Wisconsin Health Insurance
Affordable WI Health Insurance Options
It is time to research affordable Wisconsin health insurance options for next year! If you and your family live in Wisconsin you face the uncertainties of the Presidential election and the COVID-19 pandemic. Selecting the BEST insurance at the lowest rates is more critical now than ever.
TrueCoverage provides helpful resources and guidance for selecting affordable health insurance that meets your specific needs. Remember, the Open Enrollment Period residents runs through December 15th.
Select your Wisconsin Health Insurance coverage soon, and you will save yourself last-minute headaches. The TrueCoverage team is here to help by providing pre-registration services. We will contact you with health coverage packages tailored to you, your family, and your small business.
Small Business Health Insurance in Wisconsin
Suppose you own a small business in Wisconsin (between 2-50 full-time-equivalent employees (FTEs)). You can purchase qualifying coverage for your employees through the Small Business Health Option Program (SHOP) or, just as with individual plans, through a private insurance broker or insurance agent. Typical policies are for 4-6 employees.
If you contribute to your employees’ premium costs, you will qualify for business tax credits. For a full description of the advantages of employer-sponsored health insurance plans, see truecoverage.com/small-business-health-insurance.
Shopping for Health Insurance in Wisconsin
You may be looking for cheap health insurance in Wisconsin, but the lowest cost monthly payment (your Premium) may not be your best option. Lower deductibles, co-pays and other factors, such as premium tax relief and State contributions, could LOWER your total medical expenses. Perhaps you are shopping for Medicare and Medicare Advantage plans. In the USA as a whole around 13% of the population are enrolled in Medicare. Wisconsin has 14% enrollment in Medicare, and about 25% of those are enrolled in Medicare Advantage plans. When you turn 65 you are automatically eligible for Medicare but you must enroll to take advantage.
TrueCoverage is a Certified Direct Enrollment Partner of Healthcare.com and offers one of the largest selections of health insurance plans (over 50,000). TrueCoverage has the technology to filter these plans to provide you with the ‘BEST VALUE’ plans to meet your specific needs.
TrueCoverage is represented in Wisconsin by its licensed insurance advisors. They have access to the same proprietary systems and possess the specialized knowledge and insights that enable you to decide on the plan(s) which offer ‘best value’ based on your personal (company) circumstances.
10 Core Health Services Mandated for all ACA Compliant Plans
Before the Affordable Care Act became Federal law, insurers could refuse to cover various health benefits, resulting in overwhelming debt for many people. The ACA fixed those loopholes and required all qualifying plans to carry these coverages (in Wisconsin and all states):
- Emergency services
- Prescription drugs
- Ambulatory patient services (hospital services that don’t need an overnight stay)
- Laboratory services
- Maternity and newborn care
- Pediatric services (for children), including dental and vision care
- Mental health and substance abuse services
- Preventive and wellness services, including chronic disease management
- Rehabilitative/habilitative services and devices
Wisconsin, The Metal Health Insurance Tiers and You
There are four ‘metal’ tiers: Bronze, Silver, Gold, & Platinum. These ‘metal’ categories define how you and your insurance company split your health care costs. Each refers to the portion of medical expenses you must pay besides your premiums. They have nothing to do with the quality of your health care.
Quick Note: Not every insurance company offers all Metal tiers in every state and region. If they provide health insurance in your area, at the very minimum they will offer the Silver and Gold tier plans.
Below is a breakdown of costs for each metal tier. The percentages are averages estimated by your insurer, easy rules for out-of-pocket expenses. Your costs will vary: these are EXAMPLES ONLY.
Which Metal Tier is Right for You? Choosing the Right Health Insurance Plan
When choosing a health insurance plan, the last thing you want to do is choose a low premium, only to find yourself stuck with medical debt later. But there’s also no reason to pay for a high-value plan if you rarely use medical care.
When comparing plans, the most significant factor to consider is whether you and your family have recurring medical issues or expenses. If so, choose a Metal tier or healthcare plan that pays for more of those expenses.
Silver plans have been the most popular in the federal marketplace and state exchanges. 70% of consumers choose them. But the best way to plan is to think about last year’s medical expenses and select the situation matches yours most closely.
- You rarely get sick or need medical services besides an annual checkup and one or two medications you can easily pay for out-of-pocket
- You are very healthy
- You are not elderly
- If buying a family plan, your children are elementary-school age or older, very healthy, and do not participate in risky activities.
Silver (Most Popular! Often qualifies for Premium Tax Credits and insurance subsidies)
- Your family members’ one or two mild conditions require medication and specialist visits but do not need close monitoring or frequent care
- Your family members are healthy
- You are under 70
- All your children are elementary-school age or older, healthy, and play few or no sports that often cause injury (the term “sports that often cause injury” is vague, but presume it includes MOST sports and athletic hobbies).
- You or a family member has a chronic condition, sees doctors often, or needs expensive medication that would be impossible to afford out-of-pocket
- Your children are too young for elementary-school, needing frequent pediatrician visits
- You are older or at a higher risk for colds and flu than most people.
