Get affordable health insurance coverage in Wisconsin with pre-existing conditions covered, and a federal subsidy to help pay your premium. Badger State Marketplace plans are available at the absolute lowest available rates both on and off the Marketplace. Single, family, self-employed, and small-business coverage is offered from top-rated companies. For applicants that have reached age 65, Senior Supplement and Advantage options are offered. Medigap and Part D prescription drug contracts help reduce potential out-of-pocket costs. Many Advantage contracts include coverage for medications.
Your instant online free quotes allow you to easily compare the 2024 Badger State options that provide the benefits you want at a cost that fits within your budget. Your application for qualified policies during Open Enrollment is virtually guaranteed. However, you can still obtain coverage at any time throughout the year with a Special Enrollment Period (SEP) exception or choosing short-term or alternative plans. The OE period begins November 1st and ends December 15th. For Seniors, the enrollment period is from October 7th to January 15th.
Health Insurance Companies In Wisconsin
Aspirus Arise -- Aspirus is a non-profit healthcare company with their head office in Warsau. Arise is based in De Pere. Eight hospitals in Wisconsin and Michigan are included in their network. The company was formed when Aspirus and Arise Health Plan merged. Individual, family, and small and large group coverage is offered.
Chorus Community Health Plan (CCHP) offers coverage in the southeastern portion of the state. CCHP offers "Together with CCHP" and BadgerCare Plus" plan options. Formerly Children's Community Health Plan.
Common Ground Healthcare Cooperative -- CGHC offers private and business plans to residents in the Eastern portion of the state. As a nonprofit organization, they were created with the primary purpose of operating as a CO-OP Section 1322, as specified by the Affordable Care Act legislation. The service area is 19 counties and the home office is located in Brookfield. Premiums and mail correspondence are forwarded to a Milwaukee office.
Dean Health Plan -- As one of the largest integrated health plans in the US, Dean has offered policies to individuals and employers since 1983. Network providers are located predominantly in the Southern portion of the state. Catastrophic, comprehensive, and HSA options are available.
Group Health Cooperative SCW -- SCW is a non-profit company that offers plans in the Dane County area. About 80,000 persons are enrolled in single or family coverage. They own five medical clinics in Madison (Capitol, DeForest, East, Hatchery Hill, and Sauk Trails) and partner with several hospitals, including Stoughton, St. Mary's, Meriter, and University of Wisconsin. Complimentary services include massage therapy, yoga, and acupuncture.
HealthPartners -- HealthPartners is an integrated carrier that is the largest consumer-operated non-profit healthcare organization in the US. More than one million patients are served by a network with about 2,000 physicians. The company is based in Bloomington, Mn.
Medica Health Plans Of Wisconsin -- Medica is a non-profit tax-exempt company that offers coverage in Minnesota, Iowa, Wisconsin, Nebraska, North Dakota, and South Dakota. With almost 2 million persons covered, they also provide nationwide network coverage.
MercyCare Health Plans -- Since 1994 MercyCare has been offering affordable policies in southern Wisconsin and northern Illinois. Currently, more than 40,000 persons are covered. About 70 facilities are available for policyholders in Jefferson, Green, Rock, Walworth, and McHenry Counties.
Molina -- Molina offers private plans again after leaving the Exchange last year. Only Gold and Silver-tier options are available. Prices are very competitive after the DOI granted a large rate decrease.
Network Health -- Headquartered in Menasha, Network Health services 22 counties and more than 125,000 customers. In addition to private Exchange coverage, they also offer Group plans and Medicare Advantage options. "Empower," a local wellness program, is widely used and very popular. The 22 participating Counties are Brown, Calumet, Dodge, Door, Fond du Lac, Green Lake, Kewaunee, Manitowac, Marquette, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Washington, Waukesha, Waupaca, Waushara, and Winnebago.
Security Health Plan -- Security, a non-profit HMO, is part of Marshfield Clinic Health System. Policies are available to individuals, families and employers in 41 counties. Approximately 250,000 persons are covered.
Unity -- Unity Health Plans Corporation (Quartz) is part of UW Health. For more than a decade, they have been recognized as offering one of the top 50 HMO and POS products. Unity owns Quartz Health Solutions, which is a health plan management and services company. More than 1,400 doctors and specialists are available through their network, and a digital wellness program is available to all members.
Arise Health Plan -- Aspirus Arise previously was a dual venture between WPS Health Solutions and Aspirus. Created four years ago, individuals, families, and small businesses can access plans. HMO, POS, and HSA-qualified HDHP options are available.
Counties with the most participating companies are Waukesha with seven carriers, and Adams, Brown, Dodge, and Juneau with five carriers. The complete listing of health insurance companies in Wisconsin is updated each year.
