Wisconsin Health Insurance

Overview

If you live in Wisconsin and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

  • Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
  • Compare private health plans using U.S. News & World Report's health insurance ratings for Wisconsin

If you are enrolling for an Obamacare subsidized insurance plan through Healthcare.gov or a broker, the official deadline to sign up for health coverage in 2014 was March 31st. If you signed up by March 31, you would be covered by May 1 and avoid paying a penalty for not being insured.

* Note that federal officials let you get qualified coverage after March 31 IF you started an application by March 31 and finish by April 15.

Do I Qualify for a Tax Break on Health Insurance?

Use the calculator below to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.

What Plan Type is Right For Me?
How Many Need Coverage
Total Annual Income
 
 

You may qualify for Medicaid, a free, state-sponsored health insurance program. Call 800-318-2596 or go to the Health Insurance Marketplace website to find out if you can enroll in Medicaid.

You qualify for a subsidy (tax credit) that will save you money if you buy a plan on Wisconsin's new insurance marketplace, called Health Insurance Marketplace. Plans should be offered there starting October 1, 2013. While your subsidy will cover part of the monthly premium for any of the marketplace's plans, a plan that's in the "silver tier" probably offers the best deal. That's because you also qualify for a second subsidy that increases the value of benefits you'd get from any silver plan.

You qualify for a subsidy (tax credit) that will save you money if you buy a health plan on Wisconsin's new insurance marketplace, called Health Insurance Marketplace. Plans should be offered there starting October 1, 2013. Your subsidy will cover part of the monthly premium for any of the marketplace's plans, known as Qualified Health Plans.

You don't qualify for a subsidy. You can either buy a plan on the Health Insurance Marketplace website or click the button below to compare U.S. News-rated plans in your state's private insurance market. Plans on Health Insurance Marketplace will generally offer more health coverage than plans in the private market, but they also tend to cost more in monthly premiums. The Health Insurance Marketplace website should offer plans beginning October 1, 2013.

Any children in your household may be eligible for Medicaid. Call 800-318-2596 or go to the Health Insurance Marketplace website to find out if your children are Medicaid-eligible.

See Plans

If You Qualify: Plans That Cost Less

Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of Wisconsin. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage. 

Note: you had until March 31 to enroll for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty.

If You Don't Qualify: Private Plans

If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in Wisconsin’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage.  What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.

Do I Have To Buy Health Insurance?

You may have heard that everyone in Wisconsin must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more. 

U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

Where To Buy Health Insurance

Wisconsin's Official Marketplace

Health Insurance Marketplace is Wisconsin’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on Health Insurance Marketplace, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

  • Social security numbers for everyone in your household
  • Your employer’s name and address
  • Your most-recent pay stub or recent records of your wages
  • Information about other types of income you receive, such as alimony, unemployment benefits or a pension

 

Insurance Companies and Brokers

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the Health Insurance Marketplace website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

U.S. News & World Report has teamed up with eHealth.com, an online broker licensed to sell health insurance, to help you buy the health plan you want. The eHealth customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.

Qualified Plans on Health Insurance Marketplace

Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.

You should also look at a Health Insurance Marketplace plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a Health Insurance Marketplace plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"

Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.

Participating Companies

Ninety-seven exchange plans are available in Wisconsin, though many are offered only in certain counties, reports The Wisconsin State Journal. According to the Post-Crescent, residents of 59 of Wisconsin’s 72 counties can choose from at least two insurance carriers. In Dodge, Jefferson, Shawano and Walworth, residents have a choice of six insurers. In Milwaukee and Dane counties, there are four competing insurers. No insurer offers plans for residents living in Florence, Green Lake, Lafayette, Marquette and Menominee counties, according to the Post-Crescent.  

Arise (formerly WPS Health Plan). In 2006, WPS rebranded itself as Arise Health Plan. It's one of the largest health insurance companies in Wisconsin and the only nonprofit to offer statewide coverage to both the public and private sectors, according to the company. Arise offers HMO and PoS exchange plans in every tier.

Common Ground Healthcare Cooperative (CGHC). With a $56.4 million federal loan, this new, nonprofit, member-governed co-op offers exchange plans in the following 19 counties of eastern Wisconsin: Marinette, Oconto, Door, Shawano, Kewaunee, Brown, Outagamie, Manitowoc, Calumet, Winnebago, Fond du Lac, Sheboygan, Washington, Ozaukee, Waukesha, Milwaukee, Racine, Walworth and Kenosha. CGHC offers PPO exchange plans in Catastrophic through Gold tiers.

