Paul Sanchez
Wyoming residents can access affordable health insurance through the federal health insurance marketplace, which offers a range of plans from three private insurers. This virtual marketplace allows users to compare health plans and find insurance that is often more affordable than elsewhere due to federal subsidies. Wyoming has not expanded Medicaid coverage under the ACA, resulting in a coverage gap that affects about 19,000 Wyomingites, particularly non-disabled adults under 65 without children whose income is below the poverty level. However, the state offers various programs to assist specific populations, such as pregnant women, disabled individuals, and low-income families, in obtaining health coverage through Medicaid or other means.
| Characteristics | Values |
|---|---|
| Wyoming's health insurance marketplace | Provides access to health insurance products from three private insurers for 2025, including UnitedHealthcare |
| More than 42,000 Wyomingites made marketplace plan selections during the 2024 open enrollment period | |
| Wyoming benefited the most from advanced premium tax credits, bringing down the $937 average monthly market premium in the state to $118 | |
| Medicaid expansion | Wyoming has not yet expanded Medicaid eligibility under the ACA |
| Wyoming has the option to expand Medicaid coverage to all individuals under 65 whose income is less than 138% of the federal poverty level | |
| Wyoming leaders have repeatedly rejected Medicaid expansion | |
| Wyoming had the lowest rate of Medicaid use among the 10 farm states with about 73,000 — or 12.6% of the state — using it | |
| Wyoming Medicaid’s Pregnant Women programs provide health coverage for eligible pregnant women for up to 12 months postpartum | |
| The EID program is an option that allows employed individuals who are disabled to receive Medicaid by paying a monthly premium | |
| The Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) are Medicare Savings programs | |
| Small business tax credit | Provides 50% of the cost of insurance purchased through the SHOP marketplace |
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What You'll Learn
Medicaid and other government programs
Wyoming Medicaid is a joint federal and state government program that provides medical assistance to low-income and medically needy individuals and families. It offers various programs with specific eligibility criteria to ensure access to affordable healthcare for Wyoming residents.
Wyoming Medicaid Programs
Wyoming Medicaid has several programs with different eligibility criteria, including:
- Family Care : This program provides health coverage for parents or relatives caring for a child under the age of 18.
- Pregnant Women Programs : Presumptive Eligibility (PE) for Pregnant Women offers temporary Medicaid access while their eligibility for full benefits is determined. Eligible pregnant women can receive outpatient services for up to 60 days after applying, and coverage can extend up to 12 months postpartum.
- Kid Care CHIP : This program offers affordable health coverage for children of working parents in Wyoming, providing free preventive dental and health care, with other services available at a small co-pay. It is available to children whose parents' income is below 200% of the federal poverty level and are not eligible for Medicaid.
- EID Program : The EID program allows employed individuals with disabilities to receive Medicaid by paying a monthly premium, provided they meet Social Security Administration (SSA) disability guidelines.
- Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) : These Medicare Savings programs help income-qualifying Medicare beneficiaries pay for premiums, co-insurance, and deductibles.
- WHIPP (Wyoming Health Insurance Premium Payment Program) : WHIPP reimburses the cost of health insurance premiums, allowing individuals to maintain their health insurance benefits at no cost. It also covers family members who are not eligible for Medicaid but are included in the health insurance plan if determined to be cost-effective.
- Home Care Services : This program provides nursing or therapy services to individuals in their homes under a physician's plan of care.
Medicaid Expansion in Wyoming
Wyoming has had the option to expand its Medicaid coverage to all individuals under 65 with an income below 138% of the federal poverty level. However, the state has chosen not to expand the program due to strong Republican opposition and the inclusion of a work requirement in the expansion legislation. Governor Mead initially opposed Medicaid expansion but later became a proponent, presenting the SHARE (Strategy for Health, Access, Responsibility, and Employment) proposal for a modified expansion. This proposal included a small premium and copay for certain enrollees and access to vocational rehabilitation and job search services. Despite these efforts, the expansion was rejected by lawmakers, and as of 2019, expansion efforts have not gained traction.
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Premium subsidies and cost-sharing reductions
The Affordable Care Act (ACA) provides premium subsidies and cost-sharing reductions to make health insurance more affordable for people with lower or moderate incomes. Premium subsidies are tax credits that reduce enrollees' monthly payments for insurance coverage. These are available to qualifying individuals regardless of whether they owe any federal income tax. The amount of the premium tax credit is based on the income estimate and household information provided on the Marketplace application.
The second type of financial assistance, the cost-sharing reduction (CSR), reduces enrollees' out-of-pocket costs, such as deductibles, copayments, and coinsurance. Unlike premium subsidies, cost-sharing reductions are not provided as a tax credit and do not need to be "reconciled" when filing taxes. Cost-sharing reductions are only offered through silver plans, and the amount of savings depends on the enrollee's income. Lower-income enrollees will save more on out-of-pocket costs. For example, a silver plan with a $750 deductible could have a reduced deductible of $300 or $500 for those who qualify for cost-sharing reductions. Similarly, a $30 copayment for a doctor's visit could be reduced to $20 or $15.
In Wyoming, small businesses with 1-50 full-time equivalent employees can purchase insurance through the SHOP marketplace and may qualify for a tax credit worth up to 50% of their contribution to employees' premiums. Wyoming also has the option to expand Medicaid coverage to all individuals under 65 whose income is less than 138% of the federal poverty level, which would improve access to affordable health coverage in the state.
