Wisconsin Health Insurance at a Glance

Wisconsin Uses HealthCare.gov

Wisconsin uses the federally facilitated Health Insurance Marketplace at HealthCare.gov.

Individuals and families can use HealthCare.gov to compare available Qualified Health Plans and determine whether they qualify for federal Premium Tax Credits.

Marketplace plans are ACA-compliant major medical insurance and include protections such as:

• Coverage for pre-existing conditions
• ACA-required essential health benefits
• Preventive services
• Prescription drug coverage
• Hospital and emergency coverage
• Maternity and newborn care
• Defined annual limits on covered in-network out-of-pocket costs
• No medical underwriting for eligibility

Wisconsin Has an Unusually Competitive Individual Health Insurance Market

Wisconsin has more individual health insurers than many states, including several regional insurers closely connected with local health systems.

Current 2027 individual-market filings include insurers such as:

Wisconsin Health Insurance Rate Increases for 2027

Preliminary 2027 individual-market filings show another significant round of premium increases.

A current enrollment-weighted analysis of the filings estimates an average increase of approximately 21.1% before Marketplace financial assistance.

But there is substantial variation by insurer.

Why Comparing Wisconsin Plans Matters So Much in 2027

A statewide increase of about 21% does not mean every Wisconsin household will see the same change.

Current carrier requests range from the mid-teens to around 30% for several large insurers. Individual plan changes can vary even more.

Before renewing, compare:

• Your actual monthly premium after financial assistance
• Your deductible
• Your annual out-of-pocket maximum
• Primary care and specialist costs
• Hospital and outpatient cost sharing
• Your prescription formulary
• Your doctors and health system
• Any network or service-area changes

CareSource Is Staying in Wisconsin for 2027

CareSource is leaving individual Marketplace coverage in some other states, but it is continuing in Wisconsin for 2027.

In Wisconsin, the plans are issued by Common Ground Healthcare Cooperative, which became affiliated with CareSource in 2025.

CareSource's currently published 2027 Wisconsin Marketplace service area includes:

• Brown County
• Door County
• Jefferson County
• Kewaunee County
• Manitowoc County
• Marinette County
• Oconto County
• Ozaukee County
• Walworth County
• Washington County
• Waukesha County

Wisconsin's Reinsurance Program Helps Moderate Premiums

Wisconsin has a state reinsurance program called the Wisconsin Healthcare Stability Plan, or WIHSP.

The program reimburses participating individual-market insurers for part of certain high-cost claims. This reduces the amount insurers need to collect entirely through premiums.

Wisconsin's federal Section 1332 waiver supporting the program has been extended through December 31, 2028.

For 2027, the state has established reinsurance parameters that begin when an eligible claim reaches $50,000 and provide partial reimbursement up to a defined claims cap.

Wisconsin Health Insurance Is Highly Regional

Wisconsin has many health plans closely associated with regional hospital and physician systems.

A plan that works well in Milwaukee may not be available in Madison, Green Bay, Wausau, La Crosse, Eau Claire, or northern Wisconsin.

Before enrolling, check:

• Your primary care physician
• Your specialists
• Your preferred hospital system
• Your prescriptions
• Your pharmacy
• Urgent care and imaging facilities
• Out-of-area coverage if you travel frequently

Self-Employed Health Insurance in Wisconsin

We work with Wisconsin dairy and crop farmers, manufacturing contractors, construction workers, tradespeople, truck drivers, owner-operators, real estate professionals, consultants, freelancers, and small business owners.

Self-employed households have an additional challenge when using HealthCare.gov: estimating annual income.

Marketplace Premium Tax Credits in Wisconsin for 2027

Eligible Wisconsin households can still receive federal Premium Tax Credits through HealthCare.gov.

The temporary enhanced Premium Tax Credit rules that applied through 2025 have expired.

Under the general federal rules now in effect, Premium Tax Credit eligibility generally requires household income between 100% and 400% of the federal poverty level, along with the other federal eligibility requirements.

Based on the 2026 poverty guidelines used for 2027 Marketplace coverage, 400% is approximately:

Marketplace Plans vs. Other Private Health Coverage

Wisconsin residents may also encounter health insurance or health-benefit products sold outside HealthCare.gov.

These products do not necessarily offer the same benefits or consumer protections as ACA Marketplace coverage.

BadgerCare Plus in Wisconsin

Wisconsin's largest Medicaid health coverage program is called BadgerCare Plus.

