Wisconsin Health Insurance

 

Health insurance in Wisconsin

● The open enrollment for individual/family health plans 2021 is from 1 November to 15 December 2020. Outside of that window, a qualifying event is required to record or make changes to the plan (in return or out of exchange).

● Short-term health insurance plans are also available in Wisconsin, with terms of up to a year.

● Wisconsin hasn't expanded Medicaid, but there's no coverage gap.

● Wisconsin's uninsured rate is well below the national average.

● Thirteen insurers offer exchange plans for 2020; most insurers have proposed an average rate decrease for 2021.

● Wisconsin's CO-OP is one of only three that will still be operational nationwide in December 2021.

● Enrollment in Wisconsin Medicare was more than 1.2 million people as of August 2020.

This page offers assistance to consumers looking for health insurance resources in the state of Wisconsin. Here you will find useful information about the many types of health insurance coverage available. You can find the basics of wisconsin's health insurance marketplace and the next open enrollment period; a brief overview of Medicaid expansion in Wisconsin; a quick look at the availability of short-term health insurance in the state; statistics on 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 subsidized market/exchange, meaning people who shop for individual and family health plans use HealthCare.gov to sign up (as opposed to a state-run website). The exchange is used by people who need to buy their own health insurance, including precosed retirees (not yet eligible for Medicare), anyone employed in a small business that does not offer health insurance, and the self-employed.

The Wisconsin exchange offers a solid number of support options for 2020 compared to most other exchanges. Thirteen insurers offer plans for 2020, though with localized service areas (some parts of the state have five or six different health insurance companies offering stock market plans, while other counties only have one):

Aspiro arise

Common Ground Health Cooperative

Community health plan for children

Dean Health Plan

South-Central Wisconsin Group Health Cooperative

HealthPartners Insurance

Wisconsin Medical Health Plans

MercyCare HMO Inc

Molina

Network health

Health benefits of quartz

Wisconsin, Inc. Health Care Plan

Unity health insurance

The state reinsurance programme, which took effect in 2019, has kept individual market premiums under control; average rates fell again for 2020, by 3.2%.

And for 2021, most insurers have proposed another round of rate cuts. The proposed average rate changes range from a decrease of about 13% to an increase of about 6%.

Open enrollment period and dates in Wisconsin

Open enrollment in Wisconsin for 2021 health plans runs from November 1, 2020 to December 15, 2020. This sign-up window, which applies both in the exchange and outside the exchange (i.e., directly through health insurance companies), is an opportunity for people to change their coverage for 2021, renew the plan they already have, or sign up 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 incomes up to poverty level, so there is no coverage gap in Wisconsin (unlike any other state that has not implemented the ACA's Medicaid expansion). U.S. Census data indicates that Wisconsin's uninsured rate (5.5% in 2018) was by far the lowest of any state that had not expanded Medicaid at that point.

Former Wisconsin Governor Scott Walker has taken a unique approach to Medicaid in Wisconsin. The state's BadgerCare Medicaid program covered people with incomes of up to 200% poverty, but with subsidies available in the exchange starting with 100% poverty, Walker cut eligibility to the poverty level. So now people with incomes between 100 and 200% of poverty receive subsidies for purchase plans in the exchange (they are entitled to both premium subsidies and cost-sharing subsidies at that level of income).

But because Wisconsin hasn't expanded Medicaid eligibility to 138 percent of the poverty level, the state doesn't receive the largest federal funding the ACA provides for Medicaid expansion (in Medicaid expansion states, the federal government pays 90 percent of the cost of coverage for the Medicaid expansion population). So it would be less expensive for the state to expand Medicaid to people with an income of up to 138 percent of the poverty level, and receive the largest federal funding for the adult population from 0 to 138 percent of the poverty level.

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, cannot 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 can't last more than 18 months in Wisconsin.

How did Obamacare help Wisconsin residents?

Prior to the implementation of the ACA, U.S. Census data put Wisconsin's uninsured rate at 9.1%, already significantly below the national average. The uninsured rate has fallen to 5.7% by 2015 and 5.3% by 2016, although it has risen slightly, to 5.5%, by 2018. From 2013 to 2018, the uninsured rate for the whole country fell from 14.5% to 8.9%.

Although the state did not participate in the full expansion of Medicaid as written in the ACA, all low- and middle-income legal residents have access to Medicaid coverage or exchange subsidies; there's no coverage gap in Wisconsin.

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

Wisconsin Common Ground CO-OP

The Wisconsin Common Ground Healthcare Cooperative was created as part of the ACA's Consumer Operated and Oriented Plan (CO-OP). While most co-ops have closed under financial strain, common ground CO-OP Wisconsin remains operational.

For 2021, Common Ground has proposed an average rate reduction of more than 6%, which will be its third consecutive year of rate cuts, indicating a relatively stable financial position. Common Ground Healthcare CO-OP has significantly reduced premiums for 2020, on the back of another even more substantial decrease in rates for 2019.

Common Ground is one of only three CO-Po's that will still be operational in December 2021, out of 23 original CO-Po's.

Wisconsin and the Affordable Care Act

Wisconsin's current senators have both entered the Senate since 2010: Ron Johnson and Tammy Baldwin. Johnson is an opponent of the ACA and has filed a lawsuit against the federal government over the issue of subsidies for members of Congress and their staff (the lawsuit was dismissed by a federal judge in July 2014). But Baldwin is a strong supporter of the ACA.

In the House of Representatives, Wisconsin's representation passed to the Republican majority. As of December 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 was defeated by Democrat Tony Evers in the 2018 election. Evers pulled Wisconsin out of California v. Texas (Texas vs. Azar). Texas-led states want to topple the ACA, but Wisconsin is no longer part of that group of states.

CHIP Wisconsin

The Wisconsin Children's Health Insurance Program (CHIP) is provided through BadgerCare Plus.

Children's Community Health Plan (CCHP) is an HMO owned by the Children's Hospital of Wisconsin, and is the largest BadgerCare health plan in the state. CCHP also began offering qualified health plans (QHP, as opposed to the 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 insurance coverage to the individual health insurance marketplace, pre-existing conditions could result in denials of enforcement, exclusions, and initial installment-ups in nearly every state, including Wisconsin. The Wisconsin Health Insurance Risk-Sharing Plan (HIRSP) was created to cover people who could not obtain individual health insurance due to pre-existing conditions.

Now that the ACA requires all health insurance plans to be guaranteed, there is no longer a need for high-risk pools. As a result, HIRSP coverage ended on April 1, 2014, and members must have requested a new ACA-compliant plan by March 15 to have continued coverage.

Medicare coverage and enrollment in Wisconsin

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

Wisconsin is one of only three states that standardizes Medigap plans. And Medicare enrollees under the age of 65 are granted access to Medigap plans in Wisconsin, as long as they enroll within six months of enrolling in Medicare Part B.

There are still some Medicare Cost plans available in Wisconsin.

Wisconsin Health Insurance Resources

BadgerCare PLUS

Wisconsin Black Health Coalition

Medicaid for the elderly, blind or disabled

Wisconsin Department of Health Services

Medicare advice for Wisconsin residents

Medicare Rights Center (a nationwide resource that can provide information and assistance related to Medicare)