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Wisconsin Health Insurance Consumer Guide
This guide was designed to help you select the appropriate health insurance plan for you and your family. The options found in Wisconsin’s ACA Marketplace may be a good choice for many consumers, and we’re here to help explain the choices available.
Wisconsin uses the federally run health enrollment platform, known as HealthCare.gov, for residents to purchase its ACA Marketplace plans. The Marketplace provides access to health insurance products from private insurers.
The federal government helps pay for insurance through an advance premium tax credit if you buy coverage from the exchange. Depending on your income and other circumstances, you may also get help to lower your monthly insurance premium (the amount you pay to enroll in the coverage) and possibly your out-of-pocket expenses.
Explore our other comprehensive guides to coverage in Wisconsin
Dental coverage in Wisconsin
Looking to improve your smile? Dental insurance may be a smart addition to your health coverage. Our guide explores dental coverage options in Wisconsin.
Wisconsin’s Medicaid program
Although Wisconsin has not expanded Medicaid eligibility under the guidelines laid out in the Affordable Care Act (ACA), the state’s Medicaid program (BadgerCare) does cover all legally present non-elderly adults with incomes under the poverty level. Wisconsin's total Medicaid enrollment has grown to more than 1 million people.1
Enrollment for Medicare in Wisconsin
Medicare enrollment in Wisconsin stood at 1,273,287 people as of early 2023.2 Our guide looks at Medicare enrollment in the state and state regulations related to the coverage.
Short-term coverage in Wisconsin
In Wisconsin, short-term health insurance plans are available for purchase, with at least seven insurers selling short-term health insurance plans in the state in 2023.3
Frequently asked questions about health insurance in Wisconsin
Who can buy Marketplace health insurance?
To qualify for health coverage through the Wisconsin Marketplace, you must4:
- Live in Wisconsin
- Be lawfully present in the United States
- Not be incarcerated
- Not be enrolled in Medicare
Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:
- Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
- Not be eligible for enrollment in Medicaid or CHIP.
When can I enroll in an ACA-compliant plan in Wisconsin?
In Wisconsin, you can sign up for an ACA-compliant individual or family health plan from November 1 to January 15 during open enrollment.5
If you need your coverage to take effect on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.6
Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage. If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.
How do I enroll in a Wisconsin Marketplace plan?
To enroll in an ACA Marketplace plan in Wisconsin, you can:
- Visit HealthCare.gov to access Wisconsin’s health insurance Marketplace. Here you will find an online platform to shop, compare, and choose the best health plans.
- Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.7
How can I find affordable health insurance in Wisconsin?
You may find affordable health insurance options in Wisconsin by signing up through HealthCare.gov – especially if you’re eligible for subsidies.
As of 2023, about nine out of ten eligible enrollees saved money on premium payments amounting to an average savings of $562/month. As a result, the average enrollee’s premium was about $127 after subsidies.8
The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset your premium payments to help keep your expenses down. People with household incomes below 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan. Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.
Source: CMS.gov9
How many insurers offer Marketplace coverage in Wisconsin?
There are 13 insurers offering individual and family plans in Wisconsin’s exchange in 2023, down from 14 in 2022:10
- Aspirus Health Plan
- Chorus Community Health Plans (formerly Children’s Community Health Plan)
- Common Ground Healthcare Cooperative (an ACA-created CO-OP)
- Compcare Health Services Insurance Corporation (Anthem)
- Dean Health Plan
- Group Health Cooperative of South Central Wisconsin
- HealthPartners Insurance
- Medica Community Health Plan
- MercyCare HMO, Inc.
- Molina Healthcare of Wisconsin
- Network Health Plan
- Quartz Health Benefit Plans
- Security Health Plan of Wisconsin, Inc.
In most of Wisconsin’s counties, at least two insurers are offering health plans in the exchange for 2023.11
Are Marketplace health insurance premiums increasing in Wisconsin?
The following average rate changes were requested by Wisconsin’s exchange insurers for coverage in 2024:10
Wisconsin’s ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company |
|
|---|---|
| Issuer | Percent Increase |
| Aspirus Health Plan Inc | 5.5% |
| Chorus Community Health Plans (formerly Children’s Community Health Plan) | 11.55% |
| Common Ground (ACA-created CO-OP) | 7.03% |
| CompCare (Anthem BCBS) | 2.99% |
| Dean Health Plan | 7.75% |
| Group Health Cooperative | 15.76% |
| Health Partners | 4.98% |
| Medica | 4.31% |
| MercyCare | 8.84% |
| Molina | 3.93% |
| Network Health Plan | 0.95% |
| Quartz | 4.94% |
| Security Health Plan | 2.93% |
Source: HealthCare.gov10
Detailed filing data are available in SERFF and on Wisconsin’s rate review webpage.
How many people are insured through Wisconsin’s Marketplace?
During the open enrollment period for 2023 coverage, 221,128 people enrolled in private individual market plans through Wisconsin’s exchange.12
The surge in enrollment during these years happened largely due to the American Rescue Plan (ARP). Under the ARP – now extended by the Inflation Reduction Act – subsidies are more significant and accessible through the end of 2025.12
Source: 2014,13 2015,14 2016,15 2017,16 2018,17 2019,18 2020,19 2021,20 2022,21 2023,8 202422
What health insurance resources are available to Wisconsin residents?
HealthCare.gov
800-318-2596
Wisconsin Office of the Commissioner of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Wisconsin.
(800) 236-8517 / [email protected]
State Exchange Profile: Wisconsin
The Henry J. Kaiser Family Foundation overview of Wisconsin’s progress toward creating a state health insurance exchange.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- “April 2023 Medicaid & CHIP Enrollment Data Highlights” Medicaid.gov, April 28, 2023 ⤶
- “Medicare Monthly Enrollment” CMS.gov, May 2023 ⤶
- “Availability of short-term health insurance in Wisconsin” healthinsurance.org, January 9, 2023 ⤶
- ”A quick guide to the Health Insurance Marketplace” HealthCare.gov ⤶
- “When can you get health insurance?” HealthCare.gov, 2023 ⤶
- “A quick guide to the Health Insurance Marketplace®” HealthCare.gov, Accessed August, 2023 ⤶
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023 ⤶
- “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2023 ⤶ ⤶
- “2024 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2024 ⤶
- “Wisconsin Rate Review Submissions” HealthCare.gov, 2023 ⤶ ⤶ ⤶
- “2023 Qualified Health Plans” CMS.gov, Oct. 26. 2022 ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, Accessed August 2023 ⤶ ⤶
- “ASPE Issue Brief (2014)” ASPE, 2015 ⤶
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015 ⤶
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016 ⤶
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017 ⤶
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018 ⤶
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019 ⤶
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020 ⤶
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021 ⤶
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022 ⤶
- “HEALTH INSURANCE MARKETPLACES 2024 OPEN ENROLLMENT REPORT” CMS.gov, 2024 ⤶
