable Care Act and other health insurance coverage is scaling back its promotions work as federal pandemic relief dollars provided to it by the state come to an end.
A $3.2 million award announced last week by the Centers for Medicare and Medicaid Services will allow Covering Wisconsin to maintain its team of health insurance navigators, Covering Wisconsin Director Allison Espeseth said.
“The reduction of pandemic dollars and just increasing costs mean we had to make a decision about promotions and outreach, not necessarily putting as much of our funding there,” she said.
Espeseth expects Covering Wisconsin to have around 44 navigators, a slight decline from the 50 it previously had. Some positions have ended since they were funded temporarily. The amount is still higher than the 30 it had in 2021
The organization will continue to work with other groups to coordinate and collaborate on promotions, including through a partnership between the Department of Health Services and the Office of the Commissioner of Insurance.
Espeseth expects her organization to focus heavily on the Healthcare.gov open enrollment period, which runs from Nov. 1 through Jan. 15.
One change from previous periods is that those covered by the Deferred Action for Childhood Arrivals program, which delays the deportation of people without documentation who came to the country as children, can now apply for coverage.
“We're looking forward to some sense of maybe a little bit of normalcy and a little bit of calm and not so many sudden changes that we have to really quickly message out and quickly try to make sense of, not only for consumers, but also other professionals,” Espeseth said about the upcoming period.
The most recent period set a record for sign-ups, in part due to outreach efforts to help people transition from Medicaid as renewals returned to the program following a hiatus during the pandemic. That work increased coordination among groups working on health insurance coverage.
“We’re doing what we can to help encourage all these things to continue,” Espeseth said.
ThedaCare names new leader at London, Waupaca hospitals
ThedaCare on Tuesday named a new leader for its critical access hospitals in New London and Waupaca.
Jenny Derks will serve as the vice president of the medical centers and oversee their operations and strategic direction. She previously worked in leadership roles at other Fox Valley hospitals, according to a statement.
Derks will replace Kellie Diedrick, who is now vice president of critical access hospitals for ThedaCare.
ThedaCare joined forces with Froedtert Health at the start of the year.
AmeriCorps members set to support healthcare, public health work
New Wisconsin AmeriCorps members will support healthcare and public health.
The state has received $12.8 million from AmeriCorps to support 24 current programs and five future ones. Serve Wisconsin Executive Director Jeanne Duffy said Tuesday that the dollars will support 875 AmeriCorps members at over 200 service sites.
"These new AmeriCorps members will help tackle some of our toughest problems by addressing the achievement gap and educational challenges, public health and healthcare access, opioid and substance abuse, economic opportunity and housing availability, conservation and environmental sustainability, and other concerns,” she said.
At Marshfield Clinic Health System, 80 AmeriCorps members will support nonprofits and public health organizations, while 30 will work as recovery coaches to help those with substance use disorder and provide community education.
Thirty-four members will work with the Wisconsin Association of Free and Charitable Clinics to support its members and community health departments.
Fourteen members will support the United Way Fox Cities - Be Well Fox Valley initiative and work to improve health and address the social determinants of health at nonprofits and public agencies.
The funding will also support Easterseals Wisconsin, where 25 members will provide personal care and therapeutic recreation activities for those with disabilities and veterans.
Medicaid program seeks to improve customer service
Wisconsin’s Medicaid program is working to improve consumer experience, Medicaid Director Bill Hanna said Monday.
A survey from consulting firm McKinsey and Company found Wisconsin has the highest ranking among states for individuals’ experience with Medicaid eligibility, but just 46 percent of people are highly satisfied, Hanna noted.
“There is room for us to grow,” he said at the annual enrollment conference held by Covering Wisconsin, an agency that helps people find health insurance coverage.
One way DHS is doing that is through what its staff “affectionately call the pizza tracker,” which will allow people to know the status of their Medicaid application, Hanna said.
“Nowadays, everybody wants to know where we are in the process,” he said. “You order something from a pizza shop or from DoorDash, you see where you are in the process, and you get an update when your order's been received, when your order's been picked up, when the driver is approaching. We are doing something similar in our Medicaid application.”
That will help with transparency and reduce call volume, so workers can spend more time processing cases.
DHS is also using technology to improve document processing, help caseworkers search policy manuals and aid customers in finding consistent and reliable information.
An additional emphasis has been on “courteous employees,” Hanna said.
