Wisconsin Health Insurance Marketplace

In Wisconsin, the federal government operates the health insurance Marketplace.

Wisconsin now has its own Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone.

Wisconsin Plans, Benefits, and Costs


Wisconsin, Milwaukee 2015 2016
Monthly Silver Premiums for a 40 Year Old Non-Smoker $333 $326
Average Tax Credit Amount as of March 31, 2016: $315 $332

Last year average total cost for Health Insurance for a 40 Year Old Non-Smoker in your state was $18 per month after tax subsidies. See if you qualify for a free or low cost plan.

Companies can offer four types of plans: bronze, silver, gold, and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers.

Tobacco Surcharge: Wisconsin allows insurance companies to charge tobacco users 50% more than non-tobacco users.

Who Is Selling Insurance in the Wisconsin Marketplace?

On exchange plans in Wisconsin

Off exchange plans in Wisconsin

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What's Covered:

All approved plans in the state must cover the same package of benefits, called essential health benefits. In Wisconsin, the benefits include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital
  2. Emergency services
  3. Hospital stays
  4. Pregnancy and baby care; treatment for underlying causes of infertility is covered
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs, including generic and certain brand-name drugs.
  7. Rehab and habilitative services, that help people recover from an illness or injury and those that help people with developmental issues. Wisconsin offers services for children with autism spectrum disorder.
  8. Lab tests
  9. Preventive and wellness services, along with those that help people manage chronic conditions
  10. Services for children, including dental and eye care, along with residential treatment for children with emotional disabilities.

Some services not included: Infertility treatment except for that required to treat an underlying cause of fertility, non-emergency medical care outside the U.S., weight loss surgery, long-term care, and cosmetic surgery.

Will These Benefits Be in All Plans?

Although all health insurance policies have to include these benefits, some states may allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another. Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.

Financial Aid

You may be eligible for financial aid to help pay for insurance. Here’s what Wisconsin will offer:

Medicaid Expansion: Some states are expanding Medicaid so more people can get health insurance coverage. Although Wisconsin is not, you may still qualify for some type of assistance.

Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make between $11,770 and $47,080 a year, or if you have a family of four and make between $24,250 and $97,000 a year. Subsidies are based on your estimated household income for 2016 and the cost of the health plans in your area. The lower your income, the more assistance you will receive. You can use your 2015 tax return to estimate your 2016 income. When you file taxes for 2016, the IRS will adjust your subsidy based on your actual income.

Cost-sharing subsidies: Depending on your income, you may also qualify for cost-sharing subsidies that will reduce your costs when you receive medical care. Cost-sharing subsidies are available only with silver-level plans.

Calculator: You can also use our calculator to learn about costs and whether you'll qualify for subsidies or other financial aid.

BadgerCare Plus: All children under age 19, regardless of income, are eligible to enroll in BadgerCare Plus. Parents also may be eligible, depending on their income.

 

Ready to obtain the right health insurance? Check your eligibility for free or low cost health insurance through the marketplace in 4 simple steps...