Health Insurance in Wisconsin

Medicaid in Wisconsin

Wisconsin's Medicaid situation is unique among states. Through BadgerCare Plus, the state covers adults aged 19 to 64 with household incomes up to 100% FPL (about $15,060 for a single person in 2026). However, Wisconsin did not formally accept the ACA's Medicaid expansion to 138% FPL. This was a deliberate policy choice: the state covers the poorest adults through BadgerCare Plus and directs those above 100% FPL to the marketplace with subsidies.

The practical result is that there is no coverage gap in Wisconsin. Adults below 100% FPL get BadgerCare Plus. Adults above 100% FPL can access marketplace subsidies. However, Wisconsin misses out on the enhanced federal matching rate (90%) that expansion states receive. The state instead gets its standard FMAP (about 60%), costing Wisconsin taxpayers hundreds of millions of dollars more than if the state had formally expanded.

Wisconsin's uninsured rate is approximately 4.7%, with about 275,000 residents lacking coverage. This is well below the national average, reflecting BadgerCare Plus coverage and a strong employer-sponsored insurance market.

What plans cost in 2026

Wisconsin marketplace premiums are moderate. A benchmark Silver plan for a 40-year-old ranges from about $400 to $600 per month before subsidies, depending on the county. Milwaukee and Madison metro areas tend to have lower premiums due to carrier competition, while rural northern and western counties see higher prices.

Wisconsin had roughly 225,000 marketplace enrollees in 2025. With the enhanced subsidies expiring after 2025, the subsidy cliff returns at 400% FPL (about $62,160 for a family of two). Because Wisconsin sends adults between 100% and 138% FPL to the marketplace (rather than covering them through Medicaid), this population is particularly sensitive to subsidy changes.

Carriers in Wisconsin (2026)

Multiple insurers offer individual marketplace plans in Wisconsin for 2026. Carrier availability varies by county:

• Anthem Blue Cross Blue Shield offers plans in many Wisconsin counties, including both metro and rural areas. Anthem has a broad provider network and is one of the more widely available carriers in the state.
• Molina Healthcare offers plans in select counties, focused on affordable coverage with lower premiums and managed-care networks. Molina has been expanding its Wisconsin marketplace presence.
• Quartz Health Solutions is a regional carrier owned jointly by UW Health and UnityPoint Health. Quartz offers plans primarily in the Madison area and southern Wisconsin, with strong access to UW Health providers including UW Hospital.
• Common Ground Healthcare Cooperative is a Wisconsin-based co-op offering plans in the Milwaukee area and southeastern Wisconsin. As a nonprofit co-op, Common Ground focuses on member value rather than shareholder returns.
• Group Health Cooperative of South Central Wisconsin offers plans in the Madison area. They operate their own clinics in an HMO model, similar to Kaiser Permanente's approach.

Milwaukee and Madison have the most options, with four or five carriers. Rural northern Wisconsin counties may have only one or two carriers.

Key regions

Milwaukee metro

Milwaukee County and surrounding areas (Waukesha, Ozaukee, Washington) are the population center. Froedtert & the Medical College of Wisconsin, Aurora Health Care (now Advocate Aurora), Ascension SE Wisconsin, and Children's Wisconsin are major systems. Multiple marketplace carriers compete here, providing the most plan options in the state. Milwaukee has significant health disparities across neighborhoods, making affordable coverage especially important.

Madison metro

Dane County (Madison) has excellent healthcare competition. UW Health (University of Wisconsin Hospital), SSM Health St. Mary's, and UnityPoint Health Meriter are the major systems. Quartz and Group Health Cooperative have strong local presence alongside statewide carriers. Madison typically has some of the lowest marketplace premiums in the state.

Fox Valley and Green Bay

Brown County (Green Bay), Outagamie County (Appleton), and Winnebago County (Oshkosh) form a mid-state population corridor. ThedaCare, Bellin Health, and HSHS St. Vincent Hospital are key providers. Several marketplace carriers serve this area, though with fewer options than Milwaukee or Madison.

Northern Wisconsin

Marathon County (Wausau), La Crosse County, and the northwoods counties have more limited healthcare infrastructure. Marshfield Clinic Health System and Aspirus are the major providers. Carrier options thin out in the north, with some counties having only one or two marketplace choices. Premiums tend to be higher due to lower population density and fewer competing providers.

Estimate your subsidy

Wisconsin-specific things to know

No coverage gap, but the 100-138% FPL group is vulnerable. Wisconsin's decision not to formally expand means adults earning 100-138% FPL (about $15,060-$20,780 for a single person) must buy marketplace plans instead of getting free Medicaid. They qualify for subsidies, but their costs are higher than they would be under Medicaid expansion. If your income is in this range, you may also qualify for cost-sharing reductions on Silver plans, which significantly reduce deductibles and out-of-pocket costs.

BadgerCare Plus transitions can be tricky. If your income fluctuates around 100% FPL, you may move between BadgerCare Plus and marketplace coverage during the year. Report income changes promptly to avoid coverage gaps or overpayment of subsidies. The transition is not always seamless, and your providers may or may not be in-network on both sides.

Free enrollment help is widely available. Wisconsin has certified navigators and enrollment assisters through organizations like Covering Wisconsin (based at UW-Madison), community health centers, and local nonprofits. These services are free and can help you compare plans, estimate subsidies, and complete your application.

Resources

• HealthCare.gov for marketplace enrollment (Wisconsin uses the federal marketplace)
• BadgerCare Plus for Medicaid eligibility and enrollment
• Covering Wisconsin for free enrollment assistance and navigator services