2024 Rate Change Requests
Anthem BCBS HMO -- 2.99% increase
Aspirus Arise HMO -- 5.51% increase
Aspirus Arise POS -- 5.37% increase
Chorus Community Health Plans -- 11.55% increase
Children's Community Health Plan Together -- 0.96% increase
Common Ground Healthcare Cooperative EPO Individual -- 7.11% increase
Common Ground Healthcare Cooperative EPO Individual With Allergy -- 7.18% increase
Common Ground Healthcare Cooperative EPO On Exchange Individual With Vision And Allergy Testing Benefits -- 6.55% increase
Common Ground Healthcare Cooperative EPO On Exchange Individual With Dental, Vision And Allergy Testing Benefits -- 5.13% increase
Common Ground Healthcare Cooperative EPO Off Exchange Individual With Dental, Vision And Allergy Testing Benefits -- 5.72% increase
Dean Health Plan Individual HMO -- 7.20% increase
Dean Health Plan Individual EPO -- 9.71% increase
Dean Health Plan Individual HMO Direct -- 7.42% increase
Dean Health Plan Individual EPO Direct -- 9.04% increase
Dean Prevea360 Health Plan Individual HMO Marketplace -- 5.50% increase
Group Health Cooperative Individual HMO -- 12.15% increase
Group Health Cooperative Individual HMO -- Split MOOPS/No EHB Dental -- 17.77% increase
HealthPartners Individual Product 1 -- 4.99% increase
HealthPartners Individual Product 2 -- 4.90% increase
Medica Individual Choice -- 7.58% increase
Medica Engage -- 0.95% increase
Medica Essential Choice Care -- 6.55% increase
MercyCare HMO -- 8.84% increase
Molina Healthcare -- 4.30% increase
Molina Healthcare Plus Vision -- 2.03% increase
Network Health Plan ACA HMO NE WI -- 3.21% increase
Network Health Plan ACA HMO SE WI -- 1.94% decrease
Network Health Plan ACA HMO NE WI Basic -- 4.73% increase
Network Health Plan ACA HMO SE WI Basic -- 1.55% increase
Quartz Health Community Individual -- 7.62% increase
Quartz Health Individual Product One -- 8.53% increase
Quartz Health Individual Product Four -- 0.25% decrease
Security Health Plan Of Wisconsin Select -- 3.66% increase
Security Health Plan Of Wisconsin Enrich -- 3.83% increase
Security Health Plan Of Wisconsin Select -- 3.66% increase
Security Health Plan Of Wisconsin Premier HMO -- 3.05% decrease
Wisconsin Physicians Individual PPO -- 13.87% increase
Save Money With Wisconsin Catastrophic Or Bronze-Tier Plans
Most Affordable Wisconsin Health Insurance Plans
Catastrophic Tier (Must Be Under Age 30 To Qualify)
Common Ground Healthcare Cooperative Catastrophic $9450 -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance. $0 copay for primary care visits.
Chorus Community Health Plan Catastrophic -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance. First three pcp and telehealth office visits and annual eye exam covered at 100%.
Aspirus Arise HMO Catastrophic 9450 -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance. The first three pcp office visits are subject to a $0 copay.
Dean Catastrophic Safety Net -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance. The first three pcp office visits are free.
Group Health Cooperative Select Catastrophic 9450 -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance. The first three pcp office visits are free.
Quartz Catastrophic I101 -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance. First three pcp and telehealth office visits and annual eye exam covered at 100%.
Security Health Plan Premier Protection -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance.
HealthPartners Robin Select $9450 Catastrophic -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance. The first three pcp office visits are subject to a $30 copay. The first three Convenience Care pcp office visits are subject to a $15 copay.
Bronze Tier
Anthem Bronze Pathway/Lean 9450 -- $9,450 deductible with 100% coverage after deductible is met. 0% coinsurance. Telehealth benefits available.
Anthem Bronze Pathway/Lean 7500/50% Standard -- $7,500 deductible with $9,400 maximum out-of-pocket expenses and 50% coinsurance. $50 and $100 office visit copays. Urgent Care copay is $75. Tier 1 and Tier 2 drug copays are $25 and $50. ($62.50 and $150 mail order).
Anthem Bronze Lean 0% for HSA -- $7,900 deductible with 100% coverage after deductible is met. 0% coinsurance. Telehealth benefits available. HSA-eligible.
Anthem Bronze Pathway/Lean 5000 -- $5,000 deductible with $9,450 maximum out-of-pocket expenses and 40% coinsurance. $0 and $60 office visit copays (first three visits). Urgent Care copay is $75. $25 generic drug copay.
Common Ground Healthcare Cooperative HSA Bronze 7500-100 -- HSA-eligible plan with $7,500 deductible and $7,500 maximum out-of-pocket expenses. Coinsurance is 0%.
Common Ground Healthcare Cooperative Bronze Standard Plan -- $9,100 deductible with 100% coverage after deductible is met. 0% coinsurance.
Common Ground Healthcare Cooperative Bronze $9100 ($35 PCP Copay) -- $9,100 deductible with 100% coverage after deductible is met. 0% coinsurance. PCP office visits covered with $35 copay.
Chorus Core Bronze -- $9,100 deductible with $9,100 maximum out-of-pocket expenses and 0% coinsurance.
Chorus Bronze HDHP -- HSA-eligible plan with $7,000 deductible and $7,000 maximum out-of-pocket expenses. Coinsurance is 0%.
Chorus Bronze -- $7,500 deductible with $9,100 maximum out-of-pocket expenses. Office visit copays are $60 and $120, and the generic drug copay is $20.
Dean Bronze Standard 9100X -- $9,100 deductible and $9,100 maximum out-of-pocket expenses with 0% coinsurance.
Dean Bronze Value Copay 9050X -- $9,050 deductible with 100% coverage after deductible is met. 0% coinsurance. First three pcp office visits covered with $100 copay.
Dean Bronze Copay PCP 8000X -- $8,000 deductible with with $9,100 maximum out-of-pocket expenses and 20% coinsurance. $30 pcp office visit copay. $15 preferred generic drug copay.
Quartz One Bronze 1201 -- $9,100 deductible with $9,100 maximum out-of-pocket expenses and 50% coinsurance. $50 and $100 office visit copays. Urgent Care copay is $100. Tier 1 and Tier 2 drug copays are $15 (Value Tier) and $35/$160. Lab test and x-ray copays are $50 and $100.
