Wisconsin Health Insurance Consumer Guide

To qualify for health coverage through the Wisconsin Marketplace, you must³:

• Live in Wisconsin
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage offered by an employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for enrollment in Medicaid/CHIP (BadgerCare).
• Not be eligible for premium-free Medicare Part A.⁴
• If married, file a joint tax return.⁵
• Not be able to be claimed by someone else as a tax dependent.⁵

In Wisconsin, you can sign up for an ACA-compliant individual or family health plan from November 1 to January 15 during open enrollment.⁶ 

If you need your coverage to take effect on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.⁷ 

Outside of open enrollment, you’ll need a special enrollment period to sign up for coverage or switch to a different plan. In most cases, special enrollment periods are linked to specific qualifying life events.

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in Wisconsin, you can: 

• Visit HealthCare.gov to access Wisconsin’s health insurance Marketplace. Here you will find an online platform to shop, compare, and choose the best health plans. 
• Call the HealthCare.gov call center at 1-800-318-2596 (TTY: 1-855-889-4325). The Marketplace call center is available 24 hours a day, 7 days a week (closed on holidays)
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor. Use the “find local help” tool to locate enrollment assisters in your area.
• Enroll via an approved enhanced direct enrollment entity.⁸

You may find affordable health insurance options in Wisconsin by signing up through HealthCare.gov – especially if you’re eligible for subsidies, which most people are.

As of early 2024, almost nine out of ten Wisconsin health insurance Marketplace enrollees were receiving premium subsidies that amounted to an average savings of $573/month. As a result, the average enrollee’s net premium — including those who paid full price — was about $161.⁹

(Note that the chart below includes some different metrics and is based on total enrollment during the open enrollment period for 2024 coverage, whereas the numbers above are based on effectuated enrollment in early 2024.)

Source: CMS.gov¹⁰

The Affordable Care Act also ensures that people with household incomes up to 250% of the poverty level can enroll in Silver-level plans with reduced out-of-pocket costs, thanks to cost-sharing reduction (CSR) subsidies.¹¹

Between the premium subsidies and cost-sharing reductions, you may find that an ACA Marketplace plan offers the best value in terms of fitting your coverage needs and budget.

Wisconsin has not expanded Medicaid under the ACA, but also does not have a coverage gap. This is because Wisconsin allows adults with income under the poverty level to enroll in Medicaid, and Marketplace subsidies pick up where that ends, allowing those with income of at least the poverty level to enroll in subsidized Marketplace coverage. As a result, Wisconsin is the only non-expansion state that doesn’t have a coverage gap.¹²

There are 14 insurers offering individual and family plans in Wisconsin’s exchange in 2024,¹  including one newcomer — UnitedHealthcare.¹³

For 2025, all 14 insurers have filed rates and plans for Marketplace coverage.²

One of Wisconsin’s Marketplace insurers (Common Ground Healthcare Cooperative) is an ACA-created CO-OP, and is one of only three CO-OPs still operational in the U.S.¹⁴

In every Wisconsin county, Marketplace enrollees can select from among at least three insurers’ plans for 2024.¹

The following average rate changes have been proposed by Wisconsin’s exchange insurers for coverage in 2025, and are under review by state regulators² (calculated before subsidies are applied):

Source: RateReview.HealthCare.gov²

Additional filing data are available in SERFF, although Wisconsin’s rate review webpage still showed 2024 plans as of mid-August 2024.

Rates for 2025 plans will be finalized before open enrollment begins in November 2024. The proposed premium changes described above are averages across each insurer’s entire set of policies (within a given insurer’s plans, there is variation in terms of how much each plan’s rate changes), and are calculated before any subsidies are applied. But most Wisconsin Marketplace enrollees receive premium subsidies,⁹ and thus do not pay full-price for their coverage.

For perspective, here’s an overview of how full-price (unsubsidized) premiums have changed in Wisconsin’s individual/family health insurance market over time:

• 2015: Average increase of 7%.¹⁵
• 2016: Average increase of 16.8%.¹⁶
• 2017: Average increase of 15.9%.¹⁷
• 2018: Average increase of 36%.¹⁸
• 2019: Average decrease of 4.2% (reinsurance took effect).¹⁹
• 2020: Average decrease of 3.2%.²⁰
• 2021: Average decrease of 3.4%.²¹
• 2022: Average decrease of 0.3%.²²
• 2023: Average increase of 7.7%.²³
• 2024: Average increase of 6.8%²⁴

During the open enrollment period for 2024 coverage, 266,327 people enrolled in private individual market plans through Wisconsin’s exchange.²⁵

This was a record high for Wisconsin Marketplace enrollment (see chart below). Enrollment growth in recent years was largely due to the American Rescue Plan (ARP). Under the ARP – now extended by the Inflation Reduction Act – subsidies are more significant and accessible through the end of 2025.²⁵

The enrollment growth in 2024 was also due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. CMS reported that by April 2024, nearly 72,000 people had transitioned from Wisconsin Medicaid to a Marketplace plan.[efn_note]”HealthCare.gov Marketplace Medicaid Unwinding Report” Centers for Medicare & Medicaid Services. Data through April 2024; Accessed Aug. 3, 2024[/efn_note]

Source: 2014,²⁶ 2015,²⁷ 2016,²⁸ 2017,²⁹ 2018,³⁰ 2019,³¹ 2020,³² 2021,³³ 2022,³⁴ 2023,³⁵ 2024³⁶

HealthCare.gov
800-318-2596

Wisconsin Office of the Commissioner of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Wisconsin.
(800) 236-8517 / [email protected]

State Exchange Profile: Wisconsin
The Henry J. Kaiser Family Foundation overview of Wisconsin’s progress toward creating a state health insurance exchange.

Wisconsin Department of Health Services

Wisconsin Individual Health Insurance Market Analysis
An analysis of Wisconsin’s individual/family health insurance market from 2014 through 2022.