TABLE OF CONTENTS
Most Wisconsin residents receive coverage through an employer, but you also have access to Medicare, Medicaid, and individual insurance policies.
Read this guide to understand your coverage options and how to apply for health insurance in Wisconsin.
There is no state exchange available for Wisconsinites to use for ACA enrollment. You need to use the federal Health Insurance Marketplace by visiting Healthcare.gov. You’re required to create an account before you begin shopping for the right plan for you or your family. Ensure you provide correct contact information and store your password and the answers to your security questions somewhere safe.
After you set up your account, you’ll be able to compare up to three plans at a time. Based on the information you provide, Healthcare.gov will also check to see if you’re eligible for programs such as Medicaid, plus let you know if you qualify for the Advanced Premium Tax credit. There is some information you’ll need to collect and have ready before you apply for insurance.
Here is what you need for your application:
The list of plans will include things such as annual deductibles, your monthly premium, and what your copayment will be when you receive medical care. Choose your plan wisely based on your household’s needs, and the website will guide you through enrollment.
Enrolling for coverage as an individual requires the same process as enrolling for family coverage. Before you decide on a plan, carefully consider your health conditions and the needs of every person in your household. Policies that have low monthly premiums might not provide enough coverage if family members suffer from chronic conditions. You also shouldn’t seek more coverage than you need or can afford.
An individual health insurance policy can lower your financial responsibility in an emergency. You can save money if you choose a plan with a higher annual deductible and lower coinsurance, but pay more when you require care.
There are three primary types of plans. Each plan has its benefits and disadvantages.
The following health insurance companies offer individual coverage in Wisconsin, depending on what part of the state you reside:
Shopping for a family health insurance plan can be more complicated than shopping just for yourself. While you might be in perfect health, one of the other members of your household might have a preexisting condition that requires ongoing medical treatment. It’s possible to save more money by paying a higher monthly premium than you would on a discount policy.
Consider whether the monthly premium is worth the amount of coverage you and your family will receive. Plans with a high deductible may force you to pay a lot of money upfront when someone in your family needs care. Thus, paying more for that low deductible and higher coinsurance might make more sense. Choosing a plan type is crucial because you must decide if you’re willing to be confined to only seeing doctors within an approved network or seeking approval for specialist care.
The ACA offers four tiers of coverage, including Bronze, Silver, Gold, and Platinum. The tiers have differing deductibles, monthly premiums, and copayment requirements. Consider the total yearly cost of your plan before enrolling because higher copayments and deductibles could increase your total cost for care. Here is what the most affordable plans in each tier cost:
|Average premiums in Wisconsin||2019||2020||2021||2022|
|Most affordable Bronze Plan||$373||$345||$338||$325|
|Most affordable Silver Plan||$492||$470||$443||$420|
|Most affordable Gold Plan||$527||$484||$480||$445|
The state of Wisconsin offers several Medicaid plans, including its BadgerCare Plus program. Low-income residents can enroll in one of these programs as long as they meet certain criteria. Your eligibility will depend on your income, marital status, and the number of people in your household. BadgerCare offers health care to children through its CHIP program.
Medicaid is a program that is run jointly between state governments and the federal government. Wisconsin offers Medicaid to seniors who are dually eligible for Medicare and state assistance. The Medicaid program also covers residents with disabilities, those who must care for a family member with a disability, families with minor children, and pregnant women.
To qualify for Medicaid, you need to have an income below the state poverty level. The income threshold for a single person applying for Medicaid is $17,131 per year and increases depending on the number of people you support in your household. A household of five, for example, qualifies for Medicaid as long as the total household income doesn’t exceed $41,284 per year.
If you’d like to apply for Wisconsin’s Medicaid or BadgerCare Plus program, you can do so through the state’s online portal.
Wisconsin residents can receive health care coverage for children through the BadgerCare CHIP program. Eligible children benefit from access to routine physical examinations, diagnostic testing, immunizations, emergency room treatment, vision care, and dental. Children must be under 19, and the household must be under similar income thresholds as the Medicaid program.
The BadgerCare program for children assists low-income households by helping them find qualifying doctors and treatment centers for common pediatric conditions. The addition of vision and dental care makes Wisconsin’s child health care program more comprehensive than most states in the U.S.
The Medicare program is a federally funded program for retirees and those with qualifying disabilities. Wisconsinites can choose from the original Medicare program and Medicare Advantage plans through health insurance companies.
You can enroll in a Medicare Supplement Insurance (Medigap) plan to offset your out-of-pocket expenses. Wisconsin requires more coverage for Medigap policies than other states, such as copayments for nursing care and limited home health care. These plans usually cover 25% or 50% of your out-of-pocket expenses. You can choose a deductible that suits your needs.
To enroll in Original Medicare or Medicare Advantage, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability that causes you to receive SSDI benefits for at least 24 months. You may also qualify for Medicare at a younger age if you have end-stage renal disease or ALS.
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
For further assistance or if you’ve got more questions about Medicare enrollment, you can contact the Wisconsin Department of Health Services by calling 608-266-1865.
Wisconsin lets insurers offer short-term health insurance policies. However, the state has some of the strictest rules for these policies in the nation.
A short-term health insurance plan fills the gap in coverage that might result from losing your job, moving, or waiting for your Medicare benefits to come into effect. The maximum term that a short-term plan can have is one year. While most states allow short-term insurance policy renewal several times, Wisconsin won’t allow you to be covered by a short-term policy for longer than 18 months.
With a short-term plan, you’re not protected by the Affordable Care Act that protect people with preexisting conditions. You can be denied coverage or pay higher rates due to your medical history. You might not receive coverage for routine care, medical treatments for chronic conditions, or prenatal care.
The state of Wisconsin follows the federal mandate for health insurance prescribed by the Affordable Care Act. You’re required to have health insurance but won’t face a penalty if you don’t because Congress passed a measure that removed the tax penalty for not having coverage.
There are several benefits to using the Healthcare Marketplace, such as the Advanced Premium Tax credit. It isn’t a requirement, though, and you’re free to enroll in any health insurance policy you choose. Just know that you’re forfeiting the tax credit and other benefits that come along with enrolling in a policy through the marketplace.
Wisconsin residents can enroll in cost-sharing programs. These programs can help save you money because all members pool their resources to pay for medical costs, but the plans aren’t insurance and typically have extensive limitations. Wisconsin also has the Consumer Operated and Oriented Plan (CO-OP) program.
Wisconsin doesn’t have a marketplace and uses the federal Health Insurance Marketplace, which you can access by visiting Healthcare.gov.
There are 13 health insurance companies that provide plans to Wisconsinites through the Health Insurance Marketplace. Many residents have access to multiple insurance companies. There are some places where they can only access a single company.
You can choose whether you’d like to purchase a health insurance policy along with a health care savings program or a flexible spending program. These programs benefit you if you’re required to cover significant out-of-pocket expenses. It’s not a replacement for health insurance coverage.
Short-term disability coverage has a different purpose than health insurance. It is a supplement that allows you to continue paying your household bills during recovery and unable to return to work. Most people benefit the most from having short-term disability coverage in addition to a health care plan.
Health insurance allows you to receive the best possible medical care if you’re disabled due to an injury. This is often not enough to pay the rent or cover the mortgage, buy food, and pay your monthly bills, but long-term disability coverage can pay for those essentials. Long-term disability insurance will rarely meet your financial needs on its own, so don’t consider it a replacement for health insurance.
The CHIP program covers preventive care, emergency treatment, dental care, and vision to those who qualify for the program. Enrollees need to be under the age of 19.