The Cheapest Wisconsin Health Insurance for Individuals and Families
In Wisconsin, the cost of health insurance on the private market varies based on the medical costs covered. The state’s health insurance marketplace has six tiers. Each tier has a varying monthly premium, deductible and out-of-pocket cost. The Silver plan falls in the middle of the tiers and features average rates and coverage with a cost of roughly $521 per month. Common Ground Healthcare Cooperative provides the cheapest health insurance in Wisconsin through its Envision EPO - Silver 6000/80 plan. The cost for this plan is $366 per year.
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If you cannot secure health insurance in Wisconsin through your employer or programs organized by the government, such as Medicare or Medicaid, you may need to consider purchasing a private plan on Wisconsin’s insurance exchange.
Selecting a plan with low monthly premiums means you will likely pay a higher deductible and higher out-of-pocket cost. As such, you will cover a greater percentage of your medical costs out of pocket.
Various factors influence the cost of health insurance in wisconsin. Some of these are your age, coverage level and amount of deductible. MoneyGeek used these factors to identify the best health insurance in Wisconsin through the state’s insurance marketplace to ensure that you find the right level of coverage to suit your needs.
The Cheapest Health Insurance in Wisconsin by Metal Tier
Wisconsin has six different health insurance tiers. The tiers are referred to using names of metals and include Catastrophic, Bronze, Expanded Bronze, Silver, Gold and Platinum. The metal tier system defines how you split medical costs with your insurance carrier.
In most cases, the lower the value of the metal, the lower the premium and the higher the out-of-pocket cost. Depending on the tier you purchase, you may end up covering a smaller or higher percentage of your medical costs.
The costs for each of the tiers in Wisconsin are as follows:
- Catastrophic: $284 per month
- Bronze: $380 per month
- Expanded Bronze: $401 per month
- Silver: $521 per month
- Gold: $549 per month
- Platinum: $661 per month
If you expect to incur higher medical expenses in the future, you may need to purchase a Platinum or Gold plan to ensure that you keep your out-of-pocket limits minimal. If your costs are likely to be low, getting a Bronze or Catastrophic plan can help you save on your premiums.
Health insurance costs in Wisconsin vary considerably across the different tiers. The deductible amounts and out-of-pocket costs also vary significantly. You can use the table below to compare the cheapest monthly premiums for the six tiers in the state.
Wisconsin residents with low income might be eligible for cost-sharing reductions on their Silver health insurance plans. As a result, they may end up paying a lower deductible and getting more coverage than is expected.
MoneyGeek obtained the costs above from all the four types of health insurance plans found in Wisconsin. These include the EPO, HMO, POS and PPO plans, with the HMO plan being the most popular.
Cheapest Health Insurance in Wisconsin by Metal Tier
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- Metal TierPlanCompanyMonthly CostOOP Max
- CatastrophicSelect Catastrophic 8550 Ded/8550 MOOPGroup Health Cooperative-SCW$208$8,550
- BronzeMercyCare HMO Bronze Option CMercyCare Health Plans$274$8,550
- Expanded BronzeDean Focus Network Bronze Copay Plus 8500XDean Health Plan$282$8,500
- SilverEnvision EPO - Silver 6000/80Common Ground Healthcare Cooperative$366$8,550
- GoldMercyCare HMO Gold Option BMercyCare Health Plans$348$7,900
The Cheapest Health Insurance in Wisconsin by Age and Metal Tier
Several factors influence how much you pay for health insurance in Wisconsin. One of these is your age. As you grow older, your premiums will increase. For instance, the cost of a Silver plan in the state is roughly $418 for a 26-year-old and about $1,107 for a 60-year-old. This is a difference of $689 and is for an EPO plan.
Health Insurance Costs in Wisconsin by Age and Metal Tier
For this study, MoneyGeek used a sample profile for a 40-year-old male. That means the costs are averages that do not represent your actual premium and may vary due to various factors. While older people pay more for some marketplaces, they may get better rates on other health insurance marketplaces that support tax premiums and other regulatory services. You’ll be able to tell the exact cost of your coverage once you apply for a plan.
Use the table below to see how prices differ across the different tiers and ages. You can also use the MoneyGeek health insurance guide for Wisconsin to determine the right tier for your needs.
Cheapest Health Insurance in Wisconsin by Age And Metal Tier
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- PlanCompanyMonthly Rate
- CatastrophicHMOGroup Health Cooperative-SCW$149
- CatastrophicEPOCommon Ground Healthcare Cooperative$175
- CatastrophicHMODean Health Plan$189
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The Cheapest Health Insurance in Wisconsin by County
The cost of health insurance in Wisconsin depends in part on your location. Wisconsin has 72 counties grouped into 16 rating areas, and health insurance rates vary for each area.
Milwaukee is the densest County in Wisconsin. The most affordable Silver plan in the county is the Envision EPO - Silver 6000/80 from Common Ground Healthcare Cooperative, at $390 per month on average.
You can use the table below to identify the most affordable health insurance in your county for the six metal tiers.
