How Much Is Health Insurance in Wisconsin Per Month?

The monthly cost of health insurance in Wisconsin is a dynamic figure influenced by individual circumstances, the specific type of coverage selected, and available financial support. While an average cost can be provided, an individual’s actual premium will reflect their unique situation.

Key Factors Determining Your Monthly Cost

Premiums generally increase with age. For instance, the average Bronze plan premium for a 30-year-old in Wisconsin is around $408, but this can rise by approximately $18 annually for those in their 40s and about $33 per year for individuals in their 50s.

Location within Wisconsin also impacts rates, as healthcare costs and competition can vary by county or region. For example, average Bronze plan premiums for a 30-year-old can range from about $343 in counties like Dane to $535 in counties such as Rusk.

Tobacco use can lead to a substantial surcharge on premiums. Under the Affordable Care Act (ACA), health plans can charge tobacco users up to 50% more for their health insurance premiums compared to non-tobacco users.

The type of plan and its metal tier significantly affect the premium-deductible tradeoff. Plans are categorized into Bronze, Silver, Gold, and Platinum tiers. Bronze plans typically have the lowest monthly premiums but higher deductibles and out-of-pocket costs. Gold and Platinum plans feature higher monthly premiums but offer lower deductibles and out-of-pocket maximums.

Different plan structures, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), and Point of Service (POS) plans, also influence premiums. HMOs generally have lower monthly premiums due to their defined networks. PPOs, offering more flexibility, typically come with higher monthly premiums.

The chosen deductible and out-of-pocket maximum directly correlate with the monthly premium. Opting for a higher deductible or a higher out-of-pocket maximum usually results in a lower monthly premium. Premiums increase with each additional family member covered, although rates for children are generally lower than those for adults.

Understanding Health Insurance Marketplaces and Plans

Individuals in Wisconsin can obtain health insurance through several avenues. Employer-sponsored plans represent a common source of coverage, where costs are typically shared between the employee and the employer.

The Affordable Care Act (ACA) Marketplace, accessible through healthcare.gov, serves as the main platform for individuals and families in Wisconsin to shop for and enroll in health insurance plans. Plans on the Marketplace are categorized by metal tiers—Bronze, Silver, Gold, and Platinum—which indicate the level of cost-sharing. Higher-tier plans generally involve higher premiums but lower cost-sharing. Enrollment primarily occurs during the annual open enrollment period, though special enrollment periods are available for individuals experiencing qualifying life events like marriage, birth of a child, or loss of other coverage.

Some health insurance plans can also be purchased directly from insurance companies outside of the Marketplace, often referred to as “off-exchange” plans. While these plans offer coverage, they typically do not qualify for premium tax credits or other subsidies available through the Marketplace.

BadgerCare Plus is Wisconsin’s Medicaid program, providing comprehensive health coverage at little to no cost for eligible low-income individuals and families. For individuals aged 65 and older, or those with certain disabilities, Medicare provides federal health insurance coverage.

Financial Assistance Programs in Wisconsin

Several programs can help reduce the monthly cost of health insurance for eligible individuals and families in Wisconsin. Premium Tax Credits, often called subsidies, are government funds that lower monthly health insurance premiums. These credits are available through the ACA Marketplace to individuals and families whose household income falls within specific Federal Poverty Level (FPL) thresholds.

Premium Tax Credits can be applied in advance to reduce monthly premium payments, or they can be claimed as a lump sum at tax time. Eligibility extends to individuals with incomes at or above 100% of the FPL. Through the end of 2025, there is generally no upper income limit if the cost of a benchmark plan exceeds 8.5% of household income.

Cost-Sharing Reductions (CSRs) provide additional financial assistance by lowering deductibles, copayments, and out-of-pocket maximums. To qualify for CSRs, individuals must have incomes below 250% of the FPL and must enroll in a Silver plan on the Marketplace. The level of assistance provided by CSRs varies with income, with lower-income individuals receiving more substantial reductions.

BadgerCare Plus offers comprehensive coverage at little to no cost to qualifying residents. Eligibility is based on specific income thresholds, which vary for different groups, including:
Children
Pregnant individuals
Parents
Caretakers
Childless adults

For example, childless adults typically qualify with incomes at or below 100% of the FPL, while pregnant women and children may qualify at higher income levels, such as up to 300% of the FPL. Applications can be submitted through the state’s ACCESS website.