Key Facts
Wisconsin's Unique Approach to Coverage
Wisconsin has a unique approach to health coverage that falls between full Medicaid expansion and non-expansion. While the state didn't accept the ACA's full Medicaid expansion with enhanced federal funding, it covers adults through BadgerCare Plus up to 100% of the federal poverty level - something most non-expansion states don't do.
How Coverage Works by Income (Individual)
BadgerCare Plus
BadgerCare Plus is Wisconsin's Medicaid program. It provides comprehensive health coverage to low-income Wisconsinites, including a unique provision that covers childless adults - something most states that haven't fully expanded Medicaid don't offer.
Who Qualifies for BadgerCare Plus?
- Adults ages 19-64 with income up to 100% FPL ($15,060/year for individuals)
- Childless adults (this is unique among non-expansion states!)
- Parents and caretakers up to 100% FPL
- Pregnant women with income up to 306% FPL
- Children under 19 with income up to 306% FPL
BadgerCare Plus Benefits
- Doctor visits and preventive care
- Hospital inpatient and outpatient services
- Prescription drug coverage
- Mental health and substance abuse treatment
- Dental services
- Vision care
- Maternity and newborn care
- Laboratory and diagnostic services
How to Apply
You can apply for BadgerCare Plus through:
- Online at access.wisconsin.gov
- By phone: 1-800-362-3002
- In person at your local Income Maintenance agency
- Through a certified application counselor or navigator
Health Insurance Marketplace
Wisconsin uses the federal Health Insurance Marketplace at HealthCare.gov. If you earn more than 100% FPL, the marketplace is your primary option for coverage, and you'll likely qualify for substantial premium tax credits.
Available Plan Types
- Bronze: Lower premiums, higher out-of-pocket costs (60% coverage)
- Silver: Moderate premiums and costs (70% coverage) - best for subsidies
- Gold: Higher premiums, lower out-of-pocket costs (80% coverage)
- Platinum: Highest premiums, lowest out-of-pocket costs (90% coverage)
Enrollment Periods
Open Enrollment: November 1, 2024 - January 15, 2025
BadgerCare Plus accepts applications year-round, so you can apply anytime you think you might qualify.
Average Costs in Wisconsin
Health insurance costs in Wisconsin vary based on your age, location, plan type, and tobacco use. Here are typical monthly premiums before subsidies:
| Plan Type | Individual (Age 40) | Family of 4 |
|---|---|---|
| Bronze | $360 - $430 | $1,150 - $1,400 |
| Silver | $450 - $550 | $1,400 - $1,750 |
| Gold | $520 - $620 | $1,650 - $2,000 |
| BadgerCare Plus | $0 | $0 |
Frequently Asked Questions
Has Wisconsin expanded Medicaid?
Wisconsin has a unique "partial expansion" approach. While it didn't accept the full ACA Medicaid expansion with enhanced federal funding, Wisconsin covers adults up to 100% of the federal poverty level through BadgerCare Plus. Adults earning 100-138% FPL get coverage through the marketplace with subsidies.
What is BadgerCare Plus?
BadgerCare Plus is Wisconsin's Medicaid program. It covers children, pregnant women, parents, and childless adults up to 100% of the federal poverty level ($15,060/year for an individual in 2025). This is unique among non-expansion states - most don't cover childless adults at all.
When is Open Enrollment for Wisconsin health insurance?
Open Enrollment for 2025 marketplace coverage runs from November 1, 2024 through January 15, 2025. Wisconsin uses the federal marketplace at HealthCare.gov. BadgerCare Plus accepts applications year-round.
How much does health insurance cost in Wisconsin?
The average monthly premium for a benchmark Silver plan in Wisconsin is approximately $450-550 before subsidies. Many Wisconsin residents qualify for premium tax credits that significantly reduce costs, with some paying under $100 per month.
Need Help Finding Wisconsin Coverage?
Our licensed agents specialize in helping Wisconsin residents navigate BadgerCare Plus and marketplace options to find the most affordable coverage.
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