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Wisconsin health insurance

No Medicaid expansion, but no coverage gap; state will have one of only three remaining CO-OPs in the nation as of 2021.

Health insurance in Wisconsin

This page offers assistance to consumers seeking health insurance resources in the state of Wisconsin. Here, you’ll find helpful information about the many types of health insurance coverage available. You can find the basics of the Wisconsin health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in Wisconsin; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of health insurance resources for Wisconsin residents.

Wisconsin’s health insurance marketplace

Wisconsin has a federally facilitated marketplace/exchange, which means people shopping for individual and family health plans use to enroll (as opposed to a state-run website). The exchange is used by people who need to buy their own health insurance, including early retirees (not yet eligible for Medicare), anyone employed by a small business that doesn’t offer health insurance, and the self-employed.

Wisconsin’s exchange offers a robust number of carrier options for 2020 when compared with most other exchanges. Thirteen insurers are offering plans for 2020, albeit with localized service areas (some parts of the state have five or six different health insurance companies offering plans in the exchange, while other counties have just one):

  • Aspirus Arise
  • Common Ground Healthcare Cooperative
  • Children’s Community Health Plan
  • Dean Health Plan
  • Group Health Cooperative of South Central Wisconsin
  • HealthPartners Insurance
  • Medica Health Plans of Wisconsin
  • MercyCare HMO Inc
  • Molina
  • Network Health
  • Quartz Health Benefits
  • Security Health Plan of Wisconsin, Inc
  • Unity Health Insurance

The state’s reinsurance program, which took effect in 2019, has been keeping a lid on individual market premiums; average rates decreased again for 2020, by 3.2 percent.

And for 2021, the majority of the insurers have proposed another round of rate decreases. The average proposed rate changes range from a decrease of about 13 percent to an increase of about 6 percent.

Read our full overview of the Wisconsin health insurance marketplace.

Wisconsin open enrollment period and dates

Open enrollment for 2021 plans in Wisconsin ran from November 1 through December 15, 2020. This enrollment window, which applies both in the exchange and outside the exchange (ie, directly through the health insurance companies), is an opportunity for people to change their coverage for 2021, renew the plan they already have, or enroll for the first time.

Outside of the open enrollment period, Wisconsin residents can enroll or make changes to their coverage only if they experience a qualifying event.

Medicaid expansion in Wisconsin

Wisconsin has not accepted federal funding to expand Medicaid eligibility under the ACA, but Wisconsin Medicaid is available to adults with income up to the poverty level, so there’s no coverage gap in Wisconsin (unlike every other state that hasn’t implemented the ACA’s Medicaid expansion). U.S. Census data indicates that Wisconsin’s uninsured rate (5.5 percent in 2018) was by far the lowest of any of the states that had not expanded Medicaid at that point.

Wisconsin’s former governor, Scott Walker, took a unique approach to Medicaid in Wisconsin. The state’s BadgerCare Medicaid program used to cover people with incomes up to 200 percent of poverty, but with the availability of subsidies in the exchange starting at 100 percent of poverty, Walker cut BadgerCare eligibility down to poverty level. So now people with incomes between 100 and 200 percent of poverty instead receive subsidies to purchase plans in the exchange (they qualify for both premium subsidies and cost-sharing subsidies at that income level).

But because Wisconsin has not expanded Medicaid eligibility to 138 percent of the poverty level, the state does not receive the enhanced federal funding that the ACA provides for Medicaid expansion (in Medicaid expansion states, the federal government pays 90 percent of the cost of covering the Medicaid expansion population). So it would be less costly for the state to just expand Medicaid to people with income up to 138 percent of the poverty level, and receive the enhanced federal funding for the adult population from 0-138 percent of the poverty level.

Read more about Medicaid in Wisconsin, including details of the work requirement that has been approved but not yet implemented as of 2020 (the state suspended the work requirement implementation due to the COVID pandemic; its long-term future remains uncertain).

Short-term health insurance in Wisconsin

Wisconsin allows short-term health insurance plans to have a total initial duration of up to 12 months. But if the plans are renewable, the total duration, including the renewal period, can’t exceed 18 months.

This is more restrictive than the federal government rules implemented by the Trump administration, but state rules take precedence over federal rules in this case, so a short-term plan cannot have a duration of more than 18 months in Wisconsin.

Read more about short-term health insurance in Wisconsin.

How has Obamacare helped Wisconsin residents?

