You may know that Wisconsin is the nation’s leader in cheese production, but did you know that health care is one of the top industries in the state as well? It’s no wonder that Wisconsin’s healthcare system is one of the best in the nation. In addition to being home to many major health carriers, the state also has public programs to provide health care to those in need. So let us help you sort through the mountains of information about health insurance so you can make the most of your options.
Wisconsin Individual Health Coverage (WI)
There are two types of health plans available to you in Wisconsin, group policies and individual policies. For a plan that is customized to fit your health needs, take out an individual plan. Or, if you are looking for general coverage without extremely high premiums, group networks, such as HMOs and POSs for example, can do the job.
There are also some state regulations that you should be aware of. For example, if you have medical problems, you can be denied coverage by individual insurers. If you are pregnant, you will be rated as having a preexisting condition. Unfortunately, there is no creditable coverage in Wisconsin for individual health plans.
Family Medical Coverage in Wisconsin (WI)
If you need to buy a policy that covers all of your family members, you have the same choices as if you were buying an individual policy (a group plan or an individual plan). As long as your family is eligible for group coverage, you cannot be turned down by carriers in Wisconsin, nor can you be charged higher rates based on health problems. Also, if you go through certain changes, such as losing your job, getting married/divorced, or having a child, you may have special opportunities to obtain group coverage.
Getting Covered for Preexisting Conditions in Wisconsin (WI)
In Wisconsin, state law allows health insurance companies to turn people down for individual insurance coverage based on their health status. If an applicant with a preexisting condition is accepted, there is typically a 24-month exclusionary period. During this time, the insurance company will not accept claims regarding anything about the preexisting condition.
The state also has a 12-month look back period, a method used to figure out the exact time in which the preexisting condition was diagnosed or treated, during the first two years of coverage. However, regardless of the preexisting condition limitations, there is an annual open enrollment for all private-company insurance policies in Wisconsin.
If you have been turned down by an insurance company due to a preexisting condition, there are other options. The state’s Health Insurance Risk Sharing Plan (HIRSP) offers coverage to those who otherwise might be considered “uninsurable” for a policy due to a chronic illness or preexisting condition.
In addition, BadgerCare, the state’s children’s health insurance program, is another option. The program is designed to provide coverage to children and teens, up to the age of 19, and their parents who may have too great an income to qualify for Medicaid, but who may not be able to afford health insurance coverage through a private company.
Changing Health Plans in Wisconsin (WI)
At some point it may be necessary for you to change carriers or health policies. This could be because you’ve moved to a different state or are changing jobs. Whatever the reason, here’s what you should know about changing your health plan in Wisconsin:
- COBRA can help you to keep the health plan that you had under your previous employer while you are between jobs, for a certain amount of time.
- If your new employer offers you coverage, he or she can give you a waiting period before your benefits start.
- If you’ve been hired by a non-federal public employer, such as a municipal or city government for example, you might not be subject to the same laws discussed above. Check with your employer to make sure.