Answers About Health Insurance Rates in Wisconsin

  • September 13, 2016
  • |Quartz
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We've answered 9 questions about health insurance rates in Madison, WI.

The cost of health insurance may seem to be random, but in fact, insurance rates are highly regulated. The Affordable Care Act (ACA) has set new rules about what factors can affect insurance rates and how premium payments are used by the insurance company. The ACA has also specified who must be covered and at what age. The main factors affecting health insurance rates in Wisconsin are listed below.

  1. How are health insurance rates set?
    Health care reform has changed how health insurance rates in WI may be set. Under the new law, there are five factors that can be used to determine insurance premium rates – geographic location, age, plan category, the number of people covered (individual vs. family) and tobacco use.

  2. What's the average health insurance premium in WI? 
    The average monthly health insurance rate in Wisconsin for a 40-year-old non-smoker in 2016 is $326 for the silver plan without tax credits and $206 with tax credits.1

  3. Can my rate go up if I have a pre-existing condition?
    No, health insurance companies can't refuse to cover you or charge you more just because you have a pre-existing condition.

  4. If I'm a woman, can I be charged more?
    No, women cannot be charged more than men for the exact same policy in Wisconsin.

  5. How much more will my insurance rate be if I'm a smoker?
    Health insurance providers can increase your premium by up to 50 percent more if you smoke.

  6. How much more will the insurance rate be for older people?
    Premiums for older people can be up to three times higher as the premiums for younger individuals.

  7. How much can health insurance rates increase each year?
    That depends on a variety of factors and can change year by year. However, WI insurance companies must publicly justify any rate increase of 10 percent or more before raising your premium for all plans purchased after March 23, 2010 if Wisconsin’s Office of the Commissioner finds those rates unreasonable.

  8. How is my insurance premium spent?
    Under the health care law, Wisconsin health insurance companies are now required to follow the 80 / 20 rule in the individual and small group market and the 85 / 15 rule in the large group market. The 80 / 20 rule requires that 80 percent of the money insurance companies bring in from premiums must go toward health care and quality improvements. For insurance companies that sell to large groups of 50 employees or less, at least 80 percent of premiums received must be spent on health care and quality improvements.

  9. What happens if an insurance company doesn't meet the 80 / 20 rule?
    If a health insurance company doesn't spend at least 80 percent of premiums on health care and quality improvements, it is required to issue a rebate to its members.

If you're ready to start looking for medical coverage, Unity offers a variety of health insurance plans with competitive rates in Wisconsin. See which health plans you qualify for and get a quote today.



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