State Guides

Wisconsin

Wisconsin residents are now able to purchase quality health insurance plans available from Pivot Health. These plans, described below, offer individuals and families in the Badger State the ability to choose the benefit structure that best meets their insurance coverage needs and budget.

  • Short Term Health InsuranceAlso known as short term medical, or temporary health insurance, this plan provides comprehensive benefits coverage for physician visits, in-hospital care, urgent care facility visits and much more. With no provider network restrictions, insureds with this plan may seek treatment from any doctor or hospital to access benefits. Pivot Health’s fast, user-friendly online application process means that you know within minutes of applying if you’ve been approved for coverage.  Qualified applicants may choose any coverage start date – even within 24 hours after you apply.  
  • Supplemental Insurance CoverageIf you find yourself burdened by your major medical insurance plan’s high deductibles or costly coinsurance rates, supplemental – also called “gap” – insurance coverage may provide you the financial support you need.  The cash benefits provided by a supplemental coverage plan help you pay out-of-pocket medical expenses, such as insurance deductibles, copayments or coinsurance.  The cash payments provide you the flexibility to decide how to use them – you may use the cash for any expenses you incur due to a serious illness or accident.  Designed to work with your primary major medical coverage – whether you have an individual plan or employer-sponsored coverage – a supplemental insurance plan helps you protect your financial security from costly expenses related to medical care.

Pivot Health temporary medical plans also provide you many additional non-insurance benefits, including:  

Unlimited access to discounted telehealth doctor consultations.  Your time is precious – skip the waiting room!  Instead, connect directly with a doctor at whatever time of day it works for you – telehealth is available 24/7.  And it saves money compared to a standard office or urgent care facility visit.

Discounts on eye care and eyewear.  With savings of 15 percent to 40 percent on eye exams, eyeglass lenses, frames for eyeglasses and contact lenses, maintaining good eye health has never been so affordable.

Significant savings on prescription drugs.  It’s easier to pay for prescription medications with discounts of up to 75 percent on prescription drugs at thousands of pharmacies across the nation.

Health Exchange Operations in Wisconsin

A recent County Health Rankings report shows that approximately 11 percent of Wisconsin residents under the age of 65 have no health insurance, which is higher than the average national uninsured rate of 9.1 percent.  Uninsured rates vary by county:  Waukesha County reports a low 6 percent rate, while Clark County’s rate is more than triple that at 19 percent.

2017 saw changes in the carriers providing plans through the health insurance exchange.  Ambetter, United, Physicians Plus and WPS (Arise Health Plan) withdrew from the exchange at the end of 2016, and Children’s Community Health Plan and Aspirus Arise joined the exchange in 2017.  This gives Wisconsin a total of 14 insurance carriers providing coverage through the exchange.  Residents in 62 of Wisconsin’s counties have access to at least three insurance carriers; in 15 counties, however, Wisconsinites have access to only two exchange insurers, and Menominee County residents have access to only one exchange insurance carrier.

Premium adjustments for exchange plans in 2017 varied widely – from a 13 percent decrease to a 37.9 percent increase – resulting in an average increase of 15.8 percent in Wisconsin.  This rate is below the national average exchange plan premium increase of 25 percent.  But for the 15 percent of Wisconsinites who don’t qualify for federal premium subsidies, or for those who purchase off-exchange plans, this is still a significant price jump.  

A higher-than-national rate of uninsured residents, insurance carrier changes, rising premium rates and uncertainty in Washington over a possible repeal and replace of the Affordable Care Act, all underscore the importance of offering Wisconsin residents access to a broader range of health insurance choices.  

  • Pivot Health’s short term health insurance enables Wisconsinites to purchase comprehensive coverage at a fraction of the cost of major medical insurance coverage – with no provider network restrictions.
  • Pivot Health’s supplemental health insurance provides Wisconsin residents the opportunity to select insurance designed to provide financial protection against the coverage gaps of high deductible major medical insurance plans.  This supplemental insurance – also called “gap” coverage – helps insureds pay for high deductibles, out-of-pocket costs, coinsurance, copayments, and other costs that they typically incur before their high deductible major medical plans begin to pay benefits.

A Report on Wisconsin’s Well-Being

A recent Gallup-Healthways State of American Well-Being report examined how well-being varies by state.  Wisconsin ranked 28th out of the 50 states, based on survey responses to questions covering different categories of well-being.  

Wisconsin residents reported lower-than-average ratings for the following categories (ranked 31st, 39th and 39th, respectively) for:

  • Physical: having good health and enough energy to get things done daily
  • Purpose: liking what you do each day and being motivated to achieve your goals
  • Social: having supportive relationships and love in your life

However, Wisconsin scored positive rankings in these categories (ranked 7th and 15th respectively):

  • Financial: managing your economic life to reduce stress and increase security
  • Community:  liking where you live, feeling safe and having pride in your community

The State of Health in Wisconsin  

The 2017 Commonwealth Fund’s Scorecard on State Health System Performance gave Wisconsin an overall ranking of 11 out of 51 (the 50 states plus the District of Columbia).  This is the most recent version of the organization’s scorecard of its comparison for states in the U.S.

