Wisconsin is known as America’s Dairyland because it is the country’s leading producer of milk and cheese products along with other farm products like beans, peas, potatoes, corn, oats, hay and cranberries. This state is considered among the top fifteen healthiest states in the United States, as the residents of the state very well know to stay active and healthy in a beautiful environment. Despite being a healthy state, there is always more for residents to do to stay healthy and fit. Besides, leading a healthy and active lifestyle, residents should also do their bit by enrolling in an ideal health insurance plan that will safeguard them and their families during the medical emergency. Residents who are interested in health insurance plans and are looking to buy a health plan should know that the state uses the federally run exchange, which means that they need to use HealthCare.gov to enroll in exchange health care plans. Open enrollment period to enroll in the health plan starts every year from November 1 and ends on 15th December. Residents enrolling during this period are able to buy health plan that is effective from the first of January. Thus, open enrollment for 2020 health plans has ended but residents of the state with qualifying events can still enroll in the health plans or can make changes to their coverage for 2020 plans. The next open enrollment for the health plans effective in 2021 will begin on November 1, 2020. The state is known to have robust health insurance exchange with 13 insurance carriers offering health plans for 2020, which is more than most of the states. However, counties in the southern part of the state have more options of insurance carriers compared to northern part of the state.
Highlights & Updates
- Wisconsin uses the federally run health exchange so residents can enroll in health plans using HealthCare.gov.
- The next open enrollment period for health plans effective in 2021 will start from November 1, 2020. Now residents with qualifying event can only enroll or make changes in their health plan effective in 2020.
- Short-term health plans are available in Wisconsin with initial plan terms up to one year.
- The uninsured rate in Wisconsin is well below the national average.
In Wisconsin thirteen insurance carriers are offering health plans for 2020 coverage.
- Around two-third of Wisconsin enrollees have individual’s plan through the exchange.
- Due to Wisconsin’s reinsurance program, average unsubsidized premiums have dropped by 3.2% for 2020, after falling by 4.2% in 2019.
- This is one of five states that still has a CO-OP.
- In Wisconsin, the enrollment rate dropped about 9% in 2019 after falling about 7% in 2018.
Individuals & Family Health Insurance Plans
Individuals who do not have access to any employer-based health insurance plan or students who are no more covered under their parent’s health plan, or individuals who are between their jobs can look to obtain health insurance coverage through any of the individuals and family health plans that are specifically designed for such individuals. To ensure every individual has health insurance, Affordable Care Act was implemented according to which no individual can be denied coverage or charged significantly higher premiums because of gender or any past medical conditions. Wisconsin offers a broad selection of individual and family health plans that are offered by leading participating private health insurance companies or through the federal exchange. Some of the popular individual and family health insurance plans include:
Preferred Provider Organization Plans – The traditional PPO plan is ideal for individuals and families living across Wisconsin, as it offers medical benefits both in and out of network and give insured freedom to see virtually any doctor or specialist of their choice without a referral. PPO plans are favored by majority of individuals in Wisconsin because of flexibility and freedom. PPO health plan contracts with medical providers to create a network and the members of the plan who use the doctors and healthcare services within the plan’s network pay less and if they use doctors and services outside the network they have to pay additional cost. The members of the PPO plan do not require to have a primary Care Physician. The freedom and flexibility make the plan popular but these plans are more expensive. However, individuals looking to enroll in these plans should know that these plans have higher premiums and also come with deductibles and copay. Besides, one should also keep in mind that cost-sharing in out-of-network services is higher than using in-network doctors and services. No two PPO plans are similar and each plan has a very different out-of-network coverage.
Health Maintenance Organization Plans – HMO or Health Maintenance Organization is a popular individual and family health insurance plans opted by increasing number of people in Wisconsin. HMO plans are popular because of their affordability but these plans are restrictive too especially for individuals who are looking to obtain health care services outside of a network. Members of HMO plans are required to appoint a Primary Care Physician, who coordinate and manage health care of the members using in-network specialists and hospitals. HMO plans are preferred by some of the individuals because it is a really good choice for budget-conscious individuals. The monthly premium of these plans are cheaper compared to other types of plans and these plans even have low co-pays and annual deductibles. Since, these plans take benefit of bulk rates, even the prescription cost is low. Thus, a HMO plans are best for individuals who are looking for a health plan with lower premium amount and who want to have a health plan without a deductible. These plans also provide coverage for checkups and immunizations.
Exclusive Provider Organization Plans – An Exclusive Provider Organization or EPO is a health insurance plan that allows members receive healthcare services from doctors, hospitals and other healthcare providers that are within the plan network. However, members of this plan will not get any coverage if they receive healthcare outside the network. The only exception is the emergency care that is normally covered. Members of this plan are required to select a primary care physician to manager and monitor their health but they do not need to get a referral from their primary care physician to see a specialist physician. It is a type of managed care plan that provides coverage of individual’s medical expenses as long as they visit doctor and hospitals within the network. Though, members will have to pay for some of the cost on their own through co-pays but their insurance carrier will cover some of the costs, once they meet their deductible. To have insurance coverage through an EPO health insurance plan individuals are required to pay a monthly premium, cost of which depends on the area where the individual is residing and the specific plan which one is opting for.
