Wisconsin health insurance tips


Wisconsin insurance law and regulation

The Wisconsin Department of Insurance Web site contains links to the full text of the state’s insurance laws and regulations.  The Web site has not yet developed resources to help individuals find commercial low cost health plans like mini-med or core coverage, specific illness policies, Supplemental Accident Insurance and basic health insurance. A listing of Wisconsin state mandates for health insurance updated 4/2011 is available.
The state insurance department can be reached by telephone at (800) 236-8517 or by mail at 125 South Webster St., Madison WI 53703. The state children’s health insurance plan (CHIP) Web site is Wisconsin BadgerCare Plus. About 794,000 people, roughly half of them children, were covered by BadgerCare in October.

News affecting your health care

June 3, 2019 – Status of alternative non-ACA health plans: Wisconsin does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.

March 19, 2019 – Abortion laws in Wisconsin are among the most restrictive in the nation. Health plans offered in the state’s health exchange under the Affordable Care Act can only cover abortion if the woman’s life is endangered, her physical health is severely compromised, or in cases of rape or incest.

November 12, 2018 – Incoming Wisconsin Attorney General Josh Kaul says one of his first actions will be reversing course on healthcare. “I’m looking forward to working with Governor Evers to withdraw the state of Wisconsin from the lawsuit that’s seeking to invalidate the Affordable Care Act, which, if it’s successful would eliminate protections for people with a preexisting condition.”  The state’s Republican leaders still oppose Governor-elect Tony Evers’ plan to take more federal medicaid money, but they are open to protecting pre-existing conditions. It appears that Wisconsin will be a national testing ground for proposed changes in political leadership on health care. (WJT)

The history of health care planning in Wisconsin (Information is outdated and links may be expired)

5/20/2015 The finance committee of the Wisconsin legislature has approved Governor Walker’s plan to offer state workers $2,000 a year to opt out of taking state-subsidized health insurance. The measure is included in the recently passed state budget. Private employers note that they would be prohibited from offering this type of employee buy-out by federal law.

12/4/2014 166,000 Wisconsin residents signed up for Obamacare coverage this year and about the same number are expected to sign up for 2015 according to the Wisconsin Office of the Commissioner of Insurance.

2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.

7/26/2013 Affordable Smart Term Life Insurance is now available to most Wisconsin residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.

3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.

2/17/2012 Facing a loss of health insurance companies willing to offer coverage to Wisconsin individuals and families, Governor Scott Walker requested an extension to implementation of federal minimum loss ration requirement known as the “80/20” rule. Wisconsin proposed that this rule be phased in over several years. This week the federal government’s Department of Health and Human Services refused the state’s request. Four insurance companies have left the market since the implementation of federal health reform and more are likely to withdraw if they cannot operate profitably under the new rules. Fewer low cost insurance options generally means that consumers will pay more for their coverage and that the number of uninsured individuals will rise.

2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 UnitedHealthcare, Anthem Blue Cross Blue Shield and Medical Associates Health Plans are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.

11/2/2011 The Wisconsin Office of the Commissioner of Insurance estimates that new federal regulation could result in rebates to individual health insurance consumers of $4.4 million this year, $4.7 million in 2012 and $4.9 million in 2013. Some insurance companies may opt to leave the market rather than operate under the new rules. Two companies, American Republic Insurance and World Insurance Company, announced that they would leave the U.S. market for traditional health insurance sold to individuals. The customers of those companies, including those with pre-existing medical conditions, will be accepted by Celtic Insurance Company.

10/17/2011 Beginning this year (2011 tax returns that will be filed in 2012) Wisconsin residents who use a Health Savings Account are eligible for a nonrefundable individual state income tax credit in addition to the federal income tax benefits.

6/24/2011 Wisconsin adapted a new universal health insurance application that will be used by all insurance companies that offer individual major medical insurance. The form will be automatically updated on all of the OnlineAdviser network Websites that make forms available for download. UnitedHealthcare announced that it will no longer accept the old application form after July 1, 2011.

2/17/2011 Wisconsin Department of Health Services was granted more than $31 million by the U.S. Department of Health and Human Services to help make improvements in the delivery of affordable, quality health care for up to 160,000 individuals in the non-group market, one million employees of small businesses, and 770,000 participants in the BadgerCare Plus and Medicaid programs, representing nearly 35% of the state’s population.

2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.

2/8/2011 Wisconsin’s Governor Scott Walker’s first law signed includes a provision to eliminate state taxes on Health Savings Accounts. Under the new law individuals may claim a nonrefundable income tax credit for 6.5 percent of the allowable amount that they claim as federal tax deductions for their HSA contributions, or claim 6.5 percent of the federal tax−exempt earnings relating to an HSA, or both. Low-cost qualifying insurance and free Health Savings Account administration is available in Wisconsin from Celtic Insurance.

1/5/2011 Wisconsin will become the 21st state to join in a lawsuit against the federal government to block the implementation of health reform laws commonly known as Obamacare. A federal judge already found a key part of the law unconstitutional but the administration vowed to move ahead with implementation anyway. The matter is expected to be resolved by the Supreme Court in 2012.

12/16/2010 Wisconsin Department of Health Services officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.

In its initial federal grant request for the insurance exchange project the Department of Health Services said that it would: 1) Design an Exchange that moves beyond an aggregator of health insurance options, to a mechanism that influences how health care is delivered in the State. Application makes clear that Wisconsin sees the Exchange as a “transformative force”, 2) Contract to develop a predictive model to measure the impact of the insurance market reforms on Wisconsin, coupled with other requirements of the Affordable Care Act, 3) Maintain Exchange resource information on the Office of Health Care Reform web site to allow stakeholders to stay informed and provide input, and 4) Conduct surveys of the individual, small group, and large group markets, and model and analyze insurance reform impacts to assure clear understanding of Wisconsin’s current and future health insurance landscape.

The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.

5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Wisconsin is now available at Freedom Benefits.