​Click Here​ if you are applying for a Medicare Plan

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For Marketplace ACA:

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Items needed from all household members including spouse, and other dependents (whether or not they are applying for coverage):

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Full names​ as listed with Social Security

Dates of Birth

Tobacco Status regardless of method

Residential Addresses

Social Security numbers

Current Insurance Cards (if any)​​, including any ancillary coverage such as Dental, Vision, etc.

List of your Preferred Providers (doctors, dentists, hospitals, clinics, etc)

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Optional but Recommended:

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Medication List including:

Dosage

Quantity and Frequency of Refills

Type of medicine (pill, tablet, vial, inhaler, etc)

Current pharmacy

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NOTE:

Some medications are may or may not be covered depending on the plan selected. There may be alternative ways of saving money on medications including coupons and discount offers.

 

Qualifying Event Documentation

 

If you are applying for a plan outside of an open enrollment period please have available documentation proving your Qualifying Life Event. This documentation be brought to our meeting and/or emailed.​

 

If you recently lost employer insurance:

 

Obtain a letter from the company showing termination date and last date of employer-sponsored health insurance and those in your family who are losing insurance​.  Your former employer is obligated to provide this on a company letterhead for you.

 

If you were recently married:

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Marriage Certificate or License

Change of Name verification such as an updated driver's license, if applicable.

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If you recently moved:

 

Proof of new address (utility bill, bank statement, etc)

 

If you were not born in the United States, you may need to provide either Proof of Citizenship or Proof of Legal Residency.  Some documents accepted include:

 

Visa or Green Card Information

Naturalization papers

Driver's License

Social Security Card

 

You recently had a newborn baby or added a dependent:

 

Birth Certificate of newborn

Adoption or Custody Placement documents​​

 

You recently were denied Medicaid or lost Medicaid (also known as Badgercare in Wisconsin)​

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Termination letter from BadgerCare showing date your coverage ended or will be ending.

 

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PREMIUM SUBSIDY:

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To determine eligibility for the APTC (Advanced Premium Tax Credit), please bring with you information regarding:

 

Estimated Adjusted Gross Household Income for the year you are seeking coverage. Include income from your spouse even if your spouse is not applying for coverage.  Sources of income may include yearly amounts of:

Federal Taxable wages (gross)​

Tips

Self-Employment Income (net after deductible business expenses)

Unemployment Compensation

Social Security

Social Security Disability

Retirement or Pension Income

Alimony for divorces finalized before 1/1/2019

Capital Gains

Investment Income such as taxable Earnings & Interest

Rent or royalty income (net)

Excluded (untaxed) foreign income

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NOTE:

If you are new to the program or have had significant changes in income recently, you might be required to bring documentation supporting your income amounts including copies of statements, pay stubs, profit/loss ledgers for self-employed, etc.

NOTE:

If you make contributions to tax-deductible accounts such as Traditional IRA, 401-k, 403-b, HSA, etc., please have those amounts available as these contributions can lower your adjusted gross income and thus increase your eligibility for assistance.

NOTE:

Other deductible expenses include Student Loan Interest payments and Alimony payments.

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If you are a permanent resident or not a U.S. citizen, please have available appropriate documentation supporting your legal residency.​

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For Medicare-Eligible applicants:

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Have your current red/white/blue Medicare Card​​ ready and with you, or at least have your Medicare unique ID# and Effective Dates for Parts A & B.  If you do not know this or have lost your Medicare Card, call Social Security or Medicare to request the relevant information over the phone and have them mail out a new Medicare Card.  ​​​​

Alternatively, you can login to your Social Security account online at ssa.gov and download your Benefit Verification Letter, if available (see sample image of letter below).

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NOTE:

If your Medicare card has your Social Security # + a single letter as your ID# then you have an OLD card and it needs to be updated and replaced and you should call 1-800-MEDICARE immediately for a new card.

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Have your Provider Names ready including primary care, specialists and other providers such as Eye Doctors, Dentists, Chiropractors, etc.

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Have a Medication List ready including dosage and type and how many you fill including your preferred pharmacy name.

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Bring your Current Insurance Card information including ancillary plans also such as dental, vision, etc.

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ON THE DAY BEFORE OR THE DAY OF YOUR APPOINTMENT:  If you are not feeling well and think you might be sick with a cold, flu or Covid, please do NOT come to your appointment if it is scheduled to occur at Ken's office.  Instead, call Ken at 262-536-5155 and we will complete your appointment over the phone.

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PAYMENT INFORMATION

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Bring with you or have ready a method of payment to make your Initial Premium Payment (also known as your Binder Payment).  Most companies accept Automatic Draft out of a Checking or Savings Accounts (bring your routing and account # or a blank check).  Some companies accept MasterCard, Visa and Discover.  It is best to bring both if possible since each insurance company is different.