The Commonwealth Fund’s Scorecard rated Wisconsin in several areas, including:

  • Uninsured adults aged 19 to 64: 8th ranking (8 percent in Wisconsin, compared to U.S. average of 13 percent)
  • Uninsured children ages 0 to 18:  11th ranking (4 percent, compared to the U.S. average of 5 percent)
  • Adults who went without care because of cost in the previous year:  7th ranking (9 percent in Wisconsin, compared to the U.S. average of 13 percent)
  • Individuals under age 65 with high out-of-pocket costs relative to annual household income:  27th ranking (15 percent, compared to U.S. average of 14 percent)
  • At-risk adults who did not have a routine doctor visit in the previous two years:  25th ranking (13 percent in Wisconsin, the same as the U.S. average of 13 percent)
  • Adults that did not visit a dentist in the previous year: 3rd ranking (12 percent, compared to the U.S. average of 16 percent)
  • Adults with age- and gender-appropriate cancer screenings:  4th ranking (73 percent in Wisconsin, compared to the U.S. average of 68 percent)
  • Hospitalized people who said the hospital staff managed pain well, were responsive to calls for help and who explained medications and their side effects:  5th ranking (71 percent, compared to U.S. average of 68 percent)
  • Breast cancer deaths per 100,000 females: 16th ranking (19.3 in Wisconsin, compared to U.S. average of 20.6)
  • Colorectal cancer deaths per 100,000 people: 19th ranking (13.7 percent, compared to the U.S. average of 14.3 percent)
  • Suicide deaths per 100,000:  18th ranking (13.1 percent in Wisconsin, compared to the U.S. average of 13 percent)
  • Adults who report fair or poor health or activity limitations:  13th ranking (23 percent, compared to the U.S. average of 26 percent)
  • Adults who smoke:  21st ranking (17 percent in Wisconsin, the same as the U.S. average of 17 percent)
  • Adults who are obese: 22nd ranking (30 percent, compared to the U.S. average of 29 percent)
  • Children (ages 10-17) who are overweight or obese: 18th ranking (29 percent in Wisconsin, compared to the U.S. average of 31 percent)
  • Percent of adults who have lost 6 or more teeth due to decay or disease:  22nd ranking (10 percent, the same as the U.S. average of 10 percent)

Wisconsin also had positive ratings in many other categories, including:

  • Adults with a usual source of care
  • Children with emotional, behavioral, or developmental problems who received needed mental health care in the past year
  • Medicare patients whose health provider always listens, explains, shows respect, and spends enough time with them
  • Hospitalized patients given information about what to do during their recovery at home
  • A lower-than-national-average rate of hospital admissions for children with asthma

2017 Health Insurance Plans in Wisconsin

Wisconsin’s Office of the Commissioner of Insurance reported that the following health insurance companies were offering individual health insurance plans on the exchange for 2017:

  • Anthem Blue Cross Blue Shield (CompCare Health Services)
  • Aspirus Arise
  • Common Ground Healthcare Cooperative
  • Children’s Community Health Plan
  • Dean Health Plan
  • Group Health Cooperative of South Central Wisconsin
  • Gundersen Health Plan Inc.
  • Health Tradition Health Plan
  • Medica Health Plans of Wisconsin
  • MercyCare HMO Inc.
  • Molina
  • Network Health
  • Security Health Plan of Wisconsin, Inc.
  • Unity Health Insurance

Pivot Health offers in Wisconsin:

  • Short term health insurance
  • Supplemental health insurance

Medicaid Enrollment in Wisconsin

Wisconsin partially expanded its Medicaid program but did not adopt the full expansion of Medicaid under the terms of the Affordable Care Act (ACA).  Therefore, the state did not receive federal funding for its program changes.  

The BadgerCare Plus Medicaid program now includes adults who were previously not always eligible for Medicaid and who have incomes below 100 percent of the Federal Poverty Level (FPL).  Adults with incomes above that threshold were moved out of the state’s Medicaid program and into the federal health insurance exchange.  Those low-income adults receive subsidies to help pay for exchange plans they select.

Governor Scott Walker said that the new Medicaid eligibility rules were intended to increase coverage availability without adding to the state’s Medicaid spending.  He also has stated that the program expansion was designed to make people more independent by reducing the role of government in their lives.  More than 195,000 people have gained health coverage under the Walker plan since its inception.

Your Health Care Coverage Choices

If you are a Wisconsin resident and do not have health insurance:  Pivot Health’s short term health insurance offers you the choice of comprehensive medical coverage to meet your benefit and budget needs.

If you are a Wisconsin resident and have a high deductible health insurance plan:  Pivot Health’s supplemental insurance can help relieve the burden of costly out-of-pocket expenses, such as deductibles, coinsurance, copayments and more.

Pivot Health: offering you choices and flexibility that pivot to meet your needs over time.