Wisconsin Health Insurance Guide

Health Insurance Overview in Wisconsin

Wisconsin has not formally expanded Medicaid under the ACA, but the state accepted federal matching funds to expand Medicaid eligibility to 100% of the federal poverty level (rather than the traditional 138% required for ACA expansion). This unique approach — known as a 'partial expansion' — covers some adults who would not have been covered by traditional Medicaid, but leaves many in a coverage gap compared to full expansion states.

Average Health Insurance Costs in Wisconsin

Marketplace Enrollment in Wisconsin

Wisconsin residents can enroll in individual and family health insurance plans through HealthCare.gov (Federal). Open enrollment runs November 1 – January 15 (federal marketplace).

Average Premiums by City in Wisconsin

Medicaid in Wisconsin

Wisconsin BadgerCare covers adults with incomes up to 100% of the federal poverty level — below the 138% threshold of full ACA expansion. Adults between 100-138% FPL must use the marketplace.

Children's Health Insurance (CHIP) in Wisconsin

BadgerCare Plus covers children in families with incomes up to 300% of the federal poverty level.

What Makes Wisconsin Unique

Wisconsin's unique approach — expanding Medicaid to 100% of the federal poverty level but not the 138% that constitutes full ACA expansion — means the state accepts some federal expansion funds while leaving some of the same population in a coverage gap. Adults between 100-138% of the federal poverty level must purchase marketplace coverage rather than receiving Medicaid, resulting in higher costs for that group.

ACA Subsidies: What Wisconsin Residents Should Know

The enhanced subsidies first enacted in the American Rescue Plan expired at the end of 2025. For 2026, premium tax credits follow the original ACA rules: there is no credit above 400% (the “subsidy cliff”), and enrollees are expected to pay up to 9.96% of income toward the benchmark Silver plan. House in January 2026 but has not become law, so 2027 plans are being priced and subsidized under the same rules unless Congress acts.

Wisconsin’s Marketplace for 2027: Insurers, Rates, and Dates

Wisconsin residents enroll through HealthCare.gov. Full-price premiums rose about 22.8% on average for 2026, before subsidies. 12 insurers sold plans for 2026.

About 291,000 people enrolled for 2026. About 80% received premium tax credits, and the average net premium after credits was about $250 a month.

Open enrollment for 2027: November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

What’s Different About Health Coverage in Wisconsin

Wisconsin didn’t adopt full Medicaid expansion, but BadgerCare covers adults up to 100% FPL, so there is no coverage gap: below 100% you qualify for BadgerCare, above it for marketplace credits. The Wisconsin Healthcare Stability Plan, a reinsurance program since 2019, moderates premiums, and 12 insurers make it one of the more competitive markets.

Tips for Choosing Health Insurance in Wisconsin

Wisconsin residents between 100-138% of the federal poverty level must use the marketplace rather than Medicaid — ACA subsidies help cover costs for this group. BadgerCare covers adults below 100% FPL. BadgerCare Plus provides children's coverage up to 300% FPL. Milwaukee and Madison have competitive marketplace options.

• Enroll during open enrollment (November 1 – January 15 (federal marketplace)) — missing the deadline means waiting until the next open enrollment unless you have a qualifying life event.
• Wisconsin has not expanded Medicaid, so if your income falls below the federal poverty level you may fall into the coverage gap — a community health center or sliding-scale clinic can serve as a bridge until your income qualifies for marketplace subsidies.

Frequently Asked Questions

How many insurers sell marketplace plans in Wisconsin?

Twelve insurers sold Wisconsin marketplace plans for 2026.

When is open enrollment in Wisconsin for 2027?

November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

How much do Wisconsin marketplace enrollees pay after subsidies?

In 2026 about 80% of Wisconsin enrollees received premium tax credits, and the average net premium was about $250 a month. There is no credit above 400% of the federal poverty level.

The information on this page is provided for general informational purposes only and reflects estimated industry averages and program eligibility rules as of 2026. Health insurance premiums, Medicaid eligibility thresholds, marketplace options, and program rules change annually. Always verify current eligibility and enrollment options at the official HealthCare.gov (Federal) or by contacting a certified navigator or broker. Premium figures shown are approximations before subsidies — actual net premiums depend on individual income, household size, and plan selection.