Curious about how your state’s health care compares to the rest of the country? According to a study by U.S. News, Wisconsin has the 17th best health care in the country. That rating accounts for overall public health, access, and quality.
Health insurance options in Wisconsin
According to the Wisconsin Office of the Commissioner of Insurance, there are several avenues for residents to get health care:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Wisconsin residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 57% | ||
| Individual or family | 5% | ||
| Medicaid | 17% | ||
| Medicare | 15% | ||
| Military | 1% | ||
| Uninsured | 6% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Six percent of Wisconsin residents are uninsured, less than the national average. That’s a good thing for policyholders, as high rates of uninsured residents leads to higher premiums for insured people.
Wisconsin health insurance companies
Where should you turn to for health insurance in Wisconsin? These are the top insurers offering individual and family plans:
- Aspirus Arise
- Common Ground Healthcare
- Children's Community Health Plan
- Dean Health Plan
- Group Health Cooperative of South Central Wisconsin
- HealthPartners
- Medica
- MercyCare
- Molina
- Network Health
- Quartz
- Security Health Plan of Wisconsin
Specific policies depend on the county you live in. Be sure to check insurer websites to see how your zip code will impact your coverage.
Wisconsin health insurance costs and rate factors
Wisconsin residents spend an average of $8,702 every year on health care expenditures. That’s a few hundred dollars higher than the national average. So, what determines your health care premiums in Wisconsin? Exact costs depend on each individual based on these factors:
Plan type
Choosing a higher level of coverage will cost you more in monthly premiums. Marketplace plans come in metal tiers: bronze, silver, gold, and platinum.
How much should you expect to pay for health care in the Badger State? These are the average monthly premiums for a middle-aged Wisconsin resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $345 | $470 | $484 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Jumping from a bronze plan to a gold plan costs about 40 percent more. That’s because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
Catastrophic plans are the lowest level of health care coverage available in the marketplace. These plans have low monthly premiums but a $8,150 yearly deductible. You may actually save money with a bronze or silver plan when you need to use your health insurance.
Body mass index
Statistically, a high body mass index often leads to serious health conditions. That’s why insurers will look at your BMI to determine your risk-level. A high BMI leads to high insurance rates.
In 2018, Wisconsin had a 32 percent obesity rate, the 23rd highest in the country. Out of the many WI residents who used QuoteWizard to compare health care policies, 43 percent have a BMI in the obese range.
Tobacco use
Smokers pay more for health insurance because of the high risks that come with tobacco use. About 17.1 percent of Wisconsin residents are smokers, the 25th highest rate in the country.
Age
According to HealthCare.gov, older people pay up to three times more for health care than younger people. WI residents who used QuoteWizard to shop around for health insurance are, on average, 43 years old.
Location
One of the most significant factors in your rates is where you live. Health insurance marketplaces have different rules, regulations, and providers depending on your state.
Also, health insurance rates are community rated. That means that costs are based in part on the combined claims everyone files. You may face higher rates if other residents file an unusually high number of claims.
That's why your state’s overall health matters. According to America’s Health Rankings, Wisconsin is the 21st healthiest state in the country.
Wisconsin health insurance laws
The Affordable Care Act limits what insurers can use to determine your health care rates.
- Pre-existing conditions: Insurers can’t determine your costs based on whether you have a pre-existing condition. People with pre-existing conditions used to be charged more for health insurance.
- Gender: According to a study focused on health care costs, women historically pay more for coverage. But the ACA mandates that insurance companies can’t charge men and women different prices for the same plan.
- Insurance and medical history: Insurance companies used to analyze your medical history and your past insurance coverage. The ACA doesn’t allow providers to limit your coverage or boost your prices because of previous medical problems or lapses in insurance.
There are limits to how much you’ll pay out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Wisconsin law requires that health insurance companies provide at least some coverage for the following services:
- Child immunizations
- Lead screening
- Home health care
- Kidney disease
- Diabetes equipment and supplies
- Drugs for treatment of HIV infection
- Autism spectrum disorder
Insurance companies in Wisconsin must offer coverage for additional care. Check out the full list of Wisconsin's required care.
Medicare and Medicaid in Wisconsin
Government-funded health care programs Medicare and Medicaid provide low-cost health care. Medicare aids seniors, whereas Medicaid assists low-income families and children.
Medicare
Wisconsin residents over 65 are eligible for Medicare. There are several options within the program, including parts A, B, C, D, and supplemental coverage plans. You may be eligible for a Medicare Savings Program. In Wisconsin, this is also called Medicare Premium Assistance. These are the income limits to qualify for a Medicare savings program.
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid offers coverage to low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Wisconsin Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Ted Nickel
- Insurance Hotline:
- (800) 236 – 8517
- Office Hours:
- Monday - Friday
7:45 am to 4:30 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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