Health insurance in Wisconsin: What options are available?

By: Astoria
Updated: September 27, 2022
Health insurance in Wisconsin

Health Insurance in Wisconsin is quite affordable. Consider buying a private health insurance plan on the Wisconsin health care exchange if you are unable to obtain health insurance in Wisconsin through your work or government-run programs like Medicare or Medicaid.

If you choose a plan with modest monthly premiums, your deductible and out-of-pocket expenses will probably be higher. As a result, you will pay more of your medical expenses out of pocket.

Many factors influence the price of health insurance quotes in Wisconsin. Your age, the scope of your insurance, and the deductible size are a few of these. We evaluated these variables to help you locate adequate health insurance in Wisconsin through the state’s insurance marketplace and the appropriate amount of coverage for your requirements.


Wisconsin’s lowest-cost health insurance by metal tier

There are six distinct health insurance categories in Wisconsin. The metal designations used to describe the tiers are Catastrophic, Bronze, Expanded Bronze, Silver, Gold, and Platinum. The metal tier structure outlines how your insurance company and you divide medical expenses.

In most circumstances, the premium is smaller, and the out-of-pocket expense is higher the lower the metal’s value. Depending on your select tier, you may pay a lower or higher percentage of your medical expenses. In Wisconsin, the prices for each tier are as follows:

  • Bronze level: $380 monthly
  • Expanded Bronze ($401 monthly)
  • Silver costs $521 a month.
  • Gold costs $549 a month.
  • Platinum monthly fee: $661

You might need to acquire a Platinum or Gold plan if you anticipate having higher medical costs in the future to reduce your out-of-pocket payments to a minimum. Choosing a Bronze or Catastrophic plan will help you reduce your rates if your expenses are predicted to be low.

The price of health insurance in Wisconsin varies widely depending on the tier. The deductible amounts and out-of-pocket expenses differ greatly as well.

Low-income Wisconsin citizens may be qualified for cost-sharing discounts on their Silver health insurance plans. They can end up paying a lesser deductible and get greater coverage than they anticipated as a result.


The Wisconsin State’s Lowest Cost Health Insurance by Age and Metal Tier

How much you pay for health insurance quotes in Wisconsin depends on many things. Your age is among them. Your rates will rise as your age increases. For instance, a Silver plan in the state would cost around $418 for a 26-year-old and $1,107 for a 60-year-old. This is a $689 difference for an EPO health insurance plan.

We used a male 40-year-old sample profile for this investigation. In other words, the prices are averages that may not accurately reflect your premium and may vary for various reasons. In specific health insurance marketplaces, older people pay more, but others that support tax premiums and other regulatory services might receive better prices. Once you’ve applied for a plan, you’ll be able to determine the precise cost of your coverage.


The least expensive health insurance by county in Wisconsin

Your location has an impact on how much health insurance costs in Wisconsin. Wisconsin’s 16 rating zones, comprised of 72 counties, have different health insurance premium structures.

Wisconsin’s densest County is Milwaukee. The Envision EPO – Silver 6000/80 from Common Ground Healthcare Cooperative costs, on average, $390 per month, making it the least expensive Silver plan in the county.

You can use the table below to see the six metal tiers of health insurance that are the most reasonably priced in your county.

The prices for each tier above are averages for a Wisconsinian male 40 years of age who chooses health insurance within the designated county.


Wisconsin’s Cheapest Health Insurance Has High Out-of-Pocket Maximums

A plan is deemed to have a high out-of-pocket expense by us if its MOOP is $8,250 or higher. Since young people’s medical costs tend to be less than those of older people, buying a cheap plan with larger deductibles and out-of-pocket maximums may be an excellent method to save money on health insurance premiums. However, they will pay extra out of pocket if they have unanticipated high medical expenses.

The least expensive health insurance plan with high out-of-pocket expenses is Select Catastrophic 8550 Ded/8550 MOOP. This plan is from Group Health Cooperative-SCW and is in the catastrophic tier. A 26-year-old customer must pay $167.


Wisconsin’s Lowest Cost Health Insurance With Low Out-of-Pocket Maximums

If you often have high medical costs, you might consider acquiring a health insurance plan with a higher monthly premium. You can lower your deductibles and out-of-pocket expenses by doing this. As you pay for doctor visits and prescription medications, your out-of-pocket spending restrictions may be reached more quickly. Your insurance will cover any excess medical expenses.