The costs for each tier above are averages for a 40-year-old male in Wisconsin purchasing health insurance coverage within the listed county.
Cheapest Health Insurance Plans in Wisconsin by County
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- Metal TierCompanyCheapest PlanMonthly Premium
- MilwaukeeCatastrophicCommon Ground Healthcare CooperativeEnvision - Catastrophic 8550/100$241
- DaneCatastrophicGroup Health Cooperative-SCWSelect Catastrophic 8550 Ded/8550 MOOP$208
- PolkCatastrophicMedicaEngage by Medica Catastrophic$227
- St. CroixCatastrophicMedicaEngage by Medica Catastrophic$227
- PierceCatastrophicMedicaEngage by Medica Catastrophic$227
The Cheapest Health Insurance in Wisconsin With High Out-of-Pocket Maxes
According to MoneyGeek, a plan is considered to have a high out-of-pocket cost if it has a MOOP of $8,250 or more. For young people, purchasing a low-cost plan with higher deductibles and out-of-pocket maxes may be a good way to save on premiums since their medical costs tend to be lower than older people. However, if they incur unexpectedly high medical costs, they will pay more out of pocket.
Select Catastrophic 8550 Ded/8550 MOOP is the cheapest health insurance plan with high out-of-pocket costs. This plan is in the Catastrophic tier and is from Group Health Cooperative-SCW. It costs $167 for a 26-year-old buyer.
Group Health Cooperative-SCW
Health insurance plans in the Catastrophic category are only available to buyers below 30 years and those who are eligible for a hardship exemption. The most affordable health insurance plan in Wisconsin is the Select Catastrophic 8550 Ded/8550 MOOP from Group Health Cooperative-SCW.
The Cheapest Health Insurance in Wisconsin With Low Out-of-Pocket Maximums
You might consider getting a health insurance plan with higher monthly costs if you normally incur large medical expenses. Doing this allows you to pay lower deductibles and out-of-pocket costs. You can also reach your out-of-pocket limits faster as you pay for doctor’s appointments and prescription drugs. Your insurer will then be required to pay for any additional medical costs that you incur.
The most affordable health insurance plan with low MOOP in Wisconsin is Reliance $750 - 10%, which is provided by Security Health Plan. The plan costs an average of $688 per month for a 40-year-old and is in the Platinum tier.
From MoneyGeek’s analysis, a plan is considered to have a low out-of-pocket max when its cost is less than $4,250. Wisconsin’s out-of-pocket max is $1,250. This price is significantly less than MoneyGeek’s rate of $4,250, meaning that buyers may pay higher monthly premiums for their health insurance.
Security Health Plan
The cheapest health insurance plan in Wisconsin with low out-of-pocket maximums is the Reliance $750 - 10% from Security Health Plan in the Platinum tier. The advantage of this plan is that once you reach your out-of-pocket limit, your insurer will cater to all your subsequent medical costs. However, your monthly premiums will be higher.
Cheapest HMO/EPO/PPO/POS Health Insurance Plan in Wisconsin
Before choosing a health insurance plan in Wisconsin, you need to understand your preferences and needs. The most basic plan in the state is the HMO, which tends to be cheaper than the rest of the plans but does not cover services received outside your provider network.
A PPO features a wider provider network but has slightly higher premiums than the HMO. With this plan, you can see any specialist without a referral.
The third most common health insurance plan in Wisconsin is the EPO. While the policy allows you to see a specialist without a referral, it only covers your medical expenses within your provider network unless it’s an emergency.
The POS is less common than other plans due to its higher out-of-network costs. However, it is ideal if you wish to have flexibility around the providers you wish to see, as well as the ability to get cheaper coverage for specific medical cases.
From the MoneyGeek study, the cheapest health insurance coverages in Wisconsin for these plans in the Silver tier are, on average:
- HMO: The cheapest plan with a cost of $417 per month is MercyCare HMO Silver Option B from MercyCare Health Plans.
- PPO: The cheapest plan is Robin Oak $5,000 Plus Silver from HealthPartners, with a cost of $451 per month.
- EPO: Envision EPO - Silver 6000/80 from Common Ground Healthcare Cooperative is the cheapest, with a cost of $366 per month.
- POS: The cheapest plan with a cost of $500 per month is Independence $6,500 - 30% from Security Health Plan.
Cheapest Plan in Wisconsin With an HSA
A Health Savings Account (HSA) could be a good solution for someone in Wisconsin who is in good health and doesn’t anticipate needing to go to the doctor a lot. HSA plans are cheaper and allow you to make pre-tax contributions. However, they have high deductibles, meaning you’ll need to pay more out-of-pocket if you have a major medical expense.
Based on MoneyGeek, the most affordable health insurance plan in Wisconsin with an HSA costs the following for each tier:
- Bronze: Anthem Bronze Pathway X 0 for HSA from Anthem Blue Cross and Blue Shield, costing $377 per month.
- Expanded Bronze: Dean Focus Network Bronze HSA-E 6850X by Dean Health Plan with a price of $291 per month.
