Wisconsin is populated by many farms and forests, producing the most milk of any state, therefore earning the title of “the dairy capital of the US.” In addition to farms, large cities such as Green Bay, Madison, and Milwaukee bring industry, politics, and higher education to the landscape. A densely forested state, Wisconsin is home to many state parks and smaller parks that bring mountain bikers, hikers, and outdoor lovers together year-round.
Trusted health insurance companies present in Wisconsin include Anthem Blue Cross Blue Shield of Wisconsin, Celtic, Humana, and UnitedHealthcare. To compare plans from each of these companies and view rates specific to your demographic, enter your zip code below to start a quote. If you need additional assistance sorting through plans or have any questions, call one of our agents at 888 803 5917.
Wisconsin is increasing in health as time progresses in many areas. A definite positive for Wisconsin residents is that they have a low population of uninsured individuals at a little over 9 percent. There is also a low occurrence of diabetes among Wisconsin residents compared to the rest of the country, though 309,000 adults still have the illness. Wisconsin also has a very low incidence of infectious disease.
Some of the down sides of Wisconsin health include the highest percentage of adult binge drinkers in the country, as well as the least amount of public heath funding in the US. Most other statistics fall somewhere in the middle compared to the rest of the US, which indicates stability and room for improvement. Wisconsin residents should utilize their health insurance policies and stay active and healthy in order to keep getting healthier. Otherwise, they have already been making great steps forward to being a healthy population.
Health Insurance Plans
Anthem Blue Cross Blue Shield of Wisconsin
- Premier Plus are point-of-service plans, which offer the most covered services of any Anthem plan. Members receive preventive care as an instant benefit for no cost with in-network providers. These plans feature unlimited primary care office visits for a copayment of $30 as soon as your plan starts, and several options for pharmacy benefits. After meeting the deductible, which ranges from $500 to $10,000, your plan will cover 80 percent or the entirety of your in-network major medical costs.
- SmartSense Plus plans provide an option for individuals who want the essentials of health care services, yet want to save as much as possible. These plans have deductible options from $500 to $10,000, with in-network coinsurance of either 50 or 30 percent after deductible. First-dollar benefits include preventive care for no charge and the first three doctor’s office visits are a $35 copay for illness or injury. Other covered services include prescription drugs, inpatient and outpatient hospital care.
- Lumenos HSA plans are high deductible POS plans,which can be paired with a health savings account. These plans cover all types of physician and hospital services at either 50, 80, or 100 percent after you meet the deductible. Deductible options range between $1,500 and $5,500 for individuals, and the higher your deductible the less your coinsurance will be. Out-of-network care is also available for a lesser amount of coverage. If you choose to start an HSA to fund your medical costs, you can receive tax advantages and gain control over your health care spending.
- CoreShare plans have greater cost sharing and a broad range of deductibles, from $750 to $25,000 for individuals. After you meet the deductible, your plan covers all qualified services in full or at 50 percent. CoreShare plans offer preventive care with in-network providers for no charge as soon as your plan starts. Non-network care is offered for either 70 or 30 percent coinsurance after deductible if you prefer a doctor outside of the Anthem provider network. Prescription drugs are covered for a copayment or coinsurance, depending which is greater.
- Celtic Basic plans provide the necessary, bare bones benefits for a reasonable monthly premium, with the option of either 70 or 80 percent coverage after deductible. Deductibles range from $2500 to $7500 for individuals, with a separate deductible for out-of-network care. Though a limited plan, it does include benefits before meeting the deductible. First-dollar benefits include preventive care for no cost, as well as two visits to a primary care physician or specialist for a $30 copay and generic prescriptions for $15. These plans offer hospital stays, outpatient surgery, emergency care and lab work for an additional deductible per occurrence and coinsurance after deductible.
- CeltiCare Preferred plans provide comprehensive PPO coverage of either 80 or 100 percent after deductible, and immediate benefits for a low copay. Deductibles range from $1,000 to $10,000 for individuals, and twice the cost for families. With a copayment of $15 for your first two primary care or specialist office visits, these plans cover most services after deductible. Preventive care is offered at no charge with in-network providers, and generic prescription drugs are covered for a $10 copay as soon as your plan begins. After a separate pharmacy deductible, brand name prescriptions are available for a copay as well.
- CelticSaver HSA plans are high deductible plans, with the ability to open a health savings account to grow or pay for medical care with tax-advantaged funds. Preventive care is offered before you meet the deductible, and all other services are covered at 80 percent with $2,600 plans, or in full with $5,000 plans after deductible. Premiums tend to be very low due to the high deductible. Pharmacy benefits are included with the rest of your physician and hospital care, covered at your selected percentage. By adding an HSA to your plan, you can receive tax deductions on your annual income taxes, and withdraw funds for health care tax-free.
