Wisconsin Health Insurance Consumer Guide

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.

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.

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

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

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

The following average rate changes were requested by Wisconsin’s exchange insurers for coverage in 2024:¹⁰

Source: HealthCare.gov¹⁰

Detailed filing data are available in SERFF and on Wisconsin’s rate review webpage.

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

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.

Wisconsin Department of Health Services