Availability of short-term health insurance in Wisconsin

Yes. At least seven insurers offer short-term health insurance in Wisconsin.

In 2024, the Biden administration finalized new rules for short-term health plans. Short-term plans issued or sold on or after September 1, 2024 will be limited to total durations of no more than four months, including renewals. Before that, Wisconin’s rules are applicable.

Short-term health insurance in Wisconsin is regulated by state statutes (Section 632.7495(4)) which limit short-term plan duration to no more than 12 months.

The plan can be renewed – if the insurer offers that option – but the total short-term plan duration can’t exceed 18 consecutive months, including the initial term and subsequent renewals.

After 18 months, the enrollee must have a break of at least 63 days before being allowed to sign up for another short-term plan from the same insurer.

The rules for short-term health insurance in Wisconsin align with federal rules when it comes to the maximum initial term, but Wisconsin has different rules for renewals. So in Wisconsin, the initial term of a short-term plan can be just under a year. But the total duration of a short-term plan, including renewals, is capped at 18 months (as opposed to 36 months under federal rules that took effect in 2018).

Short-term health insurance in Wisconsin can be purchased by residents who can meet the underwriting guidelines set by the insurers that offer these plans.

In general, people can qualify for short-term health plans if they’re under 65 years old (some insurers will only issue plans to people who are under 64 years of age) and don’t have any of the medical conditions that will result in a declined application.¹ But the specific requirements vary from one insurance company to another.

Short-term health insurance plans usually include blanket exclusions for pre-existing conditions, and they often use post-claims underwriting. This means that if a claim is filed, the insurer can review the person’s medical records to make sure the claim isn’t related to a pre-existing medical condition).²

Short-term health plans typically do not cover all of the ACA’s essential health benefits (most commonly excluded are maternity care, prescription drugs, and mental health care),¹ and they generally impose dollar limits on the coverage they do provide. It’s important to double-check all of the plan information before purchasing a short-term policy, to make sure that you understand the limitations of the plan.

If you’re in need of health insurance coverage in Wisconsin outside of the annual open enrollment period for ACA-compliant coverage (November 1 to January 15), your first step should be to see whether you’re eligible for a special enrollment period.

If you are, you may find that you can enroll in an ACA-compliant major medical plan. A variety of qualifying life events will trigger a special enrollment period and allow you to buy a plan through the health insurance exchange in Wisconsin.

If you buy an ACA-compliant plan in the individual major medical market, you can keep it for just a short while if that’s all you need. The plans are purchased on a month-to-month basis, so there’s no annual contract or requirement that you keep the policy for a certain amount of time. So if you’re eligible for a special enrollment period, you can enroll in an ACA-compliant plan (with a premium subsidy if you’re eligible), even if you know you’ll only use it for a short time. You’ll be able to terminate the coverage when another plan takes effect. Note that subsidies for ACA-compliant plans are larger and more widely available through the end of 2025, thanks to the American Rescue Plan and Inflation Reduction Act.

Short-term health insurance plans tend to have significant coverage limitations, and often do not cover various essential health benefits, including prescriptions, maternity care, and mental health care.¹ They also tend to have limitations on the total amount of benefits that the insurance company will pay on your behalf. So it’s important to carefully read the plan information before purchasing a policy. But depending on the circumstances, a short-term medical plan might be your best or only realistic option. This includes situations like these:

• You missed open enrollment for ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period for ACA-compliant healthcare coverage.
• You’ll be eligible for Medicare soon and need something to bridge the gap before your Medicare coverage takes effect, but you aren’t eligible for a special enrollment period that would allow you to enroll in ACA-compliant coverage. (Note that although Medicare coverage is guaranteed-issue for eligible enrollees and covers pre-existing conditions right away, insurers can impose a pre-existing condition waiting period for Medigap plans; if you have a pre-existing condition and it’s not covered by the short-term plan you have prior to Medicare enrollment, your Medigap insurer may make you wait up to six months before they’ll cover the pre-existing condition.)
• You’re newly employed and have enrolled in your employer’s health plan but have a waiting period before it takes effect (if you also have a qualifying event that would allow you to sign up for an ACA-compliant individual market plan, you can use that instead).
• You’ve signed up for an ACA-compliant plan and are waiting for it to take effect.
• You’re employed by a small business that does not provide healthcare benefits for its workers, or you missed your employer’s open enrollment period for health benefits and do not qualify for a special enrollment period. During the next open enrollment period for individual market plans or your employer’s plan, you should enroll if at all possible. But until that point, a short-term health plan can provide coverage for unexpected medical events.
• You’re not eligible for Medicaid or a premium subsidy for an ACA-compliant plan through the marketplace.

Wisconsin health insurance regulations require short-term plans to conform to certain state mandates. But state law requiring uniform applications for major medical policies does not apply to short-term coverage as the state’s statute specifically excludes short-term plans from the definition of major medical coverage.