Wisconsin

What to know: Shopping for individual health insurance in Wisconsin

by Larissa

Looking for individual health insurance in Wisconsin for 2019? Head on over to our 2019 Guide.

It’s human nature to put off the hardest, most complicated task on your to-do list. So, don’t feel bad if that’s what you tend to do when it comes to shopping for health insurance. The problem is, finding good health insurance is so important! That's why Take Command Health is here to help you, free of charge. 

With rates in Wisconsin going up 36% on average for next year, it's more important than ever to make a smart choice. With the market instability driving up prices, it's rumored that Wisconsin will consider seeking a waiver in 2019 to let the state set up its own system under the federal health care law (like Minnesota has done and Iowa is pursuing).

The good news is that the state of Wisconsin has more carrier options that most states. Nearly every county in Wisconsin has two or more insurers offering on-exchange plans next year, and there are three or more insurers offering coverage in the southern part of the state. 

Read on for more information regarding individual health insurance in Wisconsin and then contact us and let us know how we can get you started!

Things to keep in mind while shopping for health insurance

  1. Open Enrollment is NOW! Open enrollment is shortened by 6 weeks this year−it began November 1st and will close December 15th unless you have a qualifying life event. 
  2. Look at ALL of your options. There are several ways to purchase health insurance. When you shop at Healthcare.gov, you’re only seeing “on-exchange” plans. However, insurance companies only make a fraction of their plans available “on exchange." If you go directly to an insurance company’s website, you’ll see their “off-exchange”plans. There are also private exchanges, co-ops, and even faith-based “medical sharing” plans that function similar to insurance. At Take Command Health, we can help you quickly see ALL of your options. 
  3. Find out if you are eligible for tax credits and cost-sharing reductions. You are only eligible if you enroll in a marketplace policy and it is worth taking some time to find out if you qualify. Keep in mind that if you meet the requirements, you only get this tax credit if you enroll in the cheapest silver plan the insurer offers. However, it may be worth it, depending on your insurance needs. (Take Command Health can help you when it comes to making this decision- remember that you’re not alone in this!) This could help you lower your deductible, copay, and out-of-pocket maximum.
  4. Consider separate plans. Shopping for insurance for you and your spouse/domestic partner? Get both individual and family quotes to find out which one is more beneficial. You might be surprised that you sometimes can save with separate plans. This varies plan to plan, but we’ll be able to help you figure out if this is applicable for your situation.
  5. Know the lingo. Brush up on all the terms so you don't get overwhelmed when signing up for a new plan.
  6. Don't put health insurance on auto-pilot. If you are currently enrolled in a marketplace health insurance plan, it will automatically renew. However, the plan may make changes to its provider network, copays, co-insurance and drug coverage. Your plan should have (or will very soon) send you a notice of any changes it will make for 2018. If you haven’t heard from them, it’s important to reach out to see what your plan will be like next year!
  7. Stay in-network. Make certain your doctors and preferred hospital are still in your network. Be aware, you may be able to use out-of-network doctors and hospitals, if you're willing to pay more. In some cases, you might not be covered at all if you go out of network. Your prescription drug coverage also could change. The plan may no longer cover the drugs you take. Let’s make sure and check your plan's drug benefits for 2018 before you allow it to renew.

Who's out 

A handful of carriers are ending coverage in the state for next year, leaving 11 insurers in Wisconsin. Anthem Blue Cross, the clear market leader this past year, is withdrawing. Molina, previously covering 30 counties concentrating around Milwaukee and the eastern part of the state, is also leaving. Mayo Clinic's HMO, Health Tradition Health Plan, will also be exiting at the end of this year. That means that about 75,000 people on those plans will need to select other insurance. And if you are one of those, our team is here to help

Who's in

With fewer options and higher rates, this may sound like a bleak situation. But take note that rate increases are calculated before premium subsidies are applied. The ACA’s premium subsidies grow to keep pace with premiums (they’re based on keeping the second-lowest-cost silver plan in each area at an affordable level.) The idea is that the larger subsidies will offset all or most of the premium increases for subsidy-eligible enrollees, so long as they’re willing to switch plans if necessary in order to get the best value.

Also keep in mind that subsidies are only applied to on-exchange plans; off-exchange plans will see the full rate increase for next year.

Another interesting trend in the state is that as many of these name brand carries are leaving, smaller, regional carriers 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.

       common-ground-logo       

Common Ground, a non-profit carrier that covers 19 counties, will be offering one of the only PPO network plans in Eastern Wisconsin (including Milwaukee). While rates have increased on average 63.03%, it's still a competitive option if you are set on a PPO. 

unity-logo      

Unity has solid coverage in Southeastern Wisconsin (excluding Milwaukee) and is offering HMO plans in 2018 like last year. Rates did increase around 34.9% compared to last year, but are likely to be on-par with other options in the area.

network-health-logo

Network Health is very targeted to the Milwaukee area. They're offering six HMO plans and will remain competitive on prices. Rates are going up 54.73%.

There are other regional players throughout the state, depending on your specific area. We're pleased to offer the full lineup of choices in the Milwaukee area, and have strong coverage throughout much of eastern and central Wisconsin as well. If you feel as though you aren't seeing the choices you'd expect in your area, feel free to let us know and we'll do some extra digging for you!

Other regional options include:

Aspirus Arise: rates increasing 33.26% 

Children’s Community Health Plan: rates increasing 23.18%

Dean Health Plan: rates increasing 49.68% 

Group Health Cooperative of South Central Wisconsin: rates increasing 13.8-32.3%

HealthPartners Insurance: rates increasing 20.58%

Medica Health Plans of Wisconsin: rates increasing 30.23% 

MercyCare HMO Inc: rates increasing 35.1% 

Security Health Plan of Wisconsin, Inc: rates increasing 29.72% 

 

Faith-based alternative

medi-share-logo

Faith-based Medi-Share has a state-wide PPO network available in 2018 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?

Hunting down and comparing all of these options can feel overwhelming. However, at TakeCommandHealth.com we help 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 plans above (no matter if the plan is off-exchange, on the marketplace, or faith-based).
  • We've negotiated some pretty awesome deals for our members. Call a doctor 24/7 for $0, medical bill negotiation support, dental, vision, and pharmacy discounts, etc. These really help save money with some of the higher deductible plans.
  • We've put together a bigger support team ready to help you tackle any issue. You can get started by chatting with us on our website or emailing us at support@takecommandhealth.com.

Remember you have until Dec 15th to select a plan that starts Jan 1st, 2018. 

Ready to get started? 

Let's do this! 

Picture of Larissa

Hi, I'm Larissa! I wrote this blog because I love helping people understand healthcare. After graduating with a degree in Public Relations, I decided to start my journey in healthcare management and stayed in the industry for 9 years. Currently, I'm pursuing my masters in counseling while still keeping my hand in the healthcare field with Take Command Health. Most importantly, I'm a single mom to a three-year-old whose goal is to experience all of the emotions every hour of every day. Learn more about me and connect with me on our about us page. Thanks!