You can’t predict when you’ll be sick or will need health care, but you can be prepared for it. If you live in Wisconsin and need to sign up for health insurance or switch plans, you have hundreds of options. It can be confusing — should you choose an HMO or a PPO? How can you save money on your health insurance bill? We’ve researched health insurance plans in Wisconsin and are sharing what we found to help you find the best health insurance plan for you.
The Best Health Insurance in Wisconsin
What is Health Insurance?
Even the best of drivers need car insurance, because things happen that are out of our control. The same is true with health insurance — you need a plan ready to go in case of an emergency. You also need annual checkups and preventive care to screen for certain diseases and stay healthy, so having health insurance is important. You may need it for yourself or for others in your household, too, such as your spouse or children.
When you’re considering your health insurance needs, you want a plan that includes the benefits you need and is affordable. The best way to find out how to get health insurance is to read articles like this and gather as much information as possible.
Average Cost of Health Insurance in Wisconsin
Wisconsin is ranked 14th out of 50 states for health care access, affordability and quality. This means you’ll have good options to choose from when you’re searching for the right health plan.
The average Wisconsin resident spends $8,700 per year on health costs, just a few hundred dollars less than the national average.
There are several different ways you can get health insurance in Wisconsin:
- From your employer
- From your spouse’s employer
- Through COBRA (an extension of your insurance plan after you leave a job)
Individual or Family plans:
- Healthcare.gov (insurance marketplace)
- A health insurance company (private)
- Medicaid – For low-income individuals or families
- Medicare – For those 65 and older or disabled and eligible for Social Security Disability benefits
Health Coverage if You’re Under 65 and Not Disabled
There are 2 primary health coverage options if you’re under the age of 65 and not eligible for Social Security Administration disability benefits:
Health Maintenance Organization (HMO) Plans
HMOs are comprised of a network of regional doctors, hospitals and specialists that you must use — if you choose a provider outside the network, you’ll pay full price. Also, you’ll need to choose a primary care doctor who will give you a referral to see a specialist.
HMO plans focus on health and wellness and support preventive care. To help you stay on track, HMO plans offer fitness and weight loss programs, blood pressure medication and smoking cessation programs. HMO plans typically cost less than PPO plans but are more limiting in where you can go for care.
Preferred Provider Organization (PPO) Plans
PPO plans are made up of a large network (usually much larger than HMO plans) of hospitals, specialists and doctors you can choose for care. You don’t have to choose a primary care doctor but you’re encouraged to do so. You’ll pay less if you choose providers within the PPO network because those providers and hospitals agree to charge preset amounts for services and care.
Referrals aren’t required with PPO plans and you can switch doctors anytime. You’ll pay less for prescription drugs if you choose a pharmacy within the PPO plan’s preferred pharmacy provider list. PPO plans give you more freedom and they’re typically priced higher.
Health Coverage if You’re 65 and Older or Disabled
If you’re about to turn 65 (3 months before and 3 months after), you can sign up for Medicare, a federally-funded health insurance plan. You can also enroll in Medicare if you’re under 65 and disabled.
Medicare is comprised of 4 parts:
- Part A: Covers inpatient hospital care, skilled nursing care, and some home care.
- Part B: Covers outpatient care, doctor and specialist visits, and medical equipment and supplies.
Part A and Part B combined are known as Original Medicare.
- Part C: Also called Medicare Advantage plans, Part C plans cover everything Part A and Part B covers, but include extras such as vision and hearing coverage, fitness programs and wellness incentive plans. Medicare Advantage plans are offered by private insurance companies.
- Part D: Covers prescription drugs and is also offered by private insurers. Part D plans can be bought as standalone plans in addition to Original Medicare plans or as part of a Medicare Advantage plan.
You can also buy a Medicare Supplement plan to fill in the gaps not covered by Original Medicare. These plans, also called Medigap plans, are offered by private insurers. You can search for a Medicare Advantage or Supplement plan by using the government’s plan finder tool at Medicare.gov.
What Does Health Insurance Cover?