In particular, Milwaukee Enrollment Services has put a major focus on customer service. The income maintenance agency that helps people sign up for Medicaid coverage previously had multiple one-star Google reviews. It now has a 4.3 rating.
DHS is also working to better engage Medicaid members between the ages of 19 and 26 who have higher procedural disenrollment rates, meaning they lost coverage because they failed to return needed information or documentation to confirm eligibility.
Part of the issue is an “information gap” due to public awareness that children can stay on their parents' health plan until they turn 26, Hanna said. That’s not the case for Medicaid, where children have to apply on their own once they turn 19.
“We haven't done a great job of making sure those individuals — those young adults and their families — understand that there is a step that they have to take when they turn 19,” he said.
The pandemic compounded that issue as the Medicaid program kept people on its rolls regardless of age changes. DHS is in the process of reaching out to young adults who were procedurally disenrolled as that policy wound down and is sending around 2,500 letters to people in that age group every two weeks.
Going forward, DHS plans to continue sending letters to those who are aging out as well as their families.
“There’s nothing like mom to get you to do that work to make sure you maintain that eligibility,” Hanna said.
Rebecca Easland, deputy insurance commissioner, spoke at the conference too. She said the Office of the Commissioner of Insurance is working closely on challenges posed by “bad actors” who are inappropriately signing Medicaid-eligible individuals up for individual coverage, in the wake of the program unwinding its continuous enrollment policy.
Inappropriate enrollments are “often driven by out-of-state agents and brokers.”
“We are taking action, where appropriate within our regulatory authority, to ensure that consumers in Wisconsin aren't harmed,” Easland said.
Wisconsin hospitals improve on quality measures, says WHA report
The Wisconsin Hospital Association reports that 28 healthcare measures it tracks through its quality data reporting website improved compared to last year, including a reduction in catheter-associated urinary tract infections and acute stroke incidents.
The two measures fell by 26.7 percent and 39.7 percent, respectively, according to a WHA report released Monday.
Patient experience scores for discharge instructions also ranked best in the nation.
The top 10 percent of Wisconsin hospitals show patient experience results up to 15 percent higher than hospitals nationwide.
“Our hospitals and health systems are dedicated to leveraging data and innovative quality initiatives to drive significant improvements in patient care and community health,” WHA CEO Eric Borgerding said in a statement.
The report also notes that 68.7 percent of Wisconsin hospitals have received four- and five-star ratings from the Centers for Medicare and Medicaid Services, greater than the 40.3 percent with the ratings nationally.
Community-Based Assistance Programs Support Applicants Where They Live and are a Gold Standard for Outreach
In this final installment of our series on Medicaid and CHIP outreach, we look at community-based assistance programs and resources in each state. Personalized assistance is critical to helping individuals and families find and access support to navigate confusing processes.
CCF’s state outreach snapshot found state-supported outreach assistance programs in 30 states. Most, states with these programs, though not all, also have an assister locator (24) to help users find assistance in their local communities. Some locator tools are simple lists, while others have interactive tools allowing for precise results. For example, Colorado’s assistance program locations are called Certified Application Assistance Sites and their state Medicaid department operates this interactive locator tool.
The snapshot also took note of assister locators hosted by organizations external to the state, typically by a nonprofit organization or navigator entity. Many of these external locators are funded entirely or in part by federal Health Insurance Marketplace navigator grants, as indicated by funding statements on webpages or use of the federal Get Covered Connector widget (see Covering Wisconsin for an example of both).
The snapshot also documents the federal and state-based navigator organizations in each state. Several states have more than one navigator entity, notably Texas has ten federal navigator organizations and Missouri has four. Similarly, Connecting Kids to Coverage grantees were included in this segment of the snapshot. Connecting Kids to Coverage is a national initiative designed to support outreach and enrollment for families with children and teens eligible for Medicaid and CHIP. In the most recent tranche of awardees, there were 43 grants totaling just over $55 million divided among 23 states, with California having the most grantee organizations (8).
World Refugee Day @ Lynden Sculpture Garden
The Institute of World Affairs (IWA) at UWM joined the HOME Refugee Steering Committee at the Lynden Sculpture Garden on Saturday, June 22, to celebrate World Refugee Day. Kim Khaira, who organized the event, noted that it is an annual celebration that brings refugees from different parts of Milwaukee together.
