Individual

Individual health insurance in Wisconsin 2019: The Ultimate Guide

by Amy

Updated 11.09.18. We will continue to update this page with the latest plan information. Stay tuned! 

Breathe easy, Wisconsin. Compared to last year's premium jumps of 44%, the 216,000 consumers buying individual health insurance in Wisconsin this year will enjoy lower rates. Governor Scott Walker credits this change in part to his new Health Care Stability Plan that will lower rates by about 4.2 percent or on average $990 for individual premiums for the year. 

It's also estimated that without The Health Care Stability plan, residents would face 6.8% premium increases on average.

While this legislation is still relatively new, it falls in line with similar efforts in Minnesota and Iowa to help stabilize the market and attract more carriers. 

Here's what to know about shopping for individual health insurance in Wisconsin for 2019. 

What’s different this year

  • Availability of short term plans that can last a year. These short term, limited duration plans (STLDs) come with more restrictions, such as limits on preexisting conditions, and offer less coverage (i.e., good bye well-visits and maternity coverage), but their lower price point can be attractive to those that are relatively healthy and looking for more affordability.

  • Association health plans: While recent legislation has opened the doors for association health plans, where small businesses and individuals can come together to buy group plans, we don’t expect this to have much of an impact this year since people are still trying to figure it out. It looks like the Wisconsin Bankers are one of the first groups to give this a shot. We will be keeping our eyes on this!

  • Premiums have stabilized. Premiums are predicted to drop 4.2% on average for individual health insurance in Wisconsin. In contrast to the startling jumps in premium pricing the past few years, Modern Healthcare reports that 16 states will see premium declines, two will see no change, and the rest see marginal, single digit increases. On average, CMS reports that rates are dropping 1.5 percent on average across the country. 

  • Individual mandate disappearing. Beginning in 2019, the Individual Mandate which fines Americans who skip out on health coverage will no longer be in effect. While some think this measure could send premium prices up as the markets adjust for an exodus of healthy young people, it might have less effect than people think. You see, healthy young peeps weren’t buying plans the way families and older folks so and the markets are priced for that. Even with the individual mandate in place, healthy young people could decide to pay $200 a month for health insurance they didn’t think they needed or a $200 fee once a year.

  • QSEHRAs are becoming more popular. For small companies and startups that can’t afford traditional group plans, QSEHRAs (aka Qualified Small Employer Health Reimbursement Arrangements) offer a new way to reimburse for premiums and medical expenses tax-free. Plus, in addition to being reimbursed for plans and alleviating the financial burden of individuals buying their own health insurance, employees can choose their own plan that works best for them instead of fitting into a one-size-fits-all group plan! If you or your employer wants to learn more about this, we have a first-of-its-kind QSEHRA guide that explains everything you need to know! 

What’s the same

Despite a lot of talk in Washington, the Affordable Care Act (also known as Obamacare) is still intact.

  • Doctor networks continue to stay small: An ongoing trend since the start of Obamacare, many plans will cover an increasingly smaller percentage of doctors in a given area. That leaves the consumer with fewer choices and a greater chance of having to go out of network to get the care they need. This is a strategy used by carriers to keep costs down, but it leaves consumers financially vulnerable for shouldering those scary and sky-high out-of-network costs. Even if your doctor is on your plan this year, it’s worth double checking for this coming year, since things might have changed. Our doctor search tool on our website is a simple way to do that!
  • Shortened enrollment period: Just like last year, open enrollment is only 6 weeks—Nov 1 to Dec 15.
  • Slashed funding: Funding for the marketplace has been further reduced, which means there will be less advertising and awareness campaigns helping people make smart choices. Federal 'navigator' grants to states that are meant to help educate and enroll people in health insurance were slashed by more than half this year. Arizona's allotment of money went down by 74 percent — from $1.17 million last year to this year's $300,000.
  • Subsidies: Federal subsidies are expected to be available to those who qualify.
  • Outages: Just like last year, there are 60 hours of scheduled downtime for scheduled maintenance that could get in the way of individuals researching and signing up for plans. Take note that from 12 a.m. to 12 p.m. every Sunday, except for the last Sunday of open enrollment, you can’t access healthcare.gov. 

Who’s in, who’s out for individual health insurance in Wisconsin 2019

Here's the full lineup for individual health insurance options in Wisconsin this year, including on-exchange plans (aka the plans you can access through the Affordable Care Act's Marketplace, and off-exchange plans that aren't available on the Exchange and are purchased directly from the carrier or a broker. Remember: If you are eligible for a tax credit, purchasing an on-exchange plan is the only way to utilize it.

Use our website to estimate your tax credit, search for your doctors, and compare on and off-exchange options in your zip code. If using a tax credit, we will automatically route your applications to healthcare.gov.

You'll notice that there's not much representation from the big brand carriers but there's an abundance of smaller, regional carriers that are filling in the gaps.

These options vary depending on where you live in the state. Just type in your zip code to see what's available.

On Exchange options for Individual Health Insurance in Wisconsin for 2019

You'll find plans from these carriers on the ACA marketplace and if you qualify for a tax credit, you can utilize it with one of these exchange plans. 