Prior to ACA implementation, U.S. Census data put Wisconsin’s uninsured rate at 9.1 percent – already significantly lower than the national average. The uninsured rate dropped to 5.7 percent by 2015, and to 5.3 percent by 2016, although it climbed slightly, to 5.5 percent, by 2018. From 2013 to 2018, the uninsured rate for the whole country fell from 14.5 percent to 8.9 percent.

Although the state has not participated in full Medicaid expansion as written in the ACA, all low- and moderate-income legal residents have access to either Medicaid coverage or exchange subsidies; there is no coverage gap in Wisconsin.

As of 2020, there were more than 185,000 people enrolled in private health plans through the Wisconsin exchange. Eighty-seven percent of them were receiving premium subsidies to make their monthly premiums much less costly, and 37 percent were receiving cost-sharing reductions that make healthcare services more affordable.

Wisconsin Common Ground CO-OP

Wisconsin’s Common Ground Healthcare Cooperative was created under the ACA ‘s Consumer Operated and Oriented Plan (CO-OP) Program. While the majority of the co-ops have closed under financial strain, Common Ground CO-OP Wisconsin remains operational.

For 2021, Common Ground has proposed an average rate decrease of more than 6 percent, which will be its third straight year of rate decreases — indicating a relatively stable financial position. Common Ground Healthcare CO-OP decreased its premiums substantially for 2020, on the heels of another even more substantial rate decrease for 2019.

Common Ground is one of only three CO-OPs that will still be operational as of 2021, out of 23 original CO-OPs.

Wisconsin and the Affordable Care Act

Wisconsin’s current Senators have both joined the Senate since 2010: Ron Johnson and Tammy Baldwin. Johnson is an ACA opponent, and brought a lawsuit against the federal government over the issue of subsidies for Congress members and their staff (the suit was thrown out by a federal judge in July 2014). But Baldwin is a strong proponent of the ACA.

In the House of Representatives, representation from Wisconsin has switched to a Republican majority. As of 2020, there are five Republicans and three Democrats representing Wisconsin in the U.S. House.

Former governor Scott Walker opposed the Affordable Care Act, but he was defeated by Democrat Tony Evers in the 2018 election. Evers pulled Wisconsin out of the California v. Texas (Texas v. Azar) lawsuit. The states led by Texas want to overturn the ACA, but Wisconsin is no longer part of that group of states.

CHIP Wisconsin

Wisconsin’s Children’s Health Insurance Program (CHIP) is provided via BadgerCare Plus.

Children’s Community Health Plan (CCHP) is an HMO owned by Children’s Hospital of Wisconsin, and is the largest BadgerCare health plan in the state. CCHP also began offering qualified health plans (QHPs, as opposed to BadgerCare/Medicaid/CHIP plans) in the Wisconsin exchange during the 2017 open enrollment period.

Does Wisconsin have a high-risk pool?

Before Obamacare brought guaranteed issue coverage to the individual health insurance market, pre-existing conditions could result in application denials, exclusions, and initial rate-ups in nearly every state, including Wisconsin. The Wisconsin Health Insurance Risk-Sharing Plan (HIRSP) was created to cover people who could not get individual health insurance because of pre-existing conditions.

Now that the ACA requires all health insurance plans to be guaranteed issue, there is no longer a need for high-risk pools. As a result, HIRSP coverage terminated on April 1, 2014, and members needed to have applied for a new, ACA-compliant plan by March 15 in order to have continuous coverage.

Medicare coverage and enrollment in Wisconsin

More than 1.2 million Wisconsin residents were enrolled in Medicare as of August 2020.

Wisconsin is one of just three states that does its own standardization for Medigap plans. And Medicare enrollees under age 65 are guaranteed access to Medigap plans in Wisconsin, as long as they enroll within six months of enrolling in Medicare Part B.

Read more about Medicare plans and Medicare enrollment in Wisconsin, including details about Medicare Advantage plans and Part D prescription drug plans (Original Medicare does not include coverage for prescription drugs, but enrollees can obtain prescription benefits by selecting a stand-alone Part D plan or a Medicare Advantage plan that includes integrated Part D prescription coverage).

There are also still some Medicare Cost plans available in Wisconsin.

Wisconsin health insurance resources

Wisconsin state-level healthcare reform legislation

Scroll to the bottom of the page to see a summary of recent Wisconsin legislation related to health care and health policy reform.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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