This year, the Committee focused on HOME as the theme. Gwendolyn Sutton, a member of the Lynden Garden HOME Refugee Steering Committee, gave the opening remarks, expressing that the day was not just about celebrating World Refugee Day, but also “the power of partnerships.” In addition, Gwendolyn said that the celebration reflects the Committee’s “commitment to raising awareness of the situation of refugees worldwide.”
The event started with prayers from different faith groups and speeches from partners, such as the Interfaith Conference of Greater Milwaukee and others. The event was attended by various community resource partners, such as the Hunger Task Force, Milwaukee Public Library, Covering Wisconsin, Community Center for Immigrants, and many others, all of whom play various role in supporting refugees.
One of the community partners, Jeremy Booth, Program Manager at the Community Center for Immigrants, noted that one of the highlights of the day is the importance of letting refugees know the community is here to support them. Similarly, Lorin Jones, Community Engagement Coordinator at the International Institute of Wisconsin, noted that the event brings needed resources to refugees and the ways to navigate them, underscoring the significant impact of the event.
Cap Times' Evjue Foundation gives $1.2 million to Madison-area causes
The Evjue Foundation, The Capital Times' charitable arm, announced today that its board has approved $1,563,000 in grants to support Madison-area nonprofits and educational institutions during the coming year.
Included in the gifts are $322,500 for 22 projects at the University of Wisconsin-Madison and $1,240,500 for 91 community organizations to support the work they do to better our community.
Among the major recipients is the Badger Prairie Needs Network in Verona, whose food pantry capacity desperately needs to be expanded. Evjue Foundation directors approved a $200,000 grant toward that expansion.
How Home to Stay gives those who have been incarcerated support to restart their lives
President Joe Biden has officially proclaimed April 2024 as Second Chance Month, calling on Congress to invest billions in mental health and substance use services, job training and affordable housing to support people who are leaving incarceration.
While people here and nationwide wait on federal action, Home to Stay makes these same resources far more accessible in Milwaukee every month.
Home to Stay is a resource event that connects those who have been incarcerated with housing, employment, health insurance and banking.
Home to Stay takes place on the first Wednesday of every month from noon to 2 p.m. at Partners in Hope, 324 W. North Ave. Partners in Hope is a division of The Community Warehouse, a faith-based organization that works with returning citizens.
Health care navigators, insurance regulators see increase in questionable sales pitches
With a growing number of people signing up for health coverage under the Affordable Care Act, regulators and health insurance navigators are seeing a troublesome counter-trend: an uptick in people enticed to sign up for coverage that isn’t right for them.
“Every day I hear from people who are grateful to have their health insurance that’s affordable and that allows them to get the health care they need,” says Julia Garvey, who helps patients sign up for coverage in the Fox Valley.
Then, from time to time, there are the red-flag cases — clients who unwittingly get hooked by unscrupulous agents or brokers who pressure them with misleading pitches, often costing them more than they’d otherwise have to pay.
“This is an issue nationally,” Garvey says. “It’s happening in other states as well.”
Gov. Evers: Announces record number of Wisconsinites enroll in health coverage on Healthcare.gov
MADISON — Gov. Tony Evers, together with Wisconsin Office of the Commissioner of Insurance (OCI) Commissioner Nathan Houdek, today announced that, according to the Centers for Medicare and Medicaid Services (CMS), 266,327 Wisconsinites signed up for health insurance on HealthCare.gov during the 2024 Open Enrollment Period. This is a record-high number of Wisconsinites enrolled, marking a 20 percent increase in enrollment from the previous period.
“The health and well-being of our state and our economy depend on the health and well-being of our communities. We’ve been steadfast in encouraging folks to explore all the available plans and take advantage of the Open Enrollment period,” said Gov. Evers. “Our state has never seen higher enrollment numbers, and I am optimistic that with this positive momentum, we will be able to continue building a healthier, stronger state together.”
More Than 20 Million People Have Signed Up For ObamaCare Plans, Blowing By Record
More than 20 million people have signed up for plans on the Affordable Care Act’s marketplaces during the annual open enrollment period, far surpassing last year’s record of more than 16 million enrollments, the Biden administration announced on Wednesday.
The figures were a landmark moment for the 2010 health law, underscoring the significance of enhanced subsidies for Americans and the continuing reach of the marketplaces after years of Republican efforts to whittle them down.