  • Aspirus Arise Health Plan of Wisconsin 
    • HMO Plans
    • HDHP Plans
    • PPO Plans
  • Common Ground Healthcare Cooperative 
    • Bronze & Catastrophic: low premiums with high deductibles
    • Silver: multiple options for moderate premiums with not as high deductibles
    • Gold: higher premiums with low deductibles
  • Dean Health Plan
    • 3 Copay Plus and Classic Plans
    • 3 Value Copay Plans
    • 3 HSA Eligible and Safety Net Plans
  • Group Health Cooperative
    • Platinum: highest monthly premium with lowest out of pocket
    • Gold: high monthly premium with lower out of pocket
    • Silver: moderate premiums with moderate out of pocket
    • Bronze: low monthly premiums with higher out of pocket
    • Catastrophic: lowest monthly premiums with highest out of pocket
    • HealthPartners
      • Atlas Gold
      • Atlas Silver
      • Atlas Bronze
      • Atlas Catastrophic
      • Atlas HSA

  • Medica 
      • Bronze, Silver, and Gold Copay plans
      • Bronze Plus and Bronze HSA plans
      • Catastrophic Plans
  • MercyCare Health Plans
    • Multiple Gold, Silver, and Bronze plans
  • Network Health Plan
    • Multiple Gold, Silver, and Bronze plans
  • SECURITY Health Plan
    • Select Gold, Silver, Bronze, HDHP, and Catastrophic Plans
  • Together with Children's Community Health Plan 
    • Multiple Gold, Silver, Bronze, and Catastrophic Plans. 
  • Unity Health Insurance 
    • Gold: Unity will pay for 80% of coverage for medical costs
    • Silver: Unity will pay for 70% of coverage for medical costs
    • Bronze: Unity will pay for 60% of coverage for medical costs
    • Catastrophic: variable coverage

Off-Exchange options for Individual Health Insurance in Wisconsin for 2019

These options are available directly from carriers or brokers and do not qualify with a tax credit. 

  • Anthem
  • Aspirus Arise Health Plan 
  • Common Ground Healthcare Cooperative
  • Group Health Cooperative
  • HealthPartners
  • Physicans Plus Insurance
  • Security Health Plan
  • Together with Children's Community Health Plan
  • UnitedHealthcare
  • Wisconsin Physicians Svc Insurance Group 

Affordable Alternatives You Should Know About

An increasing number of our customers are opting for alternatives to traditional insurance. Here’s a couple of our top picks. They might not be for everyone, but they are worth checking out and comparing to major medical plans on our platform.

Pivot short term plans: Pivot provides short term medical insurance solutions until a qualified major medical health plan is chosen, helping reduce your financial risk. Pivot plans are renewable 90 day plans which in most states can be automatically renewed 4 times without additional medical screening to provide up to 12 months of continuous coverage. 

United Health One: This alternative offers a lot of flexibility to those looking for a short term solution. First consumers choose the term length - from 30 day minimum up to the state maximum. Then they choose a deductible and coinsurance amount that fits the budget. Note that it's only available in a handful of states - thankfully Wisconsin is one of them! 

Enrollees have access to United Health Care’s large network of doctors and hospitals. With United Health One plans you must use a network doctor or hospitalin order for insurance to pay for eligible expenses, only emergencies are allowed out of network.

Faith-based: Faith-based Medi-Share has a state-wide PPO network available in 2019 managed by PHCS (Private Healthcare Systems, now owned by Multiplan). It’s smaller than some of the PPO networks in the past, but it does provide flexibility to see your doctors and will cover out-of-network expenses as long as it meets Medi-Share’s faith-based guidelines. Medi-Share won’t be for everyone, but is a worthy option to consider if it fits your personal convictions and lifestyle. Make sure to check out our Medi-Share review and compare it to other major medical plans on our website before you enroll. 

Next steps: What's my best option? 

While more choices are a welcome change, hunting down and comparing all of these options can feel overwhelming. However, our team at Take Command Health helps you compare all of your options side-by-side including off-exchange plans, marketplace plans, and faith-based options. You can use our award-winning tools to search for your doctors, check your prescriptions, and even simulate conditions and health needs to make sure you get the most of for your money.

A few other updates we'd like to tell you about: 

We've expanded the capabilities of our doctor search tool to search doctor networks from all of the carriers above (no matter if the plan is off-exchange, on the marketplace, or faith-based). 

We've negotiated some pretty awesome deals for our membersCall a doctor 24/7 for $0, enjoy medical bill negotiation support, a personal health advocate, dental, vision, and pharmacy discounts, etc. These really help save money with some of the higher deductible plans. 

We're pretty confident we have the biggest, most complete line-up of plans in Wisconsin this year. 

With growing demand, we've also put together a bigger support team ready to help you tackle any issue. You can get started by chatting with one of our licensed professionals on our website or emailing us at support@takecommandhealth.com. 

Once open enrollment begins, you can visit our website and we'll walk you through your options. Our goal is to help you get the most out of your money and find the plan that really works for you and your family. 

Remember you have until Dec 15th to select a plan that starts Jan 1st, 2019. 

For reference, here's the 2018 guide from last year.  

Picture of Amy

Hi, I'm Amy! I wrote this blog because I care about ideas (big and little) that can help fix our healthcare system. I used to work on projects for Kaiser Permanente and the Parkland Health & Hospital System so I've seen the system inside and out. It's so important that consumers keep up with industry shifts and changing health insurance regulations. I'm also Take Command Health's Content Editor and a busy mom. Learn more about me and connect with me on our about us page. Thanks!