- Copay plans from HumanaOne in Wisconsin are available in three types based on coverage level and number of benefits desired. All copay plans cover some number of office visits and prescriptions. Enhanced Copay 80 plans are their top-of-the-line PPO option with deductibles ranging from $1000 to $5000, and requiring 20 percent coinsurance on a myriad of services after deductible. Enhanced plans offer unlimited doctor’s office visits with a specialist or primary care physician. Copay 80 plans offer up to six office visits, while Copay 70 covers the first three. Each plan is a great option for those who want to save money as soon as you begin your insurance.
- Value 100 plans have three deductibles to choose from and low monthly premiums. Though the services they cover are limited, members still have access to the essentials of physician and hospital care after you meet the deductible. Covered services will cost nothing after deductible, and there are no copays associated with this plan. Preventive care is the only immediate benefit for no cost, which applies to in-network providers.
- HSA plans cover 100 percent of covered medical costs after you meet the deductible, including office visits and hospital care. Whether you choose an Enhanced HSA 100 or a traditional HSA 100 plan, both provide members the ability of adding a health savings account. Enhanced plans cover prescriptions, while the regular HSA does not, though discount cards are available to substitute for lack of coverage if needed. These are ideal plans for those who want to manage and closely monitor their medical spending.
- Copay plans come in deductible options from $1,000 to $10,000 for individuals, with several great services offered before your annual amount is met. The Copay Select plan gives members more covered services than the Value plan, including all tiers of prescription drugs, and the option of either 30, 20, or 0 percent coinsurance. Value plans cover 70 percent of care after deductible, and are more limited due to the lowered rate. Both plans offer your first four primary care and specialist office visits for a $35 copay, in addition to preventive care at no cost with in-network providers.
- High Deductible plans come in three types including Plan 100, Plan 80 and Saver 80. Plan 100 offers coverage in full after deductible when using in network doctors for all types of medical care. Plan 80 also gives members access to a wide selection of benefits, including inpatient and outpatient hospital care, prescription drugs, emergency and urgent care for 20% coinsurance. Saver 80 plans have a limited coverage range, but provide basic major medical care for a low monthly rate and a wide range of deductibles. Each of these plans covers preventive services at 100% with in-network providers.
- Health Savings Account plans give members the option to open a health savings account (HSA) to pay for medical care or build savings, and have several deductibles to choose from. These plans are available with either 70 or 100 percent coverage after deductible on a wide array of medical services, including doctor’s office visits, outpatient surgery, inpatient stays, and prescriptions. Individual deductibles range from $2,500 to $5,000 for individuals for HSA 100 plans, and $1,250 to $5,000 for HSA 70 plans. With the ability to set aside funds specifically for health care costs, HSAs provide greater flexibility and control over medical expenses that results in tax rewards.
Public Health Options
Though the state of Wisconsin was ranked very low on its public health funding, there are programs in place for individuals without insurance to use when they need medical attention. Whether you are a low-income family or about to start a family, the Wisconsin has public plans to assist needy residents. Most common is Medicaid, or ForwardHealth in Wisconsin, which offers insurance coverage to various types of individuals. Click here for more information regarding who qualifies for ForwardHealth. Other services are also available through the state. For a full list of programs and services, visit the Wisconsin Department of Health Services.
- ForwardHealth: medical insurance for residents of Wisconsin with a low income and meet other criteria such as disabilities or age.
- Health Clinics: free or low cost facilities where uninsured or underinsured persons can receive medical care.
- Health Insurance Risk Sharing Plan (HIRSP): a high-risk pool for Wisconsin residents with medical conditions preventing them from having health insurance.
- BadgerCare Plus: the Children’s Health Insurance Program (CHIP) offered in Wisconsin to children and families through ForwardHealth.
Health Insurance Laws
Wisconsin, like every other state, has protections in place to establish a health insurance company’s guidelines for acceptance. There are also legal guidelines to help the insured individual as well. Pre-existing conditions are a large determining factor of whether an individual health plan is sold or not. The definition of such a condition in Wisconsin is any instance that could have received medical care or was treated in any length of time prior to applying for a health plan. Given the broad definition, this gives insurers the power to turn down many individuals for a plan, or make price adjustments as they see fit.
Health insurers in Wisconsin have the right to issue a waiting period of two years before they will cover any care related to a person’s pre-exsiting condition. They may also attach an elimination rider to the plan to identify that they will never pay for any care of that condition as long as they use that company. Due to these widespread liberties, the Affordable Care Act has been working to abolish laws prohibiting any type of person from getting a health insurance plan. Though these laws will be in place until January 2014, they will no longer be allowed after that point.
The ACA set up a temporary high-risk pool in addition to the state’s existing one in order to accommodate individuals who have been rejected for coverage due to their health. Those who are eligible can use the Pre-Existing Condition Insurance Plan as though it were individual coverage for a healthy person. These plans offer affordable rates without excluding certain types of care or imposing waiting periods to receive them.
In the future of the Wisconsin health insurance market, there will be a state health insurance exchange established to compete with private insurers. By law, the plans administered by these exchanges must offer a specific number of benefits, which will therefore cause the existing carriers to adjust their set of covered services. When the ACA takes effect, exclusion periods and elimination riders will not be permitted, and there will be no premium increases or denial of coverage based on health status or medical history.