- Silver: Dean Focus Network Silver HSA-E 4500X from Dean Health Plan at $408 per month.
- Gold: MercyCare HMO Gold Option C from MercyCare Health Plans at $371 per month on average.
The rates outlined above are the average rates for a 40-year-old.
What to Know About Health Insurance in Wisconsin
The sample rates used in this research came from private plan data obtained from the Wisconsin insurance marketplace. However, these do not represent the exact amount that you will pay for your plan. You will need to complete a personal application on the marketplace to get your precise rates.
Low-income Wisconsin residents, as well as those who are older, may qualify for Medicaid and Medicare. These are government programs that provide cheaper medical coverage than private plans.
Private Health Insurance on the Wisconsin Marketplace
In Wisconsin, health insurance plans are categorized according to several metal tiers. Plans that are associated with cheaper metals, such as Bronze, cost less per month, but you will need to pay more out-of-pocket costs.
Before selecting a health insurance plan in any of these tiers, ensure that you understand its pros and cons. Here are some advantages and disadvantages of the six tiers available in Wisconsin.
- Catastrophic: The Catastrophic tier offers lower monthly premiums and the least benefits. It also has high deductibles and out-of-pocket maxes. In most state, including Wisconsin, this tier is only available to buyers under the age of 30 and those who have a hardship exemption.
- Bronze: While this tier features higher premiums than the catastrophic tier, it has slightly lower deductibles and out-of-pocket maxes. Plans in this tier are ideal for you if you do not anticipate high medical expenses in the future.
- Expanded Bronze: This tier has higher benefits than the Bronze and Catastrophic tiers. Contrary to the slightly higher deductibles and out-of-pocket maxes, the tier features higher monthly premiums. If you need health insurance that gives you adequate protection during an emergency, you can consider getting this plan.
- Silver: The Silver tier balances average premiums as well as deductible amounts and out-of-pocket costs. While the tier has a higher monthly premium rate than Catastrophic, Bronze and Expanded Bronze tiers, it features considerably lower out-of-pocket maxes and deductibles.
- Gold: Gold tiers have the second-highest monthly costs in Wisconsin. They also feature the second-lowest deductible amounts and out-of-pocket maxes. You could purchase a plan in this tier if you expect to incur high medical expenses in the next year.
- Platinum: Platinum plans have the highest premiums in Wisconsin as well as the lowest deductibles and out-of-pocket maxes. If there is a high likelihood that you will incur huge medical costs in the next year, platinum plans may be the most ideal to meet your needs adequately and keep your costs as low as possible.
The cost of health insurance in Wisconsin is also based on your income level. If you have an income level that’s between 100% and 400% of the federal poverty level, you may qualify for premium tax credits. Typically, this range is between $17,420 and $69,680 per year. For more details on this, check out the Healthcare.gov calculator.
Open enrollment refers to the period in a year where buyers enroll in health insurance plans on the state’s insurance marketplace or renew existing ones. This mostly happens between November and December, although dates have been extended because of COVID-19.
Health insurance buyers with incomes ranging from 138% to 250% of the federal poverty level may be eligible for cost-sharing reductions. Typically, two-person households with an income between $24,040 and $43,550 are eligible. To qualify for this, however, you will need to purchase a Silver plan.
Medicaid in Wisconsin
Qualifying residents may also get Medicaid, which is a free government program and one of the cheapest for eligible individuals. However, Wisconsin is yet to adopt Medicaid expansion. That means your eligibility is not tied to your income but will be based on the state guidelines for low-income families and children, disabled people and pregnant women.
Medicare in Wisconsin
Wisconsin residents who are 65 years of age or older, as well as individuals with certain illnesses and disabilities, may qualify for Medicare. Medicare is one of the government programs in the state although it may not cater to your entire medical expenses as is the case with Medicaid.
Although you may need to pay a portion of your medical bills out of pocket when using Medicare, the amount is significantly less than what private insurance holders pay.
Medicare insurance has three parts:
- Part A: This is the hospital insurance that covers hospice care, nursing facility care as well as hospital-based care. It may also help with some home care service coverage.
- Part B: This is medical insurance and includes outpatient and in-doctor appointment costs. It also covers medical supplies and preventive services.
- Part D: The prescription coverage includes the cost of vaccines and prescription drugs.
Expert Advice: Finding Affordable Health Insurance in Wisconsin
- When can I shop for health insurance on the Wisconsin health insurance exchange?
- How do I take advantage of cost-sharing reductions and tax credits for health insurance in Wisconsin?
Assistant Professor of Marketing at the University of Wisconsin-Green Bay
MoneyGeek's research is based on estimates, and the cheapest plan for you will depend on your individual needs and characteristics. This analysis is intended to serve as a guide and no single plan is guaranteed to be the cheapest in Wisconsin for you
MoneyGeek collected plans and premiums for health insurance in Wisconsin from the Health Insurance Exchange Public Use Files (Exchange PUFs) for all available metal tiers and across several age groups.
Health insurance premiums on this page are an estimate and exclude potential premium tax credits and cost-sharing subsidies that users may be eligible for.
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