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Wisconsin Health Insurance

Searching for good Wisconsin health insurance plans can be very difficult; but we can make this task easier for you. When you enter your zip code, we’ll show you Wisconsin health insurance quotes from leading health insurance providers in your area. Browse through the plans and see which one fits your health care needs.

Facts and Figures

  • Place in State
    Health Report Card
  • Insured 4,996,620
  • Uninsured 531,100
  • Insurance
  • Number of
    Primary Care Physicians
  • Number of
  • Average Cost of
    Health Insurance*

Breakdown of Insureds

  • Employer-sponsored health insurance 63%
  • Private plans 5%
  • Medicaid 16%
  • Medicare 16%

Insurance Carriers

State Health Report Card

The number of children under 18 living in poverty has decreased in one year. From 15.5 percent it has gone down to 12.7 percent. The rate of adult residents with diabetes also decreased from 8.2 percent to 7.1 in the past year.There are currently 830,000 adults in Wisconsin who smoke. But this is a drop from 24.1 percent to 19.1 percent in ten years.In ten years, obesity has increased from 20.0 percent to 26.9 percent.

Wisconsin Health Insurance Laws and Regulations

Insurers are required by state law to guarantee the renewal of Wisconsin health insurance plans. Members can renew their policy every time it expires. But you have to meet the insurer’s requirements so you can keep the coverage. Insurers are also prohibited to cancel your coverage when you become ill.

Newborn babies and adopted children are automatically covered for up to 60 days.

If you have a pre-existing condition, any treatment for this condition will not be covered for months or even years. This exclusion period varies depending on the insurer.

Wisconsin health insurance carriers are free to accept or deny your application. The state also allows them to set their Wisconsin health insurance quotes.

Small business owners employing 2 -50 employees can choose to cover their employees with any small business group plan. When getting Wisconsin health insurance quotes, the members of the group must be willing to comply with the insurers’ requirements.

Self-employed individuals could not join small business group plans unless they have employees.By purchasing a coverage for themselves, they will be able to deduct a portion of their premium cost from their taxes.

Heath Care Reform

Young adults in Wisconsin can now stay under their parent’s policy. The new health law mandates health insurance companies to allow parents to keep their children in their Wisconsin health insurance plans until age 26. 27,511 young adults in Wisconsin have benefited from this plan (as of June 2011). Because of the new law, Medicare members no longer need to worry about their extra prescription cost. Once they reach the donut hole in 2010, they are sent a check for a $250 rebate. 64,320 seniors in Wisconsin have received the rebate to offset the cost of their prescription drugs. A 50 percent discount was also given for brand name drugs once they’ve hit the donut hole. This resulted to an average savings of $37,919,307 for Wisconsin Medicare members. The Affordable Care Act aims to close the donut hole by 2020. One of the provisions of the health care reform is to provide preventive care services free of charge for Medicare members and free from cost-sharing for those enrolled under private plans. In 2011,647,617 Medicare members and 1,111,000 private plan members in Wisconsin have received free preventive care services like colonoscopies and mammograms. Insurers are no longer allowed to impose a lifetime limit on their members’ benefits. 2,142,000 Wisconsin residents are now free from having lifetime limits on their coverage. Patients with chronic diseases don’t have to worry about maximizing their limit because of their accumulating medical costs. The new health law protects consumers’ money through the medical loss ratio which mandates insurers to spend 80 percent of their premium dollars on medical care and only 20 percent on administrative costs. 1,536,000 Wisconsin residents are now able to maximize their premium. Through the Pre-Existing Condition Insurance Plan, Wisconsin residents who have pre-existing condition can now have affordable coverage. As of 2011, 1,000 residents now have a Wisconsin insurance. Without this provision, they would still remain uninsured. Wisconsin has received a $18.3 million grant to develop more health programs and policies. They have also received $15.4 million to create more health centers and to improve existing centers and the quality of health care delivered.


State Government Insurance Programs Offered

Health Insurance Risk Sharing Plan (HIRSP) HIRSP Federal Plan Federal Program run by HIRSP

800-828-4777 608-221-4551

HIRSP: Offers five plan options. Covers hospital and physician care, prescription drugs and insulin, maternity care and other services. HIRSP-Fed: Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs. Eligibility: HIRSP: Must be under age 65, a Wisconsin resident for at least 3 months, ineligible for employer- offered group health insurance or Medicaid or Badger Care Plus, and either: 1) Not eligible for Medicare, Lost your employer- offered group health insurance and did not voluntarily cancel coverage. In last 9 months was denied coverage due to health, or offered coverage with restricted benefits, or offered 2 coverages with premiums 50% or higher than a standard risk would be charged for the coverage, or diagnosed as HIV positive, or be eligible for Medicare due to disability. Or, 2) Be a HIPAA- eligible individual. HIRSP-Fed: Must be a U.S. citizen or legal alien, uninsured for 6 months prior to the HIRSP Federal Plan effective date, ineligible for employer-offered group health insurance or Medicaid or Badger Care Plus, and in last 9 months was denied coverage due to health, or offered coverage with restricted benefits, or offered 2 coverages with premiums 50% or higher than a standard risk would be charged for the coverage, or diagnosed as HIV-positive.

Badger Care Plus (BCP)


Coverage: BCP: Comprehensive care including but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more (offers same as Medicaid). Eligibility: BCP: Must be U.S. citizen or legal alien and resident of Wisconsin. Must be children under 19 years old without access to health insurance; or pregnant women with incomes up to 300% FPL; or parents or caretakers earning up to 200% FPL. Children under 19 years old with income greater than 200%, then you will be transferred to the Benchmark plan.

Well Woman Program


Mammograms, Pap tests, certain other health screenings, and multiple sclerosis testing for women with high risk signs of multiple sclerosis

BadgerCare Plus Core & Basic Plans


BadgerCare Plus Core & Basic Plan has suspended enrollment due to lack of space. There is now a waitlist and those on the waitlist will be able to enroll as space becomes available. Those currently enrolled in the plans will continue to be covered provided they maintain eligibility. Limited plans with basic services such as Doctor visits, Hospital services, Emergency room and ambulance, Emergency dental services, Prescription drugs, Therapy (physical, occupational therapy, and speech), Cardiac rehabilitation, Durable medical equipment, Disposable medical supplies, Dialysis/kidney-related services. Eligibility: BadgerCare Plus Core: Must be Wisconsin resident and U.S. citizen or qualified immigrant, age 19 to 64 years old, have income at or below 200% FPL. Must NOT be or have the following: Be pregnant. Have children under 19 living with you. Be eligible for or have BadgerCare Plus, Medicaid, Medicare. Have private health insurance in the last 12 months before and during the date you request Core Plan, unless you lost your health insurance for a good reason. Have access to employer-based insurance in the month you apply or next three months. Had access to employer-based health insurance in the last 12 months. BadgerCare Plus Basic: Must be on the BadgerCare Core waitlist to have the option to enroll in BagerCare Plus Basic.

Wisconsin Chronic Disease Program (WCDP)


The Wisconsin Chronic Disease Program (WCDP) assists Wisconsin residents with chronic renal disease, hemophilia, and adult cystic fibrosis. It pays health care providers for disease-related services and supplies provided to certified patients in Wisconsin Chronic Disease Program after all other sources of payment have been exhausted.

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