“The marketplaces are getting stronger and more embedded into the fabric of U.S. health care,” said Adrianna McIntyre, a health policy expert at the Harvard T.H. Chan School of Public Health. “The more the marketplaces grow, the more it enhances their stability.”
Covering Wisconsin Program Aids in Navigating Health Insurance Plans Amid Medicare Concerns
Wisconsin residents seeking guidance on their health insurance plans can turn to a program initiated by the University of Wisconsin-Madison Division of Extension, named Covering Wisconsin. This program provides aid to individuals trying to navigate their health insurance policies by introducing a ‘GetCovered Connector Tool.’ This tool effectively links individuals with local health insurance experts who can offer advice on applications, appeals, coverage issues, and more. These experts are accessible through Zoom, phone calls, or in-person consultations.
Navigating the Complex World of Health Insurance
The importance of understanding the nuances of one’s health insurance policy is emphasized by the fact that even minor miscommunications or misunderstandings can significantly affect coverage. Advocacy groups like the Multiple Sclerosis Foundation also play a critical role in helping individuals understand their rights, especially when it comes to appealing treatment or medication denials by insurance companies. The process for filing appeals and grievances is outlined on Healthcare.gov.
If you're having a health insurance dispute in Wisconsin, these organizations may be able to help
If navigating your health insurance benefits feels like finding your way through a maze, you're not alone.
"The average person is not trained to navigate the complexities of our health care system," said Adam VanSpankeren, manager of Covering Wisconsin's Navigator Program.
Covering Wisconsin connects people with health insurance experts who can help them navigate their plan. VanSpankeren said the program often helps patients "who didn't know what they didn't know."
"It shouldn't be hard to get the right care," he said.
From figuring out what to do after your health insurer denies coverage to choosing the right insurance plan, here's what experts told the Public Investigator team about finding help in Wisconsin.
Protect Our Care: Lt. Governor Rodriguez, health advocates discuss expanded savings for Wisconsinites in Green Bay during open enrollment
GREEN BAY, WI – Yesterday, Lieutenant Governor Sara Rodriguez, Covering Wisconsin Navigator Regional Lead Tony Lee and local health care advocates joined Protect Our Care Wisconsin to discuss the current Affordable Care Act (ACA) open enrollment period that began on November 1, 2023, and resources available to Wisconsinites looking to enroll in quality, affordable coverage.
Thanks to the Inflation Reduction Act the Biden administration has been able to expand availability of premium tax credits, make historic investments in the Navigator program, and lower health care costs through other initiatives. Under these new federal laws 80 percent of Wisconsinites were able to find marketplace coverage for $10 or less per month last year.
“We offer expert, free help with health insurance to anyone in Wisconsin,” said NE Wisconsin Regional Lead Tony Lee of Covering Wisconsin. “Open enrollment is still going on and runs through January 16th, plans must be submitted by that date for a February 1st start date.”
Lee directed Wisconsin residents to www.HealthCare.gov or to call 1-877-942-6837 to speak with a Navigator.
“I have seen the impact of what happens when people didn’t have access to insurance coverage,” shared Wisconsin Lieutenant Governor Sara Rodriguez. “They would come to the emergency department with their diabetes out of control, their high blood pressure uncontrolled, or a simple injury that had now become so much worse they had to be hospitalized.”
It’s open enrollment time: Here’s what you need to know to get or keep health insurance
If you’re looking for health insurance, now is the time to enroll.
Open enrollment for health insurance under the Affordable Care Act, or ACA, and Medicaid renewal are underway.
(Photo courtesy of Obamacare.com)
Advocates warn that thousands of Wisconsinites may be at risk of losing their health insurance for 2024 if they don’t apply on time.
Open enrollment for the 2023–’24 ACA Marketplace Health Insurance is available on HealthCare.gov. To ensure coverage, consumers should enroll in the federal health insurance marketplace by Jan. 16. You can find plans as low as $10 a month.
‘It can feel uncomfortable’
Kennita Hickman is an entrepreneur and insured through the Affordable Care Act.
It’s Open Enrollment Time: Here’s What you Need to Know to get or Keep Health Insurance
Open enrollment for health insurance under the Affordable Care Act, or ACA, and Medicaid renewal are underway.
Advocates warn that thousands of Wisconsinites may be at risk of losing their health insurance for 2024 if they don’t apply on time.
