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Wisconsin Health Insurance Exchange Marketplace

Wisconsin utilizes the federally run exchange marketplace, meaning that residents use HealthCare.gov to enroll in exchange plans.

Open enrollment for 2021 health plans will start on November 1, 2020, and end on December 15, 2020. But Wisconsin residents with qualifying events (as well as the loss of employer-sponsored coverage amid the Coronavirus pandemic) can still enroll or make changes to their coverage for 2020.

The state has a generally robust health insurance exchange, with 13 Wisconsin health insurance exchange carriers offering plans for 2020 — far more than most other states, and an increase from 12 participating insurers in 2019. But coverage is localized, with counties in the southern part of the state generally having more insurer choices as compared to counties in the northern part of the state.

Around two-thirds of Wisconsin’s individual market enrollees have coverage through the exchange (as opposed to off-market exchange). Wisconsin still has a functioning ACA-created CO-OP. There were 23 CO-OPs in 2014, but Wisconsin’s Common Ground Healthcare Cooperative is one of only four remaining in the United States.

Health Insurance Plans and Rates in Wisconsin

There were 14 insurers providing health insurance plans in the Wisconsin marketplace in 2017, but three left at the end of 2017. Molina rejoined the exchange for 2019, and WPS (Arise Health Plan) rejoined for 2020, bringing the total number of insurers taking part in the exchange to 13.

Rates were sharply higher in 2018, but a significant portion of the rate increase resulted from the elimination of federal funding for cost-sharing reductions (CSR). The cost of CSR has been added to silver health insurance plans, meaning that premium subsidies grew significantly in 2018, and they continue to be disproportionately large. Average rates decreased in 2019 and again in 2020, thanks to Wisconsin’s new reinsurance program.

Former Governor Scott Walker, a Republican, pushed back against the Affordable Care Act. Walker refused federal funding to expand Medicaid fully. Before leaving office, he secured federal approval to impose a Medicaid work condition in Wisconsin (which has not yet been implemented as of 2020). But Walker lost the 2018 election to Tony Evers, who wants to expand Medicaid’s coverage and would opt to go even further, with “BadgerCare for All.”

During his first year in office, Evers continued to push for Medicaid expansion. In his 2019-2020 budget, he highlighted the money that the state is leaving on the table by not expanding Medicaid. Also, the Affordable Care Act faces another challenge at the Supreme Court, Wisconsin has joined many other states in submitting amicus briefs in support of the Affordable Care Act.

Decline in the Number of 2020 Enrollment

During the open enrollment period for 2020 coverage, 195,498 individuals enrolled in private individual market plans through Wisconsin’s health insurance exchange marketplace. This was down from nearly 206,000 enrollees the previous year and was the third year in a row with declining enrollment.

In most states that utilize the federally run exchange, peak enrollment occurred in 2016, with declining enrollment from then.

But enrollment in the state’s exchange peaked in 2017. Declining enrollment has been caused by many factors: Increasing premiums for individuals who don’t get premium subsidies, the abolition of the individual mandate penalty after the end of 2018, the expansion of short-term health insurance plans and association health plans as options for individual market coverage, and the Trump Administration’s decision to reduce funding for exchange marketing and enrollment aid sharply.

Resources and References:

• Cost-Sharing Reductions
• The Expansion of Medicaid