Quartz One Bronze 1202 -- $8,000 deductible with $9,000 maximum out-of-pocket expenses and 50% coinsurance. $40 and $80 office visit copays. Urgent Care copay is $80. Lab test and x-ray copays are $60 and $120.
Quartz One Bronze 1203 HSA -- $6,850 deductible with $6,850 maximum out-of-pocket expenses and 0% coinsurance. HSA-eligible.
Group Health Cooperative Select Bronze 9100 Ded/9100 MOOP -- $9,100 deductible with $9,100 maximum out-of-pocket expenses and 0% coinsurance.
Group Health Cooperative Select Bronze 9050 Ded/9050 MOOP -- $9,050 deductible with $9,050 maximum out-of-pocket expenses and 0% coinsurance. $125 and $175 office visit copays. The Urgent Care copay is $125. Tier 1 drug copay is $35.
Group Health Cooperative Select Bronze 7500 Ded/7500 MOOP HSA -- $7,500 deductible with $7,500 maximum out-of-pocket expenses and 0% coinsurance. HSA-eligible.
Medica Bronze Standard -- $9,100 deductible with $9,100 maximum out-of-pocket expenses and 0% coinsurance.
Medica Bronze Copay -- $7,250 deductible with $9,100 maximum out-of-pocket expenses with 50% coinsurance. Office visit copays are $40 and $160. Generic and preferred brand drug copays are $15 and $200. $40 Urgent Care copay.
Medica Bronze Share Plus -- $2,700 deductible with $9,100 maximum out-of-pocket expenses with 50% coinsurance. Generic and preferred brand drug copays are $20 and $200.
Security Health Plan Select 9100 -- $9,100 deductible with $9,100 maximum out-of-pocket expenses and 0% coinsurance.
Security Health Plan Select 7500 -- $7,500 deductible with $9,000 maximum out-of-pocket expenses and 50% coinsurance. $50 and $100 office visit copays and $75 Urgent Care copay. $25 generic drug copay.
HealthPartners Atlas $7,500 HSA Bronze -- HSA-eligible plan with $7,500 deductible and $7,500 maximum out-of-pocket expenses. Coinsurance is 0%.
HealthPartners Atlas $6,250 Plus Bronze -- $6,2500 deductible and $9,100 maximum out-of-pocket expenses. Coinsurance is 30%. $30 copays for office visits and Urgent Care visits. $5 and $25 generic drug copays ($15 and $75 mail order).
Aspirus Arise HMO Bronze $9,100 -- $9,100 deductible with 100% coverage after deductible is met. 0% coinsurance.
Aspirus Arise HMO Bronze $7,500 -- $7,500 deductible with with $9,000 maximum out-of-pocket expenses and 50% coinsurance. $50 and $100 office visit copays. $75 Urgent Care copay. Tier 1Generic, preferred brand, and non-preferred brand drug copays are $25 (62.50 mail order).
Silver Tier
Anthem Silver Pathway X 6550 -- $30 and $75 office visit copays. $6,550 deductible with maximum out-of-pocket expenses of $8,700 and 35% coinsurance. Generic drug copay is $15 ($45 mail order). Preferred brand and non-preferred brand generic drug copay is $40 ($120 mail order). $75 Urgent Care copay.
Anthem Silver Pathway X 5000 -- $35 pcp office visit copay. $5,000 deductible with maximum out-of-pocket expenses of $8,250 and 25% coinsurance. Generic drug copay is $20 ($60 mail order). Preferred brand and non-preferred brand generic drug copay is $40 ($120 mail order). $75 Urgent Care copay.
Anthem Silver Pathway X 4000 -- $25 and $75 office visit copays. $4,000 deductible with maximum out-of-pocket expenses of $8,700 and 20% coinsurance. Generic drug copay is $15 ($45 mail order). Preferred brand and non-preferred brand generic drug copay is $55 ($165 mail order). $75 Urgent Care copay.
Children's Community Health Plan Together Silver -- $50 and $100 office visit copays. $5,400 deductible with maximum out-of-pocket expenses of $8,700 and 40% coinsurance. Generic drug copay is $15.
Children's Community Health Plan Together Silver Select -- $35 and $80 office visit copays. $3,250 deductible with maximum out-of-pocket expenses of $8,700 and 40% coinsurance. Generic drug copay is $15, and preferred brand drug copay is $65.
Children's Community Health Plan Standard Silver -- $35 and $70 office visit copays. $4,000 deductible with maximum out-of-pocket expenses of $8,700 and 20% coinsurance. Generic drug copay is $15, and preferred brand drug copay is $65.
Common Ground Healthcare Value 1 Silver 7000/75 -- $70 and $115 office visit copays. $7,500 deductible with maximum out-of-pocket expenses of $8,700 and 30% coinsurance. $15 and $100 copays on generic and preferred brand drugs.
Common Ground Healthcare Value 2 Silver 4000/75 -- $85 and $120 office visit copays. $5,000 deductible with maximum out-of-pocket expenses of $8,700 and 40% coinsurance. $25 generic drug copay. $115 preferred brand drug copay.
Network Health Prestige Silver Essential -- $25 and $80 office visit copay with $80 Urgent Care copay. First three office visits are covered at 100%. Lab tests and x-ray copays are $30 and $60. Deductible is $4,000 with maximum out-of-pocket expenses of $8,700 and 40% coinsurance. Generic and preferred brand drugs are subject to $20 and $80 copays ($55 and $225 mail-order).
