The Wisconsin Health Insurance Marketplace
Wisconsin’s health insurance exchange is operated by federal agencies but served by private Wisconsin insurers, offering coverage beyond the traditional individual market with cost reductions. For many residents, coverage was either too expensive or unattainable due to underwriting rules keeping certain residents from getting insured. Especially for this population and other uninsureds from Milwaukee to Green Bay, individual marketplace plans provide a new level of protection with essential health benefits and premium discounts. In each state, exchanges are an outlet for insurers to sell affordable coverage featuring certain coverage levels and benefits under the federal law known as Obamacare. The Affordable Care Act also requires the majority of Wisconsin residents to enroll in a health plan, whether a state-run plan like ForwardHealth or BadgerCare, job-based coverage or the marketplace. By offering financial assistance through subsidies, the exchange helps bridge the gap to insurance for many individuals, families and small business owners.
Health plans on the exchange are reduced in cost through tax credits, which lower premiums and cost sharing for those who qualify. A significant group of Wisconsin residents are eligible for these discounts, as you must earn between 100-400 percent FPL to receive assistance. Policies on the marketplace also secure coverage for certain types of care, known as essential health benefits. EHBs are groups of covered services such as pediatric care, maternity, prescriptions, and emergency room visits. Individual plans are sold by various regional and national insurers throughout Wisconsin.
The exchange provides beneficial coverage options for individuals, families and small businesses at affordable prices. For help and guidance with costs and coverage options, contact a licensed agent at 888 803 5917.
Each plan sold through the marketplace is grouped in one of four coverage tiers: bronze, silver, gold or platinum. Intended to create ease in the health plan shopping process, these tiers outline in simple terms how much each policy pays for covered care. Additionally, it helps you recognize plans with more affordable premiums, versus those that are more costly from month to month.
Healthy residents under age 30 also have access to catastrophic plans in addition to these four comprehensive plan types. Such plans don’t cover the majority of health care services, but only a few necessities for those who don’t tend to use much healthcare. Four office visits and preventive care are covered in full, and emergency room visits are covered at deductible. These plans cost slightly less than the bronze level policies and are not subsidy eligible. Use the cost comparison tool below to view estimates of your rates and subsidy amount for these tiers and catastrophic plans.
Premium Tax Credit
The health insurance exchange offers financial assistance to residents with family income between 100 and 400 percent of poverty. Lower income enrollees will receive the greatest amount of assistance, including help paying for monthly premiums and covered medical expenses. While it doesn’t offer the best coverage, some applicants can even qualify for a zero-premium bronze plan after their subsidy is factored in. Wisconsinites earning between 100 and 250 percent of federal poverty qualify for a cost sharing subsidy to help pay for coinsurance, copays and deductibles. If you earn up to 400 percent of poverty, you may be eligible for a premium tax credit.
Tax credits are estimated by income and family size, and the cost of the second-least expensive silver plan in your area as a percentage of income. Based on your income, you can determine about how much your premium share will be in the table below. The remainder is paid for by the tax credit. Refer to the current federal poverty level to find out where your income stands.
More insurers participate in the Wisconsin exchange than most, as thirteen companies including co-ops, HMOs and national carriers offer subsidized plans. However, these are spread throughout the state, resulting in about 1-4 different companies per region. It is also typical for these carriers’ provider networks to be somewhat limited in comparison to off-exchange plans. Reducing provider networks allows insurers to afford to offer these plans. Please check that your doctors are included in your plan’s network prior to applying. If not, you may check which plans outside the marketplace can connect you with your providers of choice. The companies below are featured on the Wisconsin marketplace. Use the tool below or call us to find out what plans are in your area at 888 803 5917.
- Anthem Blue Cross and Blue Shield of Wisconsin
- Arise Health Plan
- Common Ground Healthcare Cooperative
- Dean Health Plan
- Group Health Cooperative
- Gundersen Health Plan, Inc.
- Health Tradition Health Plan
- MercyCare Health Plans
- Molina Healthcare of Wisconsin
- Physicians Plus Insurance
- Security Health Plan
- Unity Health Insurance
Every health plan on the exchange must include ten groups of covered benefits. Cost sharing for these types of care will differ across carriers and policies, and so will specific details regarding covered services. Some services are free, including preventive screenings and shots, while the rest are covered at coinsurance, deductible or a copayment. What’s more essential than having these services covered is to read the fine print of your plan or call your insurer to confirm any kind of care is covered by your plan prior to visiting a provider.
Essential Health Benefits include:
- Emergency care
- Office visits
- Preventive, wellness, and chronic disease management services
- Prescription medications
- Pediatric care, including dental and vision
- Maternity and newborn care
- Laboratory tests
- Mental health and substance abuse services, including behavioral health care
- Rehabilitative and habilitative services and devices
Small Business Health Options Program
In addition to individual market coverage, the exchange offers small group plans through the Small Business Health Options Program (SHOP) provides small group plans at a reduced rate for qualifying businesses. Small business owners in the Badger State can insure their workers for a lower rate if they have less than 25 full-time workers who earn $50,000 per year per person. The Small Business Health Care Tax Credit is awarded to business owners with these requirements. Businesses with up to 49 workers can apply for coverage through this program, but may not qualify for a subsidy. Very small businesses receive the greatest assistance, which is half of an employer’s premium contribution. This subsidy is provided to companies employing up to 10 workers earning $25,000 per year or less each.
How to Apply
Apply for marketplace coverage with a licensed insurance agent by calling 888.803.5917. You can also apply in person at various facilities throughout the state, including health clinics and nonprofits. A self-serve online application is available at HealthCare.gov, the federal portal for Wisconsin residents. As planning your next year in medical coverage is of great importance, consulting an agent tends to be helpful. Our team can help reduce your enrollment time and connect you with a strong policy. The Wisconsin individual market is familiar territory for our licensed agents, and we’re also certified to sell marketplace plans anywhere in the state.
Compare Wisconsin Marketplace Plans
Below is a cost comparison tool providing a closer look at the marketplace policies. These rates are calculated by average premiums released by insurers on the exchange. If you’re interested in one of the plans you find in your results, or for a more precise quote of exchange plans and subsidy eligibility, call an agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.