Point of Service Plan – POS or Point of Service plan comes with the combined qualities of both HMO and PPO individual plans, benefits of which varying depending on whether the insured receive health care from in or out of the insurance carrier network of providers. members of POS plans can access healthcare from both in-network or out-of-network healthcare providers and facilities, however the level of coverage will be better when they stay in-network. Members of POS plan also required to designate a primary care physician who will not only manage their health care but also provide referral for specialist visit when needed. Depending upon the POS plan opted by individuals, healthcare services provided by Primary Care Provider do not include a deductible and preventive care benefits are included in the plan. Just like a PPO plan members of POS plan may also receive healthcare from non-network providers but they will have to pay a greater out-of-pocket costs and they may also be responsible for co-payments, coinsurance and an annual deductible.
Indemnity or Fee-For-Service Plan – Fee-for-service health insurance plan allow individuals with great flexibility of choosing any doctor and hospital of their choice, as no referrals are required for this plan. Individuals enrolled in indemnity plan are require to pay up front for the received healthcare services and then submit a claim to their health insurance carrier for reimbursement. Individuals enrolled in this plan mostly avail majority of their basic healthcare from a single doctor but it is not required for them to choose a primary care provider. Members of this plan are subjected to annual deductible and only after meeting this deductible their insurance companies will begin paying on their claims. The insurance companies pay the claims at a set percentage of the usual, customary and reasonable rate, which is the amount that healthcare providers of the insured area usually charge for any healthcare service.
Short-term Plans in Wisconsin
Short-term health insurance plans are a great solution for individuals in Wisconsin who are either between jobs, waiting for group coverage to start or if they are a recent college graduate who are no more covered under their parent’s plan. The short-term plan in this state offers healthcare coverage for a limited period of time and are limited to 364 days for a plan’s initial terms. Though renewals of short-term plans are permitted in Wisconsin but the total duration of the plan cannot be more than 18 consecutive months in a row. Short-term health plans are generally preferred by individuals due to its affordability and the benefits covered by short-term plans are generally related to emergency care. Short-term health plans work for individuals who do not require regular medical care like frequent visits to the doctor or expensive prescriptions. Though, these plans do not have benefits as major medical health insurance but the limited coverage offered at affordable price majorly appeal to individuals.
Dental Insurance Plan in Wisconsin
Dental insurance plans are an excellent option for individual and families who wish to obtain coverage for several dental care such as cleanings, root canals, dentures, as well as Orthodontics. Dental insurance works just like the medical insurance in Wisconsin. Individuals are required to pay a monthly premium to obtain certain dental benefits like regular checkups, cleanings, x-rays and other dental care services essential to promote general dental health. However, no two dental plans are alike, as some dental plans provide broader coverage and some plans require greater out-of-pocket contribution from the insured. Following three types of dental insurance plans are available in Wisconsin:
Preferred Provider Organization – It is a type of dental plan which have a specific network of participating dentists to whom plan members can visit to obtain dental care. This plan is generally cheaper compared to other dental plans because the participating dentists agree to render dental car services at negotiated rates in order to keep the dental care cost down for the members of the PPO dental plan. However, member of this plan can visit out-of-the-network dentist but the out-of-pocket costs for the members will greatly increase.
Indemnity – Indemnity dental plans provide individuals with the maximum flexibility and freedom, as they are free to go to any dentist of their choice. Though, members of this plan have to pay up front for the received dental care and later on file for the reimbursement to their insurance companies. However, the insurance carriers will only pay the Usual, Customary, and Reasonable amount. The insurance company will only reimburse the amount, which the dental care provider of their network would have charged for the same service. The members will be responsible to pay the remaining amount of the dental care from their own pocket.
Dental Discount – It is not basically a dental insurance plan but is quite similar to buying a club membership where members are given discounts on specific services. Members of the dental discount can visit dentist within the plan network to receive dental care on discounted rates. The members of dental discount always pay the specified amount of the received dental care on the card. Members are not billed for their receive dental care nor they have to fill out any reimbursement forms.
Vision Insurance in Wisconsin
Vision insurance plans in Wisconsin are offered by private health insurance carriers offering coverage on personalized eye-care and eye-wear services rendered by a diverse network of eye-care providers. Members of the vision insurance plan and their covered dependents receive annual eye exams and coverage allowances towards glasses or contact lenses following a co-payment.
Insurance Carriers in Wisconsin
Robust number of health insurance companies are operating in the Wisconsin’s federally facilitated exchange for offering health plans in 2020. Currently there are 13 insurance carriers offering plans for 2020, which include:
- Aspirus Arise
- Group Health Cooperative of South Central Wisconsin
- Common Ground Healthcare Cooperative
- Dean Health Plan
- Children’s Community Health Plan
- Security Health Plan of Wisconsin, Inc
- HealthPartners Insurance
- Medica Health Plans of Wisconsin
- MercyCare HMO Inc
- Network Health
- Unity Health Insurance
- Quartz Health Benefits