Dean Silver Classic 5000x -- $5,000 deductible with maximum out-of-pocket expenses of $8,700 and 30% coinsurance. $15 preferred generic drug copay. $50 copay for non-preferred generic and preferred brand drugs.
Dean Focus Network Silver HSA-E 4500x -- HSA-eligible plan. $4,500 deductible with maximum out-of-pocket expenses of $7,000 and 20% coinsurance.
Dean Silver Copay Plus 4800X -- $30 and $60 office visit copay with $30 Urgent Care copay. Deductible is $4,800 with maximum out-of-pocket expenses of $8,700 and 30% coinsurance. $15 preferred generic drug copay. $50 copay for non-preferred generic and preferred brand drugs.
Quartz Tiered Choice Plus Silver 1306 -- $65 and $120 office visit copays with $100 Urgent Care copay. $4,250 deductible with maximum out-of-pocket expenses of $7,000 and 50% coinsurance. Tiers 1 and 2 drug copays are $20 and $85.
Quartz Tiered Choice Plus Silver 1305 -- $55 and $90 office visit copays with $100 Urgent Care copay. $4,250 deductible with maximum out-of-pocket expenses of $5,500 and 40% coinsurance. Tiers 1 and 2 drug copays are $20 and $85.
Quartz One Silver 1303 -- $80 and $160 office visit copays with $300 Urgent Care copay. $8,500 deductible with maximum out-of-pocket expenses of $8,700 and 50% coinsurance. Tiers 1 and 2 drug copays are $35 and $125.
Group Health Cooperative Select Silver Simple Choice 4550X Ded/7900 MOOP -- $40 and $80 office visit copays with $90 Urgent Care copay. $4,000 deductible with maximum out-of-pocket expenses of $7,900 and 20% coinsurance. $25, $65, and $200 copays for Tier 1, 2 and 3 drugs.
Group Health Cooperative Silver 4900 Ded/7900 MOOP -- $50 and $75 office visit copays with $30 Urgent Care copay. $4,900 deductible with maximum out-of-pocket expenses of $7,900 and 30% coinsurance. $40 and $80 copays for Tier 1 and 2 drugs.
Medica Silver Copay -- $45 and $90 office visit copays with $45 Urgent Care copay. $3,900 deductible with maximum out-of-pocket expenses of $8,550 and 40% coinsurance. Generic and preferred brand drug copays are $15 and $120.
Security Health Plan Select $6,950 -- 30% -- $6,950 deductible with $8,550 maximum out-of-pocket expenses and 30% coinsurance. The generic, preferred brand, and non-preferred brand drug copays are $25, $60, and $120.
Security Health Plan Select $4,800 -- 30% -- $4,800 deductible with $7,900 maximum out-of-pocket expenses and 30% coinsurance. $30 and $75 office visit copays with $75 Urgent Care copay. The generic, preferred brand, and non-preferred brand drug copays are $25, $60, and $120.
HealthPartners Robin Oak $5,000 Plus Silver -- $5,000 deductible with $8,150 maximum out-of-pocket expenses and 25% coinsurance. $30 office visit copays (first three visits) with $30 Urgent Care copay (also first three visits). The low cost and high cost formulary drug copays are $5 and $25 ($15 and $75 mail order).
Aspirus Arise HMO HDHP Silver 5500 -- HSA-eligible plan with $5,500 deductible and maximum out-of-pocket expenses of $5,500 and 0% coinsurance.
Aspirus Arise HMO Silver 7150 -- $7,150 deductible with $7,150 maximum out-of-pocket expenses and 0% coinsurance. $35 and $70 office visit copays with $35 Urgent Care copay. The Tier1, Tier 2, and Tier 3 drug copays are $20, $40, and $70 ($50, $100, and $175 mail order).
Gold Tier
Security Health Plan Select $3,500-30% -- $30 and $75 office visit copays with $75 Urgent Care copay. $3,500 deductible with maximum out-of-pocket expenses of $6,500 and 30% coinsurance. Generic, preferred brand, and non-preferred brand drug copays are $20, $50, and $100.
Aspirus Arise HMO Gold 2500 -- $35 and $70 office visit copays with $35 Urgent Care copay. $2,500 deductible with maximum out-of-pocket expenses of $5,000 and 20% coinsurance. Tier 1, Tier 2, and Tier 3 drug copays are $15, $30, and $45 ($37.50, $75, and $112.50 mail order). ER copay is $450.
Molina Confident Care Gold 1 -- $10 and $50 office visit copays with $10 Urgent Care copay. Deductible is $2,925 with $6,500 maximum out-of-pocket expenses and 20% coinsurance. Blood work receives a $15 copay. Generic and preferred brand drugs are subject to a $10 and $50 copay while Tier 3 and Tier 4 drugs are subject to 30% coinsurance.
Network Health Prestige Gold Essential -- $20 and $60 office visit copays with a $60 copay for Urgent Care. Deductible is $1,750 and maximum out-of-pocket expenses are $8,550 and 20% coinsurance. Generic and preferred brand drugs are subject to $15 and $60 copays while non-preferred brand drugs are subject to 50% coinsurance. Lab and x-ray procedure copays are $25 and $50.
Network Health Prestige Gold 50 -- Deductible is $1,000 and maximum out-of-pocket expenses are $4,300 and 50% coinsurance. Generic and preferred brand drugs are subject to $15 and $50 copays while non-preferred brand drugs are subject to 50% coinsurance.
Children's Community Health Plan Together Gold -- $30 and $60 office visit copays. $2,000 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. Generic and preferred brand drug copays are $10 and $55, with other drugs subject to deductible and coinsurance.
