Wisconsin Health Insurance: 2021 Coverage Guide

Fran
Fran Majidi
August 17, 2020

Wisconsin Affordable Healthcare Insurance

Wisconsinians have a handful of options for health insurance coverage but should compare rates side by side. If you’re an individual or you’re buying coverage for a family, you can buyt the coverage you need at the best value by comparing plans with SmartFinancial. However, you may only enroll in a health plan during open enrollment, unless you are eligible for the Special Enrollment Period due to a qualifying event.

When Is Open Enrollment in Wisconsin?

November 1, 2020 - December 15, 2020. Coverage begins January 1, 2021.

How to Get Health Insurance in Wisconsin

Look at your medical bills for the previous year and predict what they will be the following year. Do you have any new ailments? Do you have upcoming procedures? How many specialists do you need to see? You’ll need this information to make the best decision about which type of coverage is right for you, and which level tier suits your needs and will be most economical. Sometimes, higher premiums end up saving you money if you frequently visit care providers.

The smartest way to get the most competitive rates for the coverage you need is to compare health insurance companies and health insurance quotes. After you submit the form you’ll get several competing health insurance rates to choose from, and we’ll connect you with an agent in your area so you can buy the coverage or ask questions about the plan you’re considering.

What Types of Health Insurance Are Available in Wisconsin?

HMOs, EPOs, PPOs and point-of-service plans are available in Wisconsin and so are catastrophic health plans. In this state you have the option of choosing a bronze, silver or gold plan. A bronze plan costs about 48 percent less but gold plans cover 80% of your medical costs, compared with 60% with a bronze plan. Look at your medical costs closely to determine which plan is most cost effective. In Wisconsin, residents are are guaranteed child immunizations, lead screening, home health care, treatment for kidney disease, diabetes equipment and supplies, drugs for HIV infection and treatment for Autism spectrum disorder.

Does Health Insurance Cover Pre-existing Conditions?

The Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • Lost or quit a job. You may have lost a job, changed jobs or even started your own business. If you lost a job and with it your health insurance, you qualify for the special enrollment period. If you changed jobs and are not offered health insurance, you qualify to buy health insurance after the enrollment period.
  • Turned 26. If you were on your parents’ health insurance plan but turned 26 after the enrollment period, you can enroll in an individual health plan.
  • Moved to another state or out of an HMO coverage area. You may have had a health plan that was only valid in one state but you moved to another state after the enrollment period. You can sign up for a new health plan.
  • Cobra coverage ended. If you extended your healthcare with Cobra and reached the deadline, you can enroll in a new health plan.
  • Divorce. If you were married and shared a health plan coverage with your spouse but divorced, you still have time to enroll in a new health plan.
  • Marriage. If you recently married, you may be able to get added onto your spouse’s policy or start an entirely new one together.
  • Birth or adoption of a child. If your baby was born or came home after the open enrollment date, you can buy health insurance for that child.
  • Death of spouse or partner. If you were covered under your spouse or partner’s health plan but that person passed away, you can take advantage of the special qualifying events exception to enroll in an individual plan.
  • Spouse of partner loses coverage. If you had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in Wisconsin?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in Wisconsin?

The average cost of health insurance in Wisconsin for a 40 year old is about $674 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in Wisconsin

The average cost of health insurance in Wisconsin for a 40 year old is about $492 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.


Medicare in Wisconsin

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease) also qualify for Medicare. Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in Wisconsin?

Over 1 million people in Wisconsin have Medicare.

How Much Is Medicare in Wisconsin?

If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Wisconsin

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Wisconsin?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.


Wisconsin State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2019 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Wisconsin Health System is listed below:

  • Wisconsin: Overall State Ranking: 12 of 50
  • Wisconsin: Overall Performance: Above Average
  • Wisconsin: Access & Affordability: 11
  • Wisconsin: Prevention & Treatment: 11
  • Wisconsin: Avoidable Hospital Use & Cost: 23
  • Wisconsin: Healthy Lives: 18
  • Wisconsin: Health Care Disparities: 27
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Wisconsin Health Insurance Coverage

The people of Wisconsin have different kinds of health insurance while some residents are not insured at all. See the breakdown below:

  • Private coverage: 57%
  • Medicaid: 17%
  • Medicare: 20%
  • Uninsured: 6%

Report: America's Health Insurance Plans

Wisconsin Health Insurance Companies

The following carriers offer health insurance and/or medicare in Wisconsin.

  • Aspirus Arise Health Plan of Wisconsin
  • Children’s Community HealthPlan
  • Common Ground Healthcare Cooperative
  • Dean Health Plan
  • Group Health Cooperative of South Central Wisconsin
  • HealthPartners Insurance Company
  • Medica Community Health Plan
  • MercyCare HMO, Inc.
  • Molina Healthcare of Wisconsin, Inc.
  • Network Health Plan
  • Quartz Health Benefit Plans Corporation
  • Security Health Plan of Wisconsin, Inc.
  • WPS Health Plan, Inc.

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