- You or a family member has an expensive chronic condition and takes several medications
- You seek urgent care or emergency care more than once per year, frequently need exams to manage a condition, or see doctors more than once per month
- You are older or at high risk for colds, flu, or injuries.
Cost-sharing reductions make Great Health Care possible for everyone
The WI Health Insurance Marketplace offers cost-sharing reductions (CSR) that are “extra savings” opportunities: discounts that lower the total amount you pay for health insurance deductibles, copayments, and coinsurance.
Once qualified for the additional cost-sharing reductions, you must enroll in a Silver Metal tier health plan. The Silver plans in Wisconsin the ONLY plans that receive these “extra savings.”
When you fill out the Marketplace health insurance application, you’ll discover if you qualify for premium tax credits and extra savings.
You can use your premium tax credit for ANY plan in the Metal Tier category. But if you also qualify for the extra savings, these will only apply to the Silver plans.
With a Silver plan you will also have a lower annual out-of-pocket maximum. After you reach your out-of-pocket maximum, your insurer pays 100% of the covered services.
Note: If you are a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder you may also qualify for additional cost-sharing reductions.
The Coronavirus Pandemic, COVID-19 Testing, and the FFCRA
COVID-19 is a hot topic health insurance issue in Wisconsin. If you lose your health insurance due to COVID-19 or your employer closed because of the Coronavirus, testing is available at no charge. The Families First Coronavirus Response Act (FFCRA), passed in March 2020, ensures that everyone can receive COVID-19 testing. You also qualify for an SEP (Special Enrollment Period).
See the 5 top Wisconsin health insurance companies at the bottom of this page.
Key Details about Health Insurance in Wisconsin
Wisconsin has legislated to protect consumers from the practice of ‘balance’ or ‘surprise’ billing. You should read our blogs When is a surprise not a surprise? When it’s a SHOCK! and Joe Biden –“ building on Medicare”).
Exploring the Wisconsin Health Insurance Marketplace
Wisconsin residents can sign up for health insurance using private insurance exchanges. These marketplaces offer more choice of ACA-compliant plans than the state exchange.
With Health Insurance Exchanges like TrueCoverage, you gain access to ancillary insurance such as:
- Accidental Death
- Critical Illness
- Medicare Advantage, Medicare Supplemental
Benefits of Working with a Health Insurance Broker
TrueCoverage is a Certified Direct-Enrollment Partner of Healthcare.gov. We offer more affordable health insurance plans than any other resource in WI, and our unique technology quickly delivers the ‘BEST VALUE’ insurance policies that address your needs.
Like brokers in every state, TrueCoverage operates without bias. Our job is to find you the best health insurance options, regardless of the insurance carrier. Brokers search for policies that best meet your needs. We are there for you throughout your contract. For example, if a dispute arises with your insurer, TrueCoverage steps in to help.
TrueCoverage is familiar with your state’s unique insurance rules, and we understand the Wisconsin health insurance options from the largest carriers to the smaller specialty health insurers.
The Top 5 Health Insurance Companies in Wisconsin
Choosing from over 50,000 plans is daunting without independent, expert advice. That is where TrueCoverage shines. To help, we have listed the top five health insurance companies in WI.
Gathered by the National Committee for Quality Assurance (NCQA), these ratings use Consumer Satisfaction, Preventive Care, and Medical treatment options to determine the score.
More details about the top 5 health Insurance companies in Wisconsin
The NCQA rates these ACA-compliant health plans as the BEST in Wisconsin:
- Dean Health Plan, Inc.
- Group Health Cooperative of South Central Wisconsin
- HealthPartners Administrators Inc.
- Network Health Plan
- Aspirus Arise Health Plan of Wisconsin, Inc
All ACA-compliant and Medicare plans have a star rating based on similar criteria.
Click below to learn more:
NOW is the best time to select your ACA Affordable Wisconsin health insurance, BEFORE Open Enrollment closes on December 15th.
Connect with the health insurance experts at TrueCoverage now to find the BEST health insurance for you, your family, and your business.
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Wisconsin residents may enroll themselves through the federal exchange at HealthCare.gov or through the CO-OP (Wisconsin Common Ground) or a private exchange such as TrueCoverage. Wisconsin has a wide choice of insurers, although some counties may only have one. Wisconsin has not expanded Medicare but having originally sided with Texas in its challenge to ACA has now withdrawn from the lawsuit. Wisconsin allows the sale of short-term insurance but limits the initial period to 12 months and to a total duration of 18 months. and limits short term health insurance plans to six months.
Named after the word “Meskonsing”, an Anglicized version of the Miami Indian name for what is now called the Wisconsin River (and roughly translated as “this stream meanders through something red”), the Badger State became the 30th state in 1848.
With more than 15,000 lakes and 26,767 miles of streams and rivers Wisconsin has enough waterways to circle the globe. Not surprisingly, the Wisconsin Dells has the highest concentration in the world of, you’ve guessed it, water parks! – with more than 200 water slides and 16 million gallons of water in total.
Sources: National Geographic; Infoplease; 50states; coolkidfacts