Common Ground Healthcare Cooperative Gold 2000/80 -- $40 and $60 office visit copays with $75 Urgent Care copay. ER copay is $300. $2,000 deductible with maximum out-of-pocket expenses of $8,550 and 20% coinsurance. $10, $50, and $100 copays on Tier 1, 2, and 3 drugs. $15 insulin copay on preferred brand drugs.
Dean Gold Copay Plus 1500X -- $30 and $60 office visit copays with $30 Urgent Care copay. $1,500 deductible with maximum out-of-pocket expenses of $5,100 and 20% coinsurance. $15 and $50 copays for Tier 1 and Tier 2 drugs. Tier 3 and Tier 4 drugs subject to 50% coinsurance.
Dean Gold Value Copay 3700X -- $25 copay for first three pcp office visits. $3,700 deductible with maximum out-of-pocket expenses of $3,700 and 0% coinsurance. Preferred generic drug copay is $15.
Group Health Cooperative Select Gold 1500 Ded/8550 MOOP -- $10 and $120 office visit copays with $10 Urgent Care copay. $1,500 deductible with maximum out-of-pocket expenses of $8,550 and 30% coinsurance. $5, $80, and $150 copays for Tier 1, 2 and 3 drugs. Tier 4 drug copay is $450.
Group Health Cooperative Select Gold 2500 Ded/6500 MOOP -- $30 and $60 office visit copays with $30 Urgent Care copay. $2,500 deductible with maximum out-of-pocket expenses of $6,500 and 30% coinsurance. $20, $40, and $80 copays for Tier 1, 2 and 3 drugs.
Group Health Cooperative Select Gold 2500 Ded/2500 MOOP HSA -- $2,500 deductible with maximum out-of-pocket expenses of $2,500 and 0% coinsurance. Policy is HSA-eligible.
Quartz One Gold 1402 Maintenance -- $40 and $90 office visit copays with $500 ER copay. $1,500 deductible with maximum out-of-pocket expenses of $7,900. Tiers 1, 2, and 3, drug copays are $10, $75, and $150 respectively. Urgent Care copay is $90.
Quartz One Gold 1405 -- $30 and $60 office visit copays. $2,000 deductible with maximum out-of-pocket expenses of $6,500. Tiers 1, 2, and 3, drug copays are $35, $150, and $250 respectively. Urgent Care copay is $60.
Medica Gold Copay -- $25 and $75 office visit copays and also $25 copay for Urgent Care. $1,100 deductible with maximum out-of-pocket expenses of $8,550 and 30% coinsurance. $5 and $100 copays for generic and preferred brand drugs.
Total Health Care USA HMO Standard -- $30 and $60 office visit copays. $1,500 deductible with maximum out-of-pocket expenses of $7,000. Tiers 1, 2, and 3, drug copays are $25, $50, and $100 respectively. Urgent Care copay is $60. $100 copay for diagnostic tests.
Physicians Health Plan Sparrow PHP Gold 1000 HMO -- $30 and $50 office visit copays. $1,000 deductible with maximum out-of-pocket expenses of $8,000. Tiers 1, 2, and 3, drug copays are $5/$20, $60, and $80 respectively. Urgent Care copay is $75.
Platinum Tier
Group Health Cooperative Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP With Massage Therapy -- $0 and $50 office visit copays with $0 Urgent Care copay. $500 deductible with maximum out-of-pocket expenses of $1,500 and 20% coinsurance. $10, $30, and $60 copays for Tier 1, 2 and 3 drugs.
Group Health Cooperative Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP With Massage Therapy -- $0 and $50 office visit copays with $0 Urgent Care copay. $500 deductible with maximum out-of-pocket expenses of $1,000 and 20% coinsurance. $10, $30, and $60 copays for Tier 1, 2 and 3 drugs.
Group Health Cooperative Select Platinum Zero Primary Care Visit Copay No Deductible With Massage Therapy -- $0 and $50 office visit copays with $0 Urgent Care copay. $0 deductible with maximum out-of-pocket expenses of $1,000 and 20% coinsurance. $10, $30, and $60 copays for Tier 1, 2 and 3 drugs.
Gunderson Platinum $1000 -- 0% -- $50 office visit copays and also $50 copay for Urgent Care. $1,000 deductible with maximum out-of-pocket expenses of $1,000 and 0% coinsurance. $5, $25, and $75 copays for generic, preferred brand, and non-preferred brand drugs. Specialty drugs are subject to 45% coinsurance.
Gunderson Platinum $500 -- 20% -- $25 office visit copays and also $25 copay for Urgent Care. $500 deductible with maximum out-of-pocket expenses of $1,000 and 20% coinsurance. $5, $25, and $75 copays for generic, preferred brand, and non-preferred brand drugs. Specialty drugs are subject to 45% coinsurance.
Short-Term Plans
Temporary coverage is offered by many reputable carriers. Rates are very low, and policies can be kept for up to three months, although renewing the plan can extend coverage. However, short-term contracts cap maximum annual payouts, out-of-pocket expenses are generally higher than Exchange plans, and federal subsidies can not be used to lower premiums. Also, since they are not "compliant" plans, the insurer is not obligated to cover pre-existing conditions. However, these contracts still must be approved by the Wisconsin Department of Insurance, and the carrier must request to file rate increases in advance.
If Open Enrollment was missed or forgotten, these types of policies are often the best choice to provide effective stopgap coverage until the next available OE. Listed below are sample monthly rates for the Milwaukee area:
35 year-old non-smoking male
$47 -- Independence American -- $5,000 deductible with 20% coinsurance
$63 -- UnitedHealthcare -- $10,000 deductible with 30% coinsurance.