Open enrollment for the 2023–’24 ACA Marketplace Health Insurance is available on HealthCare.gov. To ensure coverage, starting on Jan. 1, consumers should enroll by Dec. 15. You can find plans as low as $10 a month.
For those living without health insurance, a place to turn for answers
All at once John Manno found himself unemployed, without health insurance, and in excruciating pain. Manno, who lives in Ashland, is a freelance musician and rental property owner who has had sporadic health insurance. Just before his back gave out, he found himself completely priced out of the options he saw. Then came the diagnosis: a $100,000 surgery to address his herniated disk and a lot of questions about what insurance options he had, if any.
John Manno of Ashland, a freelance musician and rental property owner, found himself without health insurance at a time when he was recommended for major back surgery.
John ended up on the phone with Covering Wisconsin, a statewide program of UW-Madison Extension, and Health Coverage Navigator Tina Marshalek who helped him through his decisions for coverage.
“I was at the clinic here in Ashland on the phone with her,” Manno said, describing the process of sorting out his options and when his coverage could start. “It was wonderful, I’m so grateful.”
Manno has been a contracted harp player for a number of years and was doing so at an Ashland restaurant until the pandemic temporarily closed the eatery. He didn’t think much of dropping his health insurance premiums when he was on pandemic-related unemployment. That was until his herniated disk started causing neurological damage.
THU AM News: GOP bill would require insurers to cover certain clinical trial costs; Open enrollment period begins
— Sen. Andre Jacque is seeking cosponsors for a bill that would require health insurers to cover certain costs related to participating in a clinical trial.
In a memo sent to other lawmakers, the De Pere Republican says the legislation aims to ensure clinical trial participants don’t face “unnecessary denial and interruption of coverage and delays in life-saving care” due to their insurer not covering related costs.
He notes these patients may need to see out-of-network specialists during clinical trials, and denial of coverage can lead to them missing out on participating and receiving potentially lifesaving treatment.
“The Clinical Trial Coverage Act would address this problem by requiring insurers to cover out-of-network routine care costs for clinical trial participants if no in-network provider is available, ensuring families have at least some peace of mind at a time of great stress and access to clinical trials without paying significant out-of-pocket costs for physician services,” Jacque wrote in the memo.
Federal law currently requires private insurers to cover “routine services” for these trials from in-network providers, the memo shows. But some patients’ networks may not include the correct providers, leaving them to pay the full price for clinical trial-related services.
Gov. Evers, Insurance Commissioner Houdek Encourage Wisconsinites to Sign Up for Healthcare Coverage During Open Enrollment
MADISON — Gov. Tony Evers, together with Office of the Commissioner of Insurance (OCI) Commissioner Nathan Houdek, today urged Wisconsin residents to sign up for high-quality, affordable healthcare coverage during the 11th annual ‘Open Enrollment’ period.
On Wed., Nov. 1, 2023, open enrollment will begin and continue through Jan. 15, 2024. During this limited time, Wisconsinites are eligible to enroll in one of the health plans available on the individual health insurance marketplace. Those who already have insurance through the marketplace can also renew, update, or upgrade their health plans during this period.
“Healthcare shouldn’t just be for the healthy and wealthy, and that’s why expanding access to healthcare has been a top priority of my administration since Day One,” said Gov. Evers. “I encourage folks to explore all the available plans and take advantage of the Open Enrollment period so we can continue building a healthier, stronger state together.”
Wisconsinites encouraged to sign up for healthcare coverage during open enrollment
Gov. Tony Evers, together with Office of the Commissioner of Insurance (OCI) Commissioner Nathan D. Houdek, on Oct. 31 urged Wisconsin residents to sign up for high-quality, affordable healthcare coverage during the 11th annual open enrollment period.
On Wednesday, Nov. 1, open enrollment will begin and continue through Jan. 15, 2024. During this limited time, Wisconsinites are eligible to enroll in one of the health plans available on the individual health insurance marketplace. Those who already have insurance through the marketplace can also renew, update, or upgrade their health plans during this period.
“Healthcare shouldn’t just be for the healthy and wealthy, and that’s why expanding access to healthcare has been a top priority of my administration since Day One,” Evers said. “I encourage folks to explore all the available plans and take advantage of the open enrollment period so we can continue building a healthier, stronger state together.”