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Wisconsin health insurance

No Medicaid expansion, but no coverage gap; state has one of only four remaining CO-OPs in the nation.

Health insurance in Wisconsin

Wisconsin’s health marketplace

Open enrollment for 2020 health plans has ended, although Wisconsin residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.

Wisconsin’s federally facilitated 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 coverage areas:

  • 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

Read our full overview of the Wisconsin health insurance marketplace.

No Medicaid expansion, but also no coverage gap

Wisconsin has not accepted federal funding to expand Medicaid 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 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).

Read more about Medicaid in Wisconsin, including details of the work requirement that has been approved but not yet implemented as of early 2020.

Short-term health plans in Wisconsin

Wisconsin allows short-term health 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 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.

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 or exchange subsidies; there is no coverage gap in Wisconsin.

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 and is offering coverage for 2020. It is one of only four CO-OPs still operational, out of 23 original CO-OPs.

Common Ground Healthcare CO-OP also decreased its premiums substantially for 2020, on the heels of another even more substantial rate decrease for 2019.

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 four Republicans and three Democrats representing Wisconsin in the U.S. House, as well as one vacant seat.

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 Texas v. Azar lawsuit (plaintiff states want to overturn the ACA, but Wisconsin is no longer a plaintiff state).

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 in the state of Wisconsin

Nearly 1.2 million Wisconsin residents were enrolled in Medicare as of late 2019.

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 in Wisconsin, including details about Medicare Advantage plans and Part D prescription drug plans.

Helpful Wisconsin health insurance links

Other state-level health 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.