Medicaid in Wisconsin
Wisconsin's Medicaid situation is unique among states. Through BadgerCare Plus, the state covers adults aged 19 to 64 with household incomes up to 100% FPL (about $15,960 for a single person for 2027 coverage). However, Wisconsin did not formally accept the ACA's Medicaid expansion to 138% FPL. This was a deliberate policy choice: the state covers the poorest adults through BadgerCare Plus and directs those above 100% FPL to the marketplace with subsidies.
The practical result is that there is no coverage gap in Wisconsin. Adults below 100% FPL get BadgerCare Plus. Adults above 100% FPL can access marketplace subsidies. However, Wisconsin misses out on the enhanced federal matching rate (90%) that expansion states receive. The state instead gets its standard FMAP (about 60%), costing Wisconsin taxpayers hundreds of millions of dollars more than if the state had formally expanded.
Wisconsin's uninsured rate is approximately 4.7%, with about 275,000 residents lacking coverage. This is well below the national average, reflecting BadgerCare Plus coverage and a strong employer-sponsored insurance market.
What plans cost in 2027
KFF puts Wisconsin's average benchmark Silver premium for a 40-year-old at $720 a month for 2027, up from $611 in 2026 (about 18% higher). Prices vary by county, and rural northern and western counties often have fewer choices.
Wisconsin had roughly 225,000 marketplace enrollees in 2025. The enhanced subsidies expired after 2025 and were not extended, so for 2027 there is no premium tax credit above 400% FPL (about $86,560 for a household of two). Open Enrollment for 2027 coverage runs from November 1, 2026, through January 15, 2027, on HealthCare.gov. Enroll by December 15 for coverage that starts January 1. Because Wisconsin sends adults between 100% and 138% FPL to the marketplace (rather than covering them through Medicaid), this population is particularly sensitive to subsidy changes.
Carriers in Wisconsin (2027)
Twelve insurers offer individual marketplace plans in Wisconsin for 2027, but most are regional. Carrier availability varies by county:
- Anthem Blue Cross Blue Shield offers plans in many Wisconsin counties, including both metro and rural areas. Anthem has a broad provider network and is one of the more widely available carriers in the state.
- UnitedHealthcare offers plans in counties including Milwaukee and Brown (Green Bay).
- Quartz Health Solutions is a regional carrier owned jointly by UW Health and UnityPoint Health. Quartz offers plans primarily in the Madison area and southern Wisconsin, with strong access to UW Health providers including UW Hospital.
- CareSource (Common Ground Healthcare) sells plans under the Common Ground name in parts of the state, including Brown County (Green Bay).
- Group Health Cooperative of South Central Wisconsin offers plans in the Madison area. They operate their own clinics in an HMO model, similar to Kaiser Permanente's approach.
- Other regional insurers include Dean Health Plan, Network Health, Security Health Plan, Aspirus Health Plan, Medica, HealthPartners, and MercyCare Health Plans.
Most Wisconsin counties have two or three marketplace insurers for 2027. A handful have four or five, including Brown County (Green Bay), and one county has only one.
Key regions
Milwaukee metro
Milwaukee County and surrounding areas (Waukesha, Ozaukee, Washington) are the population center. Froedtert & the Medical College of Wisconsin, Aurora Health Care (now Advocate Aurora), Ascension SE Wisconsin, and Children's Wisconsin are major systems. For 2027, Anthem, Network Health, and UnitedHealthcare sell marketplace plans in Milwaukee County. Milwaukee has significant health disparities across neighborhoods, making affordable coverage especially important.
Madison metro
Dane County (Madison) has excellent healthcare competition. UW Health (University of Wisconsin Hospital), SSM Health St. Mary's, and UnityPoint Health Meriter are the major systems. Quartz, Group Health Cooperative, and Dean Health Plan are the 2027 marketplace insurers in Dane County.
Fox Valley and Green Bay
Brown County (Green Bay), Outagamie County (Appleton), and Winnebago County (Oshkosh) form a mid-state population corridor. ThedaCare, Bellin Health, and HSHS St. Vincent Hospital are key providers. Brown County has five marketplace insurers for 2027: Anthem, Common Ground (CareSource), Dean, HealthPartners, and UnitedHealthcare.
Northern Wisconsin
Marathon County (Wausau), La Crosse County, and the northwoods counties have more limited healthcare infrastructure. Marshfield Clinic Health System and Aspirus are the major providers. Carrier options thin out in the north. Aspirus Health Plan and Security Health Plan are common options there, and Anthem also sells plans in Marathon County.
Estimate your subsidy
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
Wisconsin-specific things to know
No coverage gap, but the 100-138% FPL group is vulnerable. Wisconsin's decision not to formally expand means adults earning 100-138% FPL (about $15,960-$22,025 for a single person) must buy marketplace plans instead of getting free Medicaid. They qualify for subsidies, but their costs are higher than they would be under Medicaid expansion. If your income is in this range, you may also qualify for cost-sharing reductions on Silver plans, which significantly reduce deductibles and out-of-pocket costs.
BadgerCare Plus transitions can be tricky. If your income fluctuates around 100% FPL, you may move between BadgerCare Plus and marketplace coverage during the year. Report income changes promptly to avoid coverage gaps or overpayment of subsidies. The transition is not always seamless, and your providers may or may not be in-network on both sides.
Free enrollment help is widely available. Wisconsin has certified navigators and enrollment assisters through organizations like Covering Wisconsin (based at UW-Madison), community health centers, and local nonprofits. These services are free and can help you compare plans, estimate subsidies, and complete your application.
Resources
- HealthCare.gov for marketplace enrollment (Wisconsin uses the federal marketplace)
- BadgerCare Plus for Medicaid eligibility and enrollment
- Covering Wisconsin for free enrollment assistance and navigator services