$64 -- Independence American -- $2,500 deductible with 20% coinsurance
$76 -- UnitedHealthcare -- $5,000 deductible with 30% coinsurance.
$94 -- UnitedHealthcare -- $2,500 deductible with 30% coinsurance.
$95 -- Independence American -- $1,000 deductible with 20% coinsurance.
$123 -- National General -- $5,000 deductible with 0% coinsurance.
45 year-old non-smoking married couple (2 persons)
$150 -- Independence American -- $5,000 deductible with 20% coinsurance
$166 -- UnitedHealthcare -- $10,000 deductible with 30% coinsurance.
$204 -- Independence American -- $2,500 deductible with 20% coinsurance
$245 -- UnitedHealthcare -- $5,000 deductible with 30% coinsurance.
$254 -- UnitedHealthcare -- $2,500 deductible with 30% coinsurance.
$304 -- Independence American -- $1,000 deductible with 20% coinsurance.
$319 -- National General -- $5,000 deductible with 0% coinsurance.
55 year-old non-smoking married couple (2 persons)
$269 -- UnitedHealthcare -- $10,000 deductible with 30% coinsurance.
$324 -- UnitedHealthcare -- $10,000 deductible with 20% coinsurance.
$331 -- UnitedHealthcare -- $5,000 deductible with 30% coinsurance.
$397 -- UnitedHealthcare -- $5,000 deductible with 20% coinsurance.
$412 -- UnitedHealthcare -- $2,500 deductible with 30% coinsurance.
$401 -- Companion Life -- $5,000 deductible with 20% coinsurance.
What Is WisCovered?
WisCovered was developed by OCI (Wisconsin Office of the Commisioner of Insurance) to help inform stste residents about their healthcare choices. One of the objectives is to help consumers locate an experienced and knowledgeable agent or broker that can assist with comparing and understanding plans. There is no cost to utilize the service.
The Healthcare Coverage Advisory Council's Marketing Workgroup created the concept of WisCovered. Several of the Organization's participants include ABC for Health, Dean Health Plan, Covering Wisconsin, HealthWatch Wisconsin, Milwaukee Enrollment Network, Milwaukee Health Care, Quartz, Common Ground Healthcare Cooperative, and Wisconsin Department of Health Services.
Affordable Wisconsin Senior Medigap Plans Are Available
Senior Wisconsin Health Insurance
Medigap plans are guarantee-issue during designated Open Enrollment periods. Retirees should begin reviewing plan options before they reach age 65. Applicants that have already reached age 65, but have not yet purchased supplementary benefits, should strongly consider reviewing available plans, especially if a serious medical condition exists, or there is pending surgery or major medical treatment.
Persons that have qualified for SS Disability are possibly eligible for early benefits, even if they have not reached age 65. Although prices must be approved by the State DOI, it is possible for a carrier to discount premiums for paying annually vs. monthly.
Medicare Supplement
"Basic" plans provide basic benefits, skilled nursing facility coinsurance (Part A), 175 additional days of inpatient mental health care benefits, and 40 home health care visits. 25% and 50% cost-sharing policies are also offered, which provide coverage that is similar to "L" and "K" Supplement plans.
State-issued policies receive an exception waiver from federal A-N standardization required regulations. Therefore, Wisconsin-issued plans are often different than contracts available in other states. Some of the mandated (required) benefits for all plans include:
Inpatient and outpatient Kidney disease expenses up to $30,000 per year.
Chiropractic Care.
Colorectal Cancer screening
Breast reconstruction following a mastectomy
Home Health Care
Skilled nursing facilities
$30,000 per year for treatment of kidney disease
Diabetes treatment, even if not covered by Medicare
NOTE: Advantage plans are not required to include these state-mandated benefits. Also, comprehensive mental health coverage is typically included on most plans.
