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From the Great Lakes shoreline and rolling farmlands to vibrant cities like Milwaukee and Madison, Wisconsin remains a desirable place to live, and understanding your health insurance options here is key to protecting your health and finances.
As of 2025, the uninsured rate in Wisconsin reflects steady enrollment and relatively strong access to coverage through state and federal programs. If you’re currently without coverage, here’s what you need to know about getting insured in Wisconsin.
Health Insurance Options in Wisconsin
Wisconsin offers a range of health insurance options tailored to residents’ needs, depending on age, income, employment, and family size. Here are the most common coverage types available:
Employer-Sponsored Insurance
Many Wisconsinites receive health insurance through their employer. If your workplace offers coverage, this is usually the most cost-effective and convenient option.
ACA Marketplace Plans (Healthcare.gov)
The Affordable Care Act (ACA) allows individuals and families to buy health insurance through federal or state Marketplaces. These plans offer essential health benefits, free preventive care, and protection for preexisting conditions.
Individuals and families in Wisconsin without employer coverage can shop for plans through the federal Marketplace at Healthcare.gov. If you don’t have job-based insurance, you may qualify for subsidies to lower your premiums. Use our ACA Subsidy Calculator to check your eligibility.
Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.
ACA Plan Types
ACA marketplace plans come in four “metal” levels: Bronze, Silver, Gold, and Platinum. Each offers a different balance of monthly premiums and out-of-pocket costs. Plans also vary by network and include benefits.
- Bronze: Low monthly premiums, higher out-of-pocket costs; ideal for minimal healthcare usage.
- Silver: Moderate costs; eligible for cost-sharing reductions (CSRs).
- Gold: Higher monthly premiums with lower out-of-pocket costs; best for frequent healthcare users.
- Platinum (if available): Highest premiums, lowest out-of-pocket costs.
Metal Tier Breakdown:
| Metal Tier | Insurance Company Pays | Consumer Pays |
|---|---|---|
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
Medicaid
Wisconsin’s Medicaid program includes BadgerCare Plus, Care4Kids, and other public options that provide free or low-cost health insurance to eligible low-income residents, including children, parents, pregnant women, seniors, and people with disabilities. While Wisconsin has not fully expanded Medicaid under the ACA, it does offer coverage to low-income adults up to a defined income threshold.
BadgerCare Plus also administers the state’s Children’s Health Insurance Program (CHIP), offering coverage for children under 19 and pregnant women who don’t qualify for full Medicaid. Benefits typically include preventive care, doctor visits, hospital services, mental health treatment, and prescriptions.
Student Health Insurance
College students in any state have multiple health insurance options, including staying on a parent’s plan until age 26, enrolling in a school-sponsored plan, or applying for coverage through the ACA Marketplace. Depending on your income and location, you may also qualify for Medicaid, CHIP, or low-cost catastrophic or short-term plans—making Wisconsin student health insurance accessible and flexible for a wide range of needs.
Medicare
Medicare plans are available for residents aged 65+ and younger individuals with qualifying disabilities. Options include:
- Medicare Advantage (Part C)
- Medicare Advantage is an alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
- Prescription Drug Plans (Part D)
- Medicare Part D provides prescription drug coverage for anyone with Medicare, helping pay for medications and many vaccines. Offered by private insurers, these plans vary in cost and coverage and can be joined during specific enrollment periods.
- Medicare Supplement (Medigap)
- Medicare Supplement plans, or Medigap policies, help cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare (Parts A and B) lacks an out-of-pocket maximum, these plans can limit your expenses for medical services. Wisconsin is one of only three states that uses a different structure for Medigap plans. Instead of lettered options (A–N), Wisconsin offers a Basic Plan with optional riders.
COBRA Coverage
If you’ve recently lost job-based insurance, COBRA allows you to temporarily maintain that coverage. While it typically requires paying the full premium, it ensures continuity of care until you secure a new plan.
Short-Term Plans
Short-term medical (STM) plans offer flexible, low-cost coverage for up to four months, ideal for healthy individuals in transition. However, STM plans aren’t guaranteed issue, lack subsidies, and may exclude key benefits like maternity, mental health, and pre-existing conditions, making them less suitable for long-term or comprehensive needs.
Explore all non-ACA health plans that may fit your needs and lifestyle.
Enrollment Periods in Wisconsin
Open Enrollment for 2026 Coverage:
November 1, 2025 – January 15, 2026
During this period, all eligible residents can apply for, renew, or change their health plans through the federal Marketplace.
Special Enrollment Period
If you experience a qualifying life event (QLE), such as:
- Losing job-based coverage
- Getting married or divorced
- Having a child or adopting
- Moving to a new location
- Experiencing a change in income
You can apply outside of the Open Enrollment window. You typically have 60 days from the event to enroll.
Health Insurance Providers in Wisconsin
As of 2025, these insurers typically offer individual and family plans.
- Aspirus Arise Health Plan of Wisconsin
- Children’s Community Health Plan
- Common Ground Healthcare Cooperative
- Dean Health Plan
- Group Health Cooperative of South Central Wisconsin
- HealthPartners
- Medica
- MercyCare HMO
- Molina Healthcare of Wisconsin
- Network Health Plan
- Quartz Health
- Security Health Plan
- Wisconsin Physicians Service (WPS)
- WPS Health Plan (Arise)
Plan availability may vary by ZIP code or county. Some insurers may also offer off-Marketplace plans.
Understanding Health Insurance Costs
Understanding basic cost-sharing terms can help you select the right plan:
- Premium: Your monthly payment to keep the plan active
- Deductible: What you pay before insurance begins covering services
- Copayment (Copay): A fixed cost for a specific service (e.g., doctor visit)
- Coinsurance: A percentage of service costs you pay after meeting the deductible
- Out-of-Pocket Maximum: The total you’re responsible for in a year for covered care
- In-Network vs. Out-of-Network: Using network providers helps reduce your costs
Understanding health insurance doesn’t have to be overwhelming. This glossary offers clear definitions of key terms—from agents to costs like copayments, coinsurance, and deductibles—to help you make confident coverage decisions.
Bottom Line
Health insurance in Wisconsin comes with many choices—whether from your employer, through the ACA Marketplace, or public programs like BadgerCare Plus and Medicare. By staying informed and enrolling during the appropriate period, you can secure reliable, affordable coverage that meets your needs.
Need help choosing a plan?
Use our ACA Subsidy Calculator to check for financial assistance, or speak with a licensed insurance agent for personalized support.
