See your Wisconsin health insurance coverage options.

To qualify for health coverage through the Wisconsin Marketplace, you must⁵:

• 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. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage offered by an 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/CHIP (BadgerCare).
• Not be eligible for premium-free Medicare Part A.⁶

In Wisconsin, you can sign up for an ACA-compliant individual or family health plan from November 1 to January 15 during open enrollment.⁷ 

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 1.⁸ 

Outside of open enrollment, you’ll need a special enrollment period to sign up for coverage or switch to a different plan. In most cases, special enrollment periods are linked to specific qualifying life events.

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. 
• Call the HealthCare.gov call center at 1-800-318-2596 (TTY: 1-855-889-4325). The Marketplace call center is available 24 hours a day, 7 days a week (closed on holidays)
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor. Use the “find local help” tool to locate enrollment assisters in your area.
• Enroll via an approved enhanced direct enrollment entity.⁹

You may find affordable health insurance options in Wisconsin by signing up through HealthCare.gov – especially if you’re eligible for subsidies, which most people are.

As of 2023, about nine out of ten eligible enrollees saved money on premium payments amounting to an average savings of $562/month in premium tax credits (premium subsidies). As a result, the average enrollee’s premium was about $127 after subsidies.¹⁰

The Affordable Care Act also ensures that people with household incomes up to 250% of the poverty level can enroll in Silver-level plans with reduced out-of-pocket costs, thanks to cost-sharing reduction (CSR) subsidies.¹¹

Between the premium subsidies and cost-sharing reductions, you may find that an ACA Marketplace plan offers the best value in terms of fitting your coverage needs and budget.

Source: CMS.gov¹⁰

Wisconsin has not expanded Medicaid under the ACA, but also does not have a coverage gap. This is because Wisconsin allows adults with income under the poverty level to enroll in Medicaid, and Marketplace subsidies pick up where that ends, allowing those with income of at least the poverty level to enroll in subsidized Marketplace coverage. As a result, Wisconsin is the only non-expansion state that doesn’t have a coverage gap.¹²

There are 14 insurers offering individual and family plans in Wisconsin’s exchange in 2024,¹  including one newcomer — UnitedHealthcare.¹³

One of Wisconsin’s Marketplace insurers (Common Ground Healthcare Cooperative) is an ACA-created CO-OP, and is one of only three CO-OPs still operational in the U.S.¹⁴

In every Wisconsin county, Marketplace enrollees can select from among at least three insurers’ plans for 2024.¹

WPS is no longer offering individual/family health coverage in Wisconsin as of 2024,¹⁵ but their plans were already only available outside the Marketplace in 2023, so this does not affect Wisconsin Marketplace insurer participation.¹⁶

The following average rate changes were approved for Wisconsin’s exchange insurers for coverage in 2024,¹⁷ amounting to an overall weighted average increase of 6.1%¹  (before subsidies are applied):

Source: HealthCare.gov¹⁷

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

The premium changes described above are averages across each insurer’s entire set of policies (within a given insurer’s plans, there is variation in terms of how much each plan’s rate changes), and are calculated before any subsidies are applied. But most Wisconsin Marketplace enrollees receive premium subsidies,¹⁰ and thus do not pay full-price for their coverage.

For perspective, here’s an overview of how full-price (unsubsidized) premiums have changed in Wisconsin’s individual/family health insurance market over time:

• 2015: Average increase of 7%.¹⁸
• 2016: Average increase of 16.8%.¹⁹
• 2017: Average increase of 15.9%.²⁰
• 2018: Average increase of 36%.²¹
• 2019: Average decrease of 4.2% (reinsurance took effect).²²
• 2020: Average decrease of 3.2%.²³
• 2021: Average decrease of 3.4%.²⁴
• 2022: Average decrease of 0.3%.²⁵
• 2023: Average increase of 7.7%.²⁶

During the open enrollment period for 2023 coverage, 221,128 people enrolled in private individual market plans through Wisconsin’s exchange.²⁷

This was the highest Wisconsin Marketplace enrollment had been since 2018, and enrollment growth in 2022 and 2023 was 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 2025.²⁷

But while nationwide Marketplace enrollment reached record-high levels in 2022 and again in 2023, that was not the case in Wisconsin. Peak enrollment in Wisconsin’s Marketplace came in 2017, when nearly 243,000 people signed up for coverage.²⁸

Source: 2014,²⁹ 2015,³⁰ 2016,³¹ 2017,²⁸ 2018,³² 2019,³³ 2020,³⁴ 2021,³⁵ 2022,³⁶ 2023¹⁰

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

Wisconsin Individual Health Insurance Market Analysis
An analysis of Wisconsin’s individual/family health insurance market from 2014 through 2022.