Companies Offering Traditional Medicare Supplement Plans In Wisconsin
Aetna
American Continental
American National Life
American Retirement Life
Americo
Blue Cross Blue Shield of Wisconsin
Catholic United Financial
Cigna
Colonial Penn
Combined Insurance
GCU
Gerber Life
Globe Life
Government Personnel Mutual
Humana
Individual Assurance
Liberty Bankers Life
Manhattan Life
Medico
Mutual Of Omaha
Order Of United Commercial Travelers
Pekin Life
Physicians Life
Polish Falcons Of America
Puritan Life
Quartz (Gunderson Life)
Renaissance Life
Reserve National
Security Health Plan Of Wisconsin
State Farm
Thrivent
Unified Life
United American
United World Life
Western Catholic Union
Wisconsin Physicians Service
Wisconsin Medicare Supplement Rates (Largest Counties)
Monthly rates for a 65 year-old female residing in Dane County
Plan A
$88 -- Accendo
$89 -- BCBS Of Wisconsin
$91 -- Manhattan Life
$93 -- Humana
$94 -- Capitol Life
$98 -- Philadelphia American
$99 -- Union Security
$100 -- Lumico Life
$104 -- Aetna
$106 -- Americo
$106 -- Guarantee Trust Life
$108 -- National Health
$111 -- United World Health
$114 -- AARP-UnitedHealthcare
$123 -- Cigna
$144 -- Medico
Plan B
$104 -- Accendo
$106 -- Manhattan Life
$107 -- Humana
$110 -- Capitol Life
$113 -- BCBS Of Wisconsin
$115 -- Philadelphia American
$116 -- Union Security
$118 -- Lumico Life
$121 -- Aetna
$115 -- Guarantee Trust Life
$125 -- Americo
$127 -- National Health
$130 -- United World Life
$137 -- Cigna
$165 -- Medico
Plan C
$114 -- Accendo
$124 -- BCBS Of Wisconsin
$125 -- Guarantee Trust Life
$128 -- Union Security
$132 -- Lumico Life
$132 -- Aetna
$132 -- United World Life
$134 -- Manhattan Life
$143 -- Americo
$145 -- Humana
$147 -- Cigna
$165 -- Medico
Plan D
$100 -- Accendo
$112 -- Guarantee Trust Life
$112 -- BCBS Of Wisconsin
$113 -- Union Security
$116 -- Lumico Life
$116 -- Aetna
$118 -- United World Life
$121 -- Manhattan Life
$128 -- Americo
$129 -- Humana
$132 -- Cigna
$152 -- Medico
Plan F
$114 -- Accendo
$126 -- Guarantee Trust Life
$129 -- Union Security
$129 -- BCBS Of Wisconsin
$133 -- United World Life
$133 -- Lumico Life
$134 -- AARP-UnitedHealthcare
$135 -- Manhattan Life
$137 -- Aetna
$144 -- Americo
$146 -- Humana
$148 -- Cigna
$166 -- Medico
Plan G (HD)
$44 -- United World Life
Monthly rates for a 65 year-old female residing in Milwaukee County
Plan A
$99 -- Accendo
$110 -- BCBS Of Wisconsin
$110 -- Capitol Life
$110 -- Humana
$111 -- Guarantee Trust Life
$112 -- Lumico Life
$112 -- Union Security
$122 -- Americo
$123 -- Aetna
$131 -- United World Life
$138 -- United American
$141 -- AARP-UnitedHealthcare
$152 -- Medico
Plan B
$117 -- Accendo
$121 -- Manhattan Life
$127 -- Humana
$128 -- Guarantee Trust Life
$128 -- Capitol Life
$131 -- Union Security
$131 -- Lumico Life
$138 -- BCBS Of Wisconsin
$143 -- Aetna
$145 -- Americo
$154 -- United World Life
$175 -- Medico
Plan C
$135 -- Medico
$137 -- Manhattan Life
$138 -- Accendo
$144 -- Philadelphia American
$145 -- National Health
$147 -- Humana
$152 -- Capitol Life
$154 -- Lumico Life
$155 -- Union Security
$159 -- Aetna
$172 -- Americo
$184 -- United American
$188 -- United World Life
$189 -- Cigna
$207 -- Medico
Wisconsin Part D Prescription Drug Plans Monthly Rates And Benefits
AARP MedicareRx Walgreens -- $21.60 with $350 deductible. 30-Day Preferred Pharmacy Supply copays are $1 (Tier 1), $10 (Tier 2), $40 (Tier 3), 45% (Tier 4), and 27% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $3 (Tier 1), $30 (Tier 2), $120 (Tier 3), 45% (Tier 4), and n/a (Tier 5). 3,251 available formulary drugs. 3.0 Plan Summary Star Rating.
AARP MedicareRx Saver Plus -- $39.10 with $505 deductible. 30-Day Preferred Pharmacy Supply copays are $1 (Tier 1), $6 (Tier 2), 17% (Tier 3), 42% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $3 (Tier 1), $18 (Tier 2), 17% (Tier 3), 42% (Tier 4), and n/a (Tier 5). 3,170 available formulary drugs. 3.0 Plan Summary Star Rating.
AARP MedicareRx Preferred -- $113.00 with $0 deductible. 30-Day Preferred Pharmacy Supply copays are $7 (Tier 1), $12 (Tier 2), $47 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $21 (Tier 1), $36 (Tier 2), $141 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3,624 available formulary drugs. 3.5 Plan Summary Star Rating.
Cigna Saver Rx -- $12.50 with $505 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $10 (Tier 2), $40 (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $30 (Tier 2), $120 (Tier 3), 50% (Tier 4), and N/A (Tier 5). 3,327 available formulary drugs. 3.0 Plan Summary Star Rating.
Cigna Secure Rx -- $40.80 with $505 deductible. 30-Day Preferred Pharmacy Supply copays are $1 (Tier 1), $3 (Tier 2), $20 (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $3 (Tier 1), $9 (Tier 2), $60 (Tier 3), 50% (Tier 4), and N/A (Tier 5). 3,208 available formulary drugs. 3.0 Plan Summary Star Rating.
Cigna Extra Rx -- $55.90 with $100 deductible. 30-Day Preferred Pharmacy Supply copays are $4 (Tier 1), $10 (Tier 2), $45 (Tier 3), 50% (Tier 4), and 31% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $12 (Tier 1), $30 (Tier 2), $135 (Tier 3), 50% (Tier 4), and N/A (Tier 5). 3,383 available formulary drugs. 3.0 Plan Summary Star Rating.
Elixir RxSecure -- $42.60 with $480 deductible. 30-Day Preferred Pharmacy Supply copays are $1 (Tier 1), $4 (Tier 2), 15% (Tier 3), 27% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $3 (Tier 1), $12 (Tier 2), 15% (Tier 3), 27% (Tier 4), and N/A (Tier 5). 3,085 available formulary drugs. 3.0 Plan Summary Star Rating.
