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When shopping for health insurance in Wisconsin there are a few options to consider. Are you interested in individual health insurance or family insurance? Depending on your health status, are you eligible for coverage on the individual market? Or do you have a preexisting condition that prevents you from obtaining an individual health insurance policy? What if you own your own business? No matter what your situation is HealthPlanOne can help you compare plans and choose from options that are right for your needs and your budget. If you have a preexisting condition, a disability, or earn a low income, you may qualify for a free or low cost health care program offered by the government. You also may be eligible for Wisconsin Medicaid, BadgerCare, the Well Woman Program, or the Wisconsin Health Insurance Risk Sharing Plan. Eligibility requirements for each of these options are available on this page.
What Every Wisconsin Resident Should Know About Health Insurance
The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not subject to medical underwriting, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you.
Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits. If this is the case with your new job, consider getting a short-term policy from the point where your previous coverage ends to the time when your new company's insurance kicks in. Such options are available through HealthPlanOne. Simply visit our Short-Term information page for your free quotes.
It is important not to have a lapse in coverage of more than 63 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important.
What If I'm Between Jobs?
As previously mentioned, it is important not to have a break in coverage of more than 63 days. As a result, if you've recently lost your job look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs to invest in an individual/family insurance policy through HealthPlanOne.
With individual coverage, you choose the health insurance carrier and benefits you want with the help of HealthPlanOne. We will quote plans for you and your family from all the different carriers available in Wisconsin so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. Even if you are not between jobs, a plan on the individual market through HealthPlanOne could still be the best option for your family. Many companies do not offer benefits to their employees, and often those companies that do offer benefits do so at an exorbitant cost for low quality plans. It is important to note that with individual coverage in Wisconsin each person who applies is medically underwritten and may be approved, denied, or rated-up by the carrier depending on their health history in recent months.
If you're healthy and are between jobs, are unhappy with the health insurance offered by your employer, or are not offered benefits by your company, enter your zip code into the HealthPlanOne quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat or toll-free at (877) 567-5267 to answer any questions.
If you're not healthy there are still many programs available to you. See below for details on the options which best fit your medical and financial situation.
Small Group Plans
If you are self-employed you can apply for a small group plan. You must have 2 or more eligible employees who each work at least 30 hours per week. Small group plans are medically underwritten by all carriers in Wisconsin. This means that though no one in the group can be denied coverage, the carrier can increase the rates based on the health history of employees enrolling. HealthPlanOne can help you by quoting plans for small groups. Simply call us toll-free (877) 567-5267.
Visit our Wisconsin Small Business Group page for more information.
Medicaid in Wisconsin - ForwardHealth
Medicaid is a government program designed to help the poor obtain health care services. Pregnant women and children under age 19 who meet certain income requirements may be eligible for Medicaid coverage along with aged, blind, and disabled individuals in Wisconsin. Wisconsin's Medicaid Program, or ForwardHealth, provides medical coverage for needy Wisconsin residents who qualify.
Wisconsin's ForwardHealth Medicaid Plans for Elderly, Blind or Disabled are for those who are aged 65 or older, blind or disabled; have a family income at or below the monthly program limit; and who are United States citizens or legal immigrants.
BadgerCare Plus is a program under Wisconsin's Medicaid program that caters to eligible Pregnant women, children and families, adults with no dependent children, and family planning individuals.
BadgerCare Plus for pregnant women includes benefits such as prenatal care, doctor and clinic visits, dental care, prescription drugs, as well as labor and delivery. Pregnant women pay no premiums or copayments but must have an income level of 200-300% the Federal Poverty Level.
All children under the age of 19 can enroll in BadgerCare Plus regardless of income level. BadgerCare Plus covers parents and caretakers at higher income levels (up to 200% of the FPL), young adults who are leaving foster care when they turn 18, parents with incomes up to 200% of FPL who have kids in foster care, and more farm families and self employed families. The BadgerCare Plus plan also provides access to basic health care to long term uninsured adults with an income at or below 200% of the FPL.
BadgerCare Plus provides certain family planning services to women between the ages of 15 and 44. Services include contraceptive services and supplies, natural family planning supplies, pap tests, STD tests and treatments, routine preventive services and family planning pharmacy visits.
The Medicaid program works like any other insurance coverage in many ways. Medicaid pays health insurance providers for covered services after all other medical insurances, including Medicare, have been paid. A Medical Eligibility Card is issued to eligible individuals and allows you to receive medical services from a provider if:
- You are Medicaid eligible on the date the service is received, and
- the services is offered by the Medicaid Program, and
- the provider accepts Medicaid, and
- the provider agrees to bill Medicaid for the service
To learn more about Wisconsin's Medicaid program, please visit http://dhs.wisconsin.gov/MEDICAID/
Click here for information on Wisconsin Medicare plans
Wisconsin Well Woman Program
The Wisconsin Well Woman Program, or WWWP, is a program that provides preventive health screening services to women with little or no health insurance coverage.
Well Woman offers services such as mammograms, pap tests, health screenings, and multiple sclerosis testing. There is no premium or copayments for services and no deductible for the Well Woman Program.
Eligibility criteria include:
- You much be a woman between the ages of 45 and 64
- Your income must be within the program's guideline limits
- You must not have health insurance or have limited health insurance that does not cover routine checkups and screenings.
Income guideline limits are as follows: A family size of 1 cannot exceed an annual gross income of $27,075. A family income must be at or below 250% of the federal Poverty Level.
To learn more about the Wisconsin Well Woman Program, please visit http://dhs.wisconsin.gov/womenshealth/wwwp/ or call 1.608.266.8311.
Wisconsin High Risk Pool
Wisconsin's Health Insurance Risk-Sharing Plan (HIRSP) provides health insurance coverage to residents of Wisconsin who are denied health insurance due to preexisting conditions or who have lost their employer-sponsored group health insurance coverage.
Eligibility criteria for HIRSP include:
- You are a resident of Wisconsin
- You have lost group coverage or exhausted COBRA
- You are not eligible for Medicaid or BadgerCare Plus
- You have been denied coverage because of a preexisting condition
- Are under the age of 65, on Medicare Disability, and are not eligible for group coverage
There are five plan options under HIRSP: HIRSP 1,000; HIRSP 2,500; HIRSP 5,000; HIRSP Medicare Supplement; and HIRSP Health Savings Account.
Covered services under HIRSP plans include medical services, anesthesia services, consultations, prescriptions, home care, radiology services, lab and x-rays, as well as pap tests and pelvic exams. Other services include prostate cancer screening, skilled nursing care, hospice care, and diabetes services and treatment. Preventive services such as routine exams, yearly physicals, and routine dental care are not covered as well as cosmetic treatments, infertility services and drugs, and hearing and vision care.
Premiums depend on the age, gender, and plan chosen. Premiums can range from as low as $339 quarterly to as high as $3,384 quarterly.
To learn more about the Wisconsin Health Insurance Risk-Sharing plan visit http://www.hirsp.org/index.shtml