Security Health Plan offers a $750 – 10% reliance and is Wisconsin’s cheapest health insurance plan with a low MOOP. The Platinum tier plan has an average monthly cost of $688 for a 40-year-old.

According to our study, a plan is deemed to have a modest out-of-pocket maximum when its price is less than $4,250. The out-of-pocket maximum in Wisconsin is $1,250. Given that this cost is considerably lower than our rate of $4,250, purchasers might have to pay greater health insurance premiums per month.


Wisconsin’s most affordable HMO, EPO, PPO, and POS health insurance plan

Before selecting a Wisconsin health insurance plan, you must know your preferences and requirements. The HMO, which tends to be less expensive than the other plans but does not cover services obtained outside your provider network, is the most basic plan available in the state.

A PPO has a more extensive provider network than an HMO, but its rates are slightly higher. Under this plan, you do not need a referral to consult a specialist.

The EPO is Wisconsin’s third most popular health insurance option. The insurance only pays for medical expenses inside your provider network unless there is an emergency, even if it permits you to consult a specialist without a referral.

Due to its higher out-of-network rates, the POS is less popular than other plans. It is great, though, if you want the freedom to choose the healthcare professionals you want to work with and the ability to get more affordable health insurance in Wisconsin for particular medical issues.

According to the our analysis, the average cost of health insurance for these Silver-tier plans in Wisconsin is as follows:

  • HMO: MercyCare Health Plans’ MercyCare HMO Silver Option B is the least expensive plan, costing only $417 per month.
  • PPO: HealthPartners’ Robin Oak $5,000 Plus Silver plan is the least expensive option and costs $451 a month.
  • For EPO, Common Ground Healthcare Cooperative’s Envision EPO – Silver 6000/80 is the least expensive at $366 per month.
  • POS: Independence $6,500, which costs 30% less than Security Health Plan, is the least expensive plan at a monthly cost of $500.

Health insurance in Wisconsin

Cheapest HSA-Eligible Plan in Wisconsin

For a person in Wisconsin who is in good health and doesn’t anticipate needing to visit the doctor frequently, a Health Savings Account (HSA) can be a smart option. HSA plans are more affordable and let you contribute before taxes. However, they have high deductibles, so you’ll need to pay more out-of-pocket if you have a significant medical bill.

According to NewHealthInsurance, the price for each tier of Wisconsin’s most cost-effective health insurance plan with an HSA is as follows:

  • Bronze: Anthem Blue Cross and Blue Shield’s Anthem Bronze Pathway X 0 for HSA costs $377 per month.
  • Expanded Bronze: Dean Health Plan’s Dean Focus Network Bronze HSA-E 6850X costs $291 per month.
  • Silver: Dean Health Plan’s Dean Focus Network Silver HSA-E 4500X, priced at $408 per month.
  • Gold: MercyCare Health Plans’ MercyCare HMO Gold Option C costs, on average, $371 per month.

The prices listed above are the typical prices for a 40-year-old.


What Wisconsin Residents Should Know About Health Insurance

The private plan data received from the Wisconsin insurance marketplace served as the source of the sample rates used in this study. These do not, however, accurately reflect the price you will pay for your plan. You must complete a personal application on the market to acquire your exact costs.

Low-income Medicaid and Medicare may be available to Wisconsin citizens and seniors. These are public programs that offer less expensive health insurance than private policies.


The Wisconsin Marketplace for Private Health Insurance

Health insurance plans are divided into different metal levels in Wisconsin. Plans linked with less expensive metals, like Bronze, cost less per month, but you will incur more out-of-pocket expenses.

Make sure you know the advantages and disadvantages of each health insurance plan before choosing one from one of these tiers. Here are some benefits and drawbacks of the six tiers Wisconsin offers.