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Employer-provided health insurance
In Wyoming, small businesses and employers with between 1 and 50 full-time employees can offer health insurance through the SHOP marketplace. While not mandatory, employers can choose to share the cost of these premiums with their employees. For instance, if a business has fewer than 25 employees earning less than an average of $50,000 per year, they may qualify for a tax credit worth up to 50% of their contribution to employees' premiums.
The ACA requires health insurance to provide coverage for birth control and breastfeeding. While traditional health insurance is the most expensive option for businesses, it does have the advantage of guaranteed enrollment. As long as the worker enrolls during their initial enrollment period, the insurance company cannot turn them down or charge a higher premium because of their medical history.
Under the Affordable Care Act, employers with fewer than 50 workers are not required to offer health insurance. However, if they have 50 or more employees, they must offer an ACA-qualified health insurance plan to all employees working more than 30 hours per week, or pay a penalty. The ACA will also make health insurance more affordable by providing health insurance tax credits and cost-sharing to the uninsured, underinsured, and small businesses.
Health insurance premiums paid by employers are fully deductible as a business expense under federal and Wyoming state law. They are also not taxable to the employee. Health-sharing plans feature lower overall costs and their monthly costs are tax-deductible to the employee. However, employer assistance for paying health-sharing costs is taxable to the employee.
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Tax credits and insurance reforms
Wyoming has several programs in place to help its residents afford medical insurance. Firstly, the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs are Medicare Savings programs that assist income-qualifying Medicare beneficiaries in paying for Medicare premiums, as well as Medicare co-insurance and deductibles in some cases. Additionally, Wyoming provides medical assistance through Medicaid to select populations, including through the Family Care program, which offers health coverage for parents or relatives caring for a child under 18.
Wyoming also has the option to expand Medicaid coverage to all individuals under 65 whose income is less than 138% of the federal poverty level. However, the state has chosen not to expand this program. If it did, it would not only improve access to affordable health coverage but also help the "safety net" of physicians, hospitals, and academic medical centers better serve their low-income patients and reduce cost-shifting.
The ACA (Affordable Care Act) also plays a role in making health insurance more affordable for Wyomingites by providing health insurance tax credits and cost-sharing to the uninsured, underinsured, and small businesses. The small business tax credit provides 50% of the cost of insurance purchased through the SHOP marketplace. Eligible small businesses may use tax credits to help provide insurance benefits to their employees. Wyoming businesses with fewer than 25 employees making less than an average of $50,000 per year may qualify for a tax credit worth up to 50% of their contribution to employees' premiums.
The ACA also created health insurance marketplaces to make shopping for health insurance easier and more transparent. Wyoming residents can use the Health Insurance Marketplace, also called the Exchange, to explore different plan options, apply for insurance coverage, and examine eligibility for cost assistance. These marketplaces allow patients and their families to compare health plans and provide clear information about provider availability, benefits, and costs.
Furthermore, the ACA has implemented insurance reforms to make the market more accessible, predictable, and fair. For example, plans must cover certain preventive services, such as mammograms and colonoscopies, without any patient out-of-pocket costs, and lifetime dollar limits on essential health benefits are no longer allowed. Additionally, insurers in all states can no longer deny insurance to those with pre-existing conditions.
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Private insurers and their rates
Wyoming residents can access affordable, comprehensive health insurance through the Wyoming Marketplace, which offers health insurance products from three private insurers for 2025. These include UnitedHealthcare, which is new to Wyoming's individual market for 2025. The availability of insurers varies across Wyoming's counties, with three counties along the western edge of the state having only two participating Marketplace insurers as UnitedHealthcare does not offer coverage in those areas.
Wyoming's Marketplace insurers have proposed average rate changes for 2025, which are reviewed by the federal government (CMS) as the state does not have an effective rate review program. The rates are finalized before open enrollment, which typically begins in November. It is important to note that overall average rate changes reflect how full-price premiums change year-over-year and do not account for subsidies or age-based annual increases in premiums.
Most enrollees in Wyoming's exchange receive premium subsidies, which significantly offset the cost of their coverage. Additionally, Wyomingites may qualify for advance premium tax credits and cost-sharing reductions when purchasing coverage through the Marketplace, further lowering their out-of-pocket medical expenses.
Medicare Advantage plans, offered by private companies contracting with Medicare, are also an option for Wyoming residents. These plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and other specialized options.
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Frequently asked questions
Wyomingites can afford medical insurance through a variety of options. These include Medicaid, the Health Insurance Marketplace, and private insurers. Wyoming has not expanded its Medicaid program, so only certain groups qualify. The Health Insurance Marketplace offers premium subsidies and cost-sharing reductions to those who qualify. Private insurers like Blue Cross Blue Shield offer Gold, Silver, and Bronze plans at different price points.
The cheapest health insurance option in Wyoming is Medicaid if you qualify. For those who don't qualify for Medicaid, a Silver plan or a Bronze plan can be a good option, with potential discounts and cost-sharing reductions. Blue Cross Blue Shield sells the cheapest Gold plans in Wyoming.
To qualify for Medicaid in Wyoming, you must meet certain income requirements and fit into another category. For example, a woman with breast or cervical cancer can qualify if she earns less than $3,138 per month. Other categories include being a former foster youth, having a disability, or being pregnant.
You can get health insurance discounts in Wyoming through premium subsidies. These are available to those with lower incomes, and almost everyone in Wyoming who shops on HealthCare.gov qualifies. The average subsidy savings is $864/month, bringing the average net premium down to $108/month.
Blue Cross Blue Shield is considered the best health insurance company in Wyoming, offering the cheapest rates across the state. Mountain Health CO-OP also offers good value for money, with lower out-of-pocket maximums.