Humana WalMart Value Rx Plan -- $22.70 with $480 deductible. 30-Day Preferred Pharmacy Supply copays are $1 (Tier 1), $4 (Tier 2), 18% (Tier 3), 38% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $3 (Tier 1), $12 (Tier 2), 18% (Tier 3), 38% (Tier 4), and N/A (Tier 5). 3,221 available formulary drugs. 4.0 Plan Summary Star Rating.
Humana Premier Rx Plan -- $77.80 with $480 deductible. 30-Day Preferred Pharmacy Supply copays are $1 (Tier 1), $4 (Tier 2), $45 (Tier 3), 49% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $3 (Tier 1), $12 (Tier 2), $135 (Tier 3), 49% (Tier 4), and N/A (Tier 5). 3,281 available formulary drugs. 4.0 Plan Summary Star Rating.
Humana Basic Rx Plan -- $42.40 with $480 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $1 (Tier 2), 19% (Tier 3), 39% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $3 (Tier 2), 19% (Tier 3), 39% (Tier 4), and N/A (Tier 5). 3,104 available formulary drugs. 4.0 Plan Summary Star Rating.
Mutual Of Omaha Rx Premier -- $35.00 with $480 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $13 (Tier 2), 23% (Tier 3), 44% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $39 (Tier 2), 23% (Tier 3), N/A (Tier 4), and N/A (Tier 5). 3,045 available formulary drugs. 3.5 Plan Summary Star Rating.
Mutual Of Omaha Rx Plus -- $92.50 with $480 deductible. 30-Day Preferred Pharmacy Supply copays are $1 (Tier 1), $3 (Tier 2), 17% (Tier 3), 44% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $3 (Tier 1), $9 (Tier 2), 17% (Tier 3), N/A (Tier 4), and N/A (Tier 5). 2,995 available formulary drugs. 3.5 Plan Summary Star Rating.
SilverScript Choice -- $36.00 with $205 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $5 (Tier 2), $35 (Tier 3), 42% (Tier 4), and 29% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $15 (Tier 2), $105 (Tier 3), 42% (Tier 4), and N/A (Tier 5). 3,014 available formulary drugs.
SilverScript Plus -- $52.20 with $0 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $2 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $0 (Tier 2), $120 (Tier 3), 50% (Tier 4), and N/A (Tier 5). 3,060 available formulary drugs.
SilverScript SmartRx -- $7.30 with $445 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $19 (Tier 2), $46 (Tier 3), 46% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $57 (Tier 2), $138 (Tier 3), 46% (Tier 4), and N/A (Tier 5). 3,564 available formulary drugs.
WellCare Value Script -- $14.80 with $445 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $8 (Tier 2), $43 (Tier 3), 47% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $24 (Tier 2), $129 (Tier 3), 47% (Tier 4), and N/A (Tier 5). 3,475 available formulary drugs.
WellCare Classic -- $33.90 with $445 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $1 (Tier 2), $30 (Tier 3), 33% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $6 (Tier 2), $90 (Tier 3), 33% (Tier 4), and N/A (Tier 5). 3,105 available formulary drugs.
WellCare Wellness Rx -- $14.60 with $445 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $7 (Tier 2), $43 (Tier 3), 47% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $21 (Tier 2), $129 (Tier 3), 47% (Tier 4), and N/A (Tier 5). 3,475 available formulary drugs.
WellCare Medicare Rx Select -- $26.80 with $300 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $3 (Tier 2), $47 (Tier 3), 42% (Tier 4), and 27% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $9 (Tier 2), $141 (Tier 3), 42% (Tier 4), and N/A (Tier 5). 3,475 available formulary drugs.
WellCare Medicare Rx Value Plus -- $76.10 with $0 deductible. 30-Day Preferred Pharmacy Supply copays are $1 (Tier 1), $4 (Tier 2), $47 (Tier 3), 45% (Tier 4), and 33% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $3 (Tier 1), $12 (Tier 2), $141 (Tier 3), 45% (Tier 4), and N/A (Tier 5). 3,485 available formulary drugs.
WellCare Medicare Rx Saver -- $39.50 with $445 deductible. 30-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $2 (Tier 2), $35 (Tier 3), 37% (Tier 4), and 25% (Tier 5). 90-Day Preferred Pharmacy Supply copays are $0 (Tier 1), $6 (Tier 2), $105 (Tier 3), 37% (Tier 4), and N/A (Tier 5). 3,105 available formulary drugs.
Medicare Advantage Plans Without Drug Prescription Benefits
AARP Medicare Advantage Essential
Allwell Medicare Essentials
Anthem MediBlue Access Core
DeanCare Gold Shared Value
DeanCare Gold Basic
DeanCare Gold Enhanced
Essence
HumanaChoice
Network PlatinumPlus
Network PlatinumPremier
NetworkPrime (MSA)
Secure Saver (MSA)
Spirit
UnitedHealthcare Medicare Advantage Open Essential
UW Health Senior Preferred Elite (no Rx)
Medicare Advantage Plans With Drug Prescription Benefits (Many Plans Offer Coverage With And Without RX)
AARP Medicare Advantage Value
AARP Medicare Advantage Walgreens
Aetna Medicare Value
Allwell Dual Medicare
Anthem MediBlue Plus
Essence
Essence Rx
Esteem Rx
HealthPartners Robin Birch
HealthPartners Robin Maple
Humana Gold Plus
Humana Value Plus
iCare Medicare Plan
Molina Medicare Complete Care
Network PlatinumSelect
Network PlatinumChoice
Prevea360 Medicare Advantage Essential
Spirit Rx
Surety Rx
UnitedHealthcare Dual Complaete LP
UnitedHealthcare Dual Complete LP1
UnitedHealthcare Medicare Advantage Assist