  • Catastrophic: This tier has the lowest monthly premiums and the fewest advantages. The deductibles and out-of-pocket maximums are likewise hefty. This category is often restricted to buyers under 30 and those who qualify for a hardship exemption, including Wisconsin.
  • Bronze: This tier offers slightly lower deductibles and out-of-pocket maximums than the catastrophic category, although having higher premiums. If you don’t think your future medical bills will be significant, plans in this tier are perfect for you.
  • Expanded Bronze: Compared to the Bronze and Catastrophic categories, the Expanded Bronze tier offers greater rewards. The tier has higher monthly premiums than the somewhat higher deductibles and out-of-pocket maximums. Consider purchasing this plan if you require affordable health insurance in Wisconsin that can adequately protect you in an emergency.
  • Silver: The Silver tier balances average premiums, deductible sums, and out-of-pocket expenses. The out-of-pocket maximums and deductibles are significantly lower than those of Catastrophic, Bronze, and Expanded Bronze levels, despite the tier having a higher monthly premium rate.
  • Gold: In Wisconsin, Gold tiers have the second-highest monthly expenses. Additionally, they have the second-lowest deductibles and out-of-pocket maximums. If you anticipate having high medical costs in the coming year, you could choose to buy a plan in this category.
  • Platinum: In Wisconsin, platinum plans are the most expensive but have the lowest deductibles and out-of-pocket maximums. Platinum plans might be the best health insurance option in Wisconsin to effectively fulfill your demands and keep your expenditures as low as possible if there is a strong possibility that you will incur high medical costs in the upcoming year.
Things to remember!

Your income level and the cost of health insurance are both factors in Wisconsin. You can be eligible for premium tax credits if your income is between 100% and 400% of the federal poverty line. This range typically falls between $17,420 and $69,680 annually. Check out the calculator for more information.

This is referred to as open enrollment, when consumers can sign up for new affordable health insurance plans in Wisconsin on the state’s insurance marketplace or renew current ones. Although dates have been extended due to COVID-19, this typically occurs between November and December.


Wisconsin Medicaid

Additionally, Medicaid is a free government health insurance program in Wisconsin and one of the most affordable for qualified people, and it is available to qualify locals. Wisconsin has not yet enacted Medicaid expansion, though. Your eligibility will be determined by the state’s requirements for low-income families with children, disabled individuals, and pregnant women rather than your income.


Wisconsin’s Medicare

Medicare may be available to Wisconsin adults 65 and over and those with specific diseases and impairments. Although it might not cover all of your medical bills, as with Medicaid, Medicare is one of the state’s government programs.

Medicare may require you to pay a portion of your medical expenses out of pocket, but this amount is much lower than those with private insurance.

Medicare consists of three components:

  • Part A: Hospice care, nursing facility care, and hospital-based care are covered by Part A of the hospital insurance. Additionally, some home care service coverage may benefit from it.
  • Part B: This is health insurance, which covers outpatient and in-office visits to the doctor. Additionally, it includes preventive services and medical supplies.
  • Part D: Vaccinations and prescription medications are covered by the prescription coverage.


Frequently Asked Questions

How much does health insurance typically cost in Wisconsin?

On average, Wisconsin residents should budget $486 per person for an immediate major medical individual health insurance plan. Prices vary, and your rates may be lower if you’re in good health.


Without a job, how can I acquire health insurance?

With discounts based on your income and household size, you might be able to obtain an affordable health insurance plan in Wisconsin through the Marketplace if you’re unemployed. Medicaid or the Children’s Health Insurance Program (CHIP) may also be able to provide you with free or affordable health insurance coverage in Wisconsin.


What is Wisconsin long-term care?

Long-term care encompasses any service or support that you may require as a result of a disability, aging, or chronic illness that prohibits you from performing daily tasks. This covers activities like taking a shower, getting dressed, preparing meals, leaving for work, and paying bills.


What is the process for WI short-term health insurance?

The original periods of Wisconsin short-term health insurance plans are only allowed to be for 364 days. In Wisconsin, short-term plans are eligible for renewal, although their total duration cannot exceed 18 months in a run. When there are no more than 63 days in between coverage periods, that is considered a consecutive period.


Does Wisconsin Medicaid cover dentures as part of dental insurance?

Wisconsin Medicaid pays a maximum amount per member, per denture, every six months for total or partial denture repair. Dentists may file a claim or adjustment request with laboratory bills if laboratory costs exceed the maximum compensation allowed.



The most cost-effective option for you will rely on your unique demands and traits; the NewHealthInsurance study is based on estimates. Based on this analysis, which is simply designed as a suggestion, no single plan in Wisconsin is guaranteed to be the least expensive option for you.

NewHealthInsurance gathered plans and rates for health insurance in Wisconsin from the Health Insurance Exchange Public Use Files (Exchange PUFs) for all possible metal tiers and a range of age groups.

The estimated cost of health insurance premiums on this page does not include any potential premium tax credits or cost-sharing subsidies for which customers may qualify.


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