Health insurance usually covers basic hospital care, emergency room visits, outpatient care, doctor and specialist visits, some physical and occupational therapy and medical supplies. Depending on the plan, it may also cover:
- Vision care and eyewear supplies
- Hearing care and hearing aid supplies
- Dental care
- Fitness programs
- Smoking cessation programs
- Wellness and incentive plans
What Does Health Insurance Not Cover?
Although some plans cover vision, hearing and dental care, they usually charge additional fees for these. Some plans include prescription drug coverage if you use non-specialized drugs. Most private insurance plans have an established list of typical drugs and preferred pharmacies. If you need drugs that aren’t on the list, you’ll pay considerably more.
Health insurance plans vary so you need to read the fine print regarding what’s covered. Every plan included deductibles, copays and out-of-pocket costs you must pay. Your plan may cover emergency room visits after you pay a $50 deductible, for example. Check your plan’s Evidence of Coverage, which explains the details of what is and isn’t covered.
Best Health Insurance Providers in Wisconsin
We’ve gathered information from sources such as J.D. Power and the National Committee for Quality Assurance (NCQA) to compile a list of our top 5 picks for health insurance plans in Wisconsin. All of these private insurance companies offer both HMO and PPO plans.
1. Dean Health Plan
Dean Health Plan received high ratings in the J.D. Power 2019 Commercial Member Health Plan Satisfaction Study as well as NCQA’s 2018–2019 Health Insurance Plan Ratings Report. Its Medicare Advantage plans were also high in national rankings of Best Medicare Advantage Insurance plans.
Overall, its plans rated high in these areas:
- Overall satisfaction
- Provider choice
- Billing and payment
- Customer service
- Coverage and benefits
- Prevention and treatment
Dean Health Plan serves Wisconsin residents exclusively and offers affordable individual, group (employer-sponsored) and family plans. Its network consists of more than 2,500 providers, 28 hospitals and 180 primary care sites. It also has a 24-hour nurse hotline and a healthy rewards program. For a family of 2 earning $75,000 per year, a silver plan costs $1,209 per month.
2. Anthem BlueCross BlueShield of Wisconsin
Anthem BlueCross BlueShield of Wisconsin offers a wide range of low-cost individual, group and family plans, including Medicare Advantage plans. Some plans feature $0 monthly premiums, with $0 doctor visit copays and $0 annual deductibles.
Its site makes it easy to find a plan, locate your doctor, and learn about benefits and coverage. You can sign up online or speak to a customer service representative on the phone. Anthem was the #2 choice in J.D. Power’s study and top-rated by the NCQA.
HealthPartners gets high marks with a large network of board-certified doctors and 300+ convenient locations. It offers 24/7 online care, over 50 specialties and many wellness incentives.
HealthPartners’ basic HMO plan features a $33 monthly premium, $100 emergency room copay and fitness programs. It also offers highly ranked Medicare Advantage plans and Medicaid plans for low-income applicants.
4. United Healthcare
United Healthcare offers family, group, individual, short term disability and Medicare Advantage plans. They also offer fitness and wellness programs, dental and vision coverage and online visits.
United Healthcare’s vision plan was ranked first in J.D. Power’s 2018 Vision Plan Satisfaction Report.
Some of its basic plans feature a $33 monthly premium, while dental and vision coverage costs an extra $28 per month.
5. Medica Healthcare of Wisconsin
Medica Healthcare Plans also ranked highly in J.D. Power’s study. Medica received high marks for customer satisfaction in NCQA’s report and insures 1.4 million members across 8 states, including Wisconsin.
Medica offers individual and family plans, group plans and Medicare Advantage plans, and features a large network of more than 33,000 providers. It also offers dental coverage and pet insurance plans.
You're free to see any provider, but you’ll receive the highest level of benefits and the lowest out-of-pocket costs when you see providers in its network.
Research Plans and Explore Your Options
There are lots of great resources like the ones we unearthed to help you find the best health insurance plan in Wisconsin. Since many of Wisconsin’s plans are highly rated, you’re bound to find a plan that fits your health care and budget needs.
Make a list of plan features you want such as prescription drugs, vision and dental coverage, and talk to family members and friends about their plans, too. By researching options thoroughly you’ll be sure to find the most affordable health insurance plan for you and your family.