Wisconsin did not adopt the ACA Medicaid expansion in the same way as most expansion states. Instead, Wisconsin covers qualifying adults through BadgerCare Plus up to approximately 100% of the federal poverty level.

Children and pregnant people can qualify at substantially higher income levels.

Why Wisconsin Does Not Have the Traditional Medicaid Coverage Gap

Wisconsin's Medicaid structure is unusual.

Marketplace Premium Tax Credit eligibility generally begins at 100% of the federal poverty level, while BadgerCare Plus generally covers qualifying adults through 100% of the poverty level.

That creates a bridge between BadgerCare Plus and Marketplace financial assistance that does not exist in some other states that did not adopt Medicaid expansion.

New BadgerCare Plus Work Requirements Begin in 2027

A new federal Medicaid work and community-engagement requirement begins affecting some Wisconsin BadgerCare Plus adults in 2027.

The timing differs depending on whether someone is newly applying or already enrolled.

People subject to the rule can meet it through qualifying activities such as:

• Paid work
• Volunteer or community service
• Participation in a qualifying work program
• Participation in an education program
• Being enrolled in school at least half-time
• A combination of qualifying activities

Wisconsin also says someone can satisfy the requirement by having at least $580 in monthly income during the applicable qualifying month.

Not Every BadgerCare Plus Member Has to Meet the Work Requirement

Wisconsin says the new requirement may apply to certain people ages 19 through 64, but there are important exemptions.

For example, people may not be subject to the requirement if they are pregnant, have a qualifying disability or serious medical condition, have dependent children under age 19 living with them, or meet another exemption under the federal rules.

Medicaid Retroactive Coverage Also Changes in 2027

Another federal Medicaid change takes effect in Wisconsin on January 1, 2027.

Wisconsin currently allows newly eligible Medicaid applicants to receive retroactive coverage for qualifying medical expenses incurred before the application date.

Under the new rules, Wisconsin says the retroactive coverage period will generally be shortened from three months to two months.

What If You Lose BadgerCare Plus?

Losing Medicaid or BadgerCare Plus can create a Special Enrollment Period through HealthCare.gov.

This could become especially relevant in 2027 as some adults begin navigating the new work and community-engagement requirements.

Depending on your circumstances, replacement coverage may include:

• A HealthCare.gov Marketplace plan
• An employer-sponsored health plan
• A spouse's employer-sponsored plan
• Other available individual coverage

Wisconsin Open Enrollment for 2027

Wisconsin follows the federal HealthCare.gov Open Enrollment schedule.

Open Enrollment for 2027 coverage runs from November 1, 2026 through January 15, 2027.

• November 1, 2026: Open Enrollment begins.
• December 15, 2026: Select a plan by this date for coverage beginning January 1, 2027.
• January 15, 2027: Open Enrollment ends. Coverage selected by this deadline generally begins February 1.

Leaving a Job or Losing Employer Health Insurance?

Losing qualifying employer-sponsored health coverage can create a Special Enrollment Period through HealthCare.gov.

Depending on your circumstances, compare:

• COBRA continuation coverage
• A spouse's employer-sponsored plan
• A HealthCare.gov Marketplace plan
• BadgerCare Plus if eligible
• Other available individual coverage

COBRA can allow you to temporarily keep your existing employer health plan, but the monthly premium may rise substantially when the employer stops contributing.

Learn more about COBRA alternatives →

Wisconsin Health Insurance for Early Retirees

Retiring before age 65 can create several years between employer health insurance and Medicare eligibility.

Depending on your circumstances, you may compare:

• HealthCare.gov Marketplace coverage
• COBRA
• A spouse's employer-sponsored plan
• Other available private coverage

Marketplace financial assistance can make income planning especially important because pensions, taxable retirement withdrawals, investment income, farm income, self-employment income, and other income can affect household MAGI.

Small Business Health Insurance in Wisconsin

Wisconsin small-group health insurers are also requesting premium increases for 2027.

A current analysis of preliminary filings puts the unweighted average requested increase at approximately 13.3% across the small-group insurers included in the analysis.

Depending on the business, strategies worth comparing may include:

How We Help Wisconsin Residents

Serving Clients Across Wisconsin

We work with Wisconsin residents by phone and video, so you don't need to live near a local insurance office.

Official Wisconsin Health Insurance Resources

Common Questions About Wisconsin Health Insurance