CompCare Health Services Insurance Corporation (Anthem). Established in 1969 as Comprehensive Care Corporation, CompCare is the health maintenance organization (HMO) subsidiary of Blue Cross and Blue Shield of Wisconsin (BCBSWi), according to Anthem. CompCare is affiliated with the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, Washington, D.C., and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of providers. Wisconsin residents who buy a CompCare exchange plan may not have access to the entire Anthem Blue Cross and Blue Shield network of doctors and hospitals. Anthem offers PoS exchange plans in Catastrophic through Gold tiers.

Dean Health Plan. Established in 1904, Dean Health system is a for-profit company and claims to be one of the largest U.S. integrated healthcare systems, serving over 300,000 people. In 2013, DHP joined SSM Health Care system, which owns St. Mary’s Hospital and St. Clare Hospital in Wisconsin. DHP offers HMO exchange plans in Catastrophic through Gold tiers as well as a Bronze-tier EPO exchange plan.

Group Health Cooperative of South Central Wisconsin. Established in the mid-1970s, GHC-SCW is one of the oldest nonprofit, member-governed co-ops in the United States, serving more than 72,000 people. Group Health offers HMO exchange plans in every tier.

Gundersen Health Plan. Gundersen Health is a nonprofit health care system providing health services to residents in 19 counties in Iowa, Minnesota and Wisconsin. Gundersen offers coverage to residents living in the following 10 counties in Wisconsin: Buffalo, Crawford, Grant, Jackson, Juneau, La Crosse, Monroe, Richland, Trempealeau and Vernon. Gundersen is affiliated with the following hospitals: Palmer Lutheran Health Center, Gundersen Tri-County Hospital and Clinics, and St. Joseph’s Health Services–Gundersen Lutheran. Gundersen offers PoS exchange plans in every tier.

Health Tradition Health Plan. Established in 1986 as Greater La Crosse Health Plans, Health Tradition has over 40,000 members, according to the company. Health Tradition offers HMO exchange plans in Catastrophic through Gold tiers.

Medica Health Plans of Wisconsin. Established in 1975 as Physicians Health Plan, Medica became an independent health plan in 2001. Medica has over 1.5 million members in Minnesota and parts of Wisconsin, North Dakota and South Dakota. Its network includes 27,000 doctors at over 4,000 medical facilities. Medica offers PPO exchange plans in Catastrophic through Gold tiers.

MercyCare Health Plans. Established in 1994 as a subsidiary of Mercy Health System Corporation, MercyCare has more than 40,000 members in southern Wisconsin and northern Illinois, according to the company. Its service area includes the following counties: Jefferson, Green, Rock, Walworth and McHenry. MercyCare offers HMO exchange plans in Bronze through Gold tiers.

Molina Healthcare of Wisconsin. Established in 1980 in California, Molina Healthcare is a multi-state health care organization with a focus on providing government-sponsored health services to over 5 million Americans in 15 states, according to the company. In Wisconsin, Molina offers HMO exchange plans in Silver and Gold tiers.

Physicians Plus Insurance Corporation. Established in 1986 and owned by Meriter Health Services, Physicians Plus serves more than 105,000 residents of south-central Wisconsin. Its network includes more than 3,000 providers in 20 Wisconsin counties, according to the company. Physicians Plus offers HMO exchange plans in Catastrophic through Gold tiers.

Security Health Plan of Wisconsin. This nonprofit health maintenance organization (HMO) has several networks offering coverage in different regions of Wisconsin. A complete listing of each network’s service area is available. Security Health offers HMO and EPO exchange plans in Catastrophic through Gold tiers.

Unity Health Insurance. Tracing its history back to 1983, Unity Health became a subsidiary of University Health Care (UHC) and affiliated with the University of Wisconsin Hospitals and Clinics Authority (UWHC) as well as the University of Wisconsin Medical Foundation (UWMF) in 2005, according to the company. Unity Health offers HMO exchange plans in every tier. 

Need More Help?

The Wisconsin Office of the Commissioner of Insurance exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. The office can be reached at 800-236-8517 or emailed at ocicomplaints@wisconsin.gov. Residents can file an insurance complaint online.

Health Insurance Guide

U.S. News offers information on how to buy health insurance and publishes plan ratings for every state. If you’re over 65, see the guide to Medicare plans. Otherwise, start by looking up the Health Insurance Guide for your state.

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2014-05-01