Alyssa Lane
Major medical insurance in Madison, Wisconsin, is offered by several providers, including the City of Madison, Schwarz Insurance, Frank Insurance Group, and Informed Choice Insurance Agency. The City of Madison provides employees with a choice of plans, including health maintenance organizations (HMOs) such as Dean Health Plan, Group Health Cooperative (GHC), and Quartz - UW Health. Additionally, the city offers optional dental and vision insurance. Residents of Madison can also seek assistance from organizations like Covering Wisconsin and The Health Insurance Store to find suitable health insurance plans, including Medicare and individual or family coverage options. Madison residents have access to a range of health insurance solutions, with experts guiding them through the insurance landscape to ensure they receive the necessary coverage for themselves and their families.
| Characteristics | Values |
|---|---|
| Location | Madison, Wisconsin |
| Type of Insurance | Major medical insurance |
| Providers | Covering Wisconsin, Aging and Disability Resource Center of Dane County, Compass Wisconsin Threshold, Public Health Services, The Health Insurance Store, Schwarz Insurance, Frank Insurance Group, Informed Choice Insurance Agency, HealthMarkets |
| Plan Options | Medicare, Individual & Family Coverage, Employer Group Plans, ACA Health Insurance Plans, Medicare Supplements, Group Health Insurance, Dental Insurance, Vision Insurance, Prescription Drug Coverage, Travel Insurance, Cancer Insurance, Life Insurance |
| Additional Services | Free consultation, health incentive accounts, assistance with enrollment and plan selection |
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What You'll Learn
Medicare and Individual & Family Plans
In Madison, Wisconsin, there are several options for Medicare and individual and family health insurance plans.
Medicare Advantage Plans
Medicare Advantage plans (also known as Medicare Part C) are offered by Medicare-approved private insurance companies. These plans provide the same level of coverage as Original Medicare (Part A and Part B) but are administered through the private insurance company rather than the government-run Medicare program. Medicare Advantage plans may also offer additional benefits beyond Original Medicare, such as routine vision, dental, hearing, or wellness programs. In 2023, there were 126 Medicare Advantage plans available in Wisconsin, with an average monthly premium of $27.28.
Individual & Family Plans
There are several health insurance providers in Wisconsin that offer individual and family plans, including Dean Health Plan, Group Health Cooperative of South Central Wisconsin, and WPS Health Insurance. These plans typically have annual medical deductibles of $500 for single coverage and $1,000 for family coverage. Single plans cover only the employee, while family plans can cover any combination of the employee, spouse, and/or dependents.
City of Madison Employee Plans
The City of Madison offers its employees a choice of health insurance plans through the Wisconsin Public Employer Group Health Insurance program. These include three health maintenance organizations (HMOs) with networks in the Dane County service area: Dean Health Plan, Group Health Cooperative (GHC) of South Central Wisconsin - Dane Choice, and Quartz - UW Health. Employees can sign up for health insurance when they start their eligible employment, during the annual open enrollment period, or within a specified time after a qualifying event, such as a family status change or loss of other coverage.
Additionally, the City of Madison offers optional vision and dental insurance through Delta Vision's Select Network and Delta Dental, respectively. Prescription drug insurance is provided through Navitus Health Solutions for employees enrolled in health insurance coverage.
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Vision and Dental Insurance
The City of Madison offers its employees a range of health insurance options, including vision and dental insurance.
Vision Insurance
Eligible employees can sign up for vision insurance when they start their employment with the City of Madison, during the annual open enrollment period, or within 30 days of experiencing a qualifying life event. Current employees cannot make changes to their vision coverage outside of the open enrollment period unless they have experienced a qualifying event, such as a change in family status. The City of Madison offers optional vision insurance through Delta Vision's Select Network. Additionally, Delta Dental of Wisconsin has partnered with EyeMed to provide a vision care discount program. This program offers savings on eye exams, glasses, contact lenses, and laser vision correction.
Dental Insurance
The City of Madison provides its employees with optional dental insurance through Delta Dental. Similar to vision insurance, employees can enroll in dental insurance when they start their employment, during the annual open enrollment period, or within 30 days of a qualifying event. Employees cannot make changes to their dental coverage outside of the open enrollment period unless there is a qualifying event. The City does not contribute to the premium for this benefit.
Additional Resources
Covering Wisconsin is a non-profit organization that helps residents of Wisconsin find and utilize health insurance. The Aging and Disability Resource Center of Dane County and Compass Wisconsin Threshold are also resources that can help individuals apply for public benefits and health insurance. These organizations can assist with applications for programs like Medicare and Social Security, as well as benefits for children with special healthcare needs.
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Prescription Drug Insurance
In Madison, Wisconsin, prescription drug insurance is provided through Navitus Health Solutions. Employees who are enrolled in health insurance coverage are automatically enrolled in Navitus and will receive a separate Navitus membership card.
The City of Madison offers its employees the choice of any plan offered through ETF's Wisconsin Public Employer Group Health Insurance PO 14. This includes three health maintenance organizations (HMOs) with networks in the Dane County service area: Dean Health Plan, Group Health Cooperative (GHC) of South Central Wisconsin - Dane Choice, and Quartz - UW Health.
There are also several other options for prescription drug insurance in Madison, Wisconsin. SeniorCare, for example, is a program that helps older adults pay for prescription drugs and vaccines. To enroll, individuals must be Wisconsin residents and U.S. citizens or qualifying immigrants. Additionally, Medicare Part D offers prescription drug coverage, and there are programs such as NeedyMeds and Rx Outreach that provide information on free or low-cost prescription drug programs for those in need.
For those seeking help with drug and alcohol addiction treatment, the Madison Wisconsin Recovery Center offers a range of services, including evidence-based therapies, holistic practices, and support groups. The center works closely with individuals to optimize insurance coverage for treatment expenses.
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Short-term Health Insurance
In Madison, Wisconsin, short-term health insurance is available through companies like UnitedHealthcare, which offers plans underwritten by the Golden Rule Insurance Company. These plans can provide flexible, limited-duration coverage for individuals in various life situations, such as those who are between jobs, gig workers, new college graduates, or early retirees.
When considering a short-term health insurance plan in Madison, Wisconsin, it's important to carefully review the plan details. While these plans can offer financial protection and flexibility, they may not provide the same comprehensive coverage as ACA plans. Applicants should also be aware that their application may be declined or their pre-existing conditions may not be covered. Obamacare, on the other hand, guarantees coverage for all applicants and their pre-existing conditions, regardless of health status.
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Affordable Care Act (ACA) Health Insurance Plans
The Affordable Care Act (ACA) has expanded access to health insurance for many Americans, including those in Madison, Wisconsin. Under the ACA, individuals have a range of options for obtaining major medical insurance, including:
Employer-Sponsored Health Insurance Plans: Many individuals in Madison, Wisconsin, may obtain health insurance through their employer. The City of Madison, for example, offers its employees a choice of plans through the Wisconsin Public Employer Group Health Insurance Program, including three health maintenance organizations (HMOs): Dean Health Plan, Group Health Cooperative (GHC) of South Central Wisconsin - Dane Choice, and Quartz - UW Health. These plans typically provide comprehensive coverage for medical, dental, and vision care, with the cost shared between the employer and employee.
Individual Health Insurance Marketplace: For those who are self-employed or not covered by an employer-sponsored plan, the ACA established Health Insurance Marketplaces, also known as exchanges. Individuals in Madison can visit the Health Insurance Marketplace website or work with a certified application counsellor or broker to compare plans, prices, and enrol. Financial assistance in the form of premium tax credits and cost-sharing reductions may be available to eligible individuals and families based on income and household size.
Medicaid Expansion: Wisconsin has expanded its Medicaid program under the ACA, providing coverage to a larger number of low-income individuals and families. Individuals can apply for Medicaid at any time through the Health Insurance Marketplace or their state's social services agency. Those who qualify for Medicaid may receive comprehensive health benefits with little or no out-of-pocket costs.
Young Adult Coverage: The ACA allows young adults to remain on their parent's health insurance plan until they turn 26 years old, regardless of their student status, marital status, or residence. This provision has helped increase the number of insured young adults in Madison and across the country.
Standardized Benefits and Consumer Protections: All ACA-compliant major medical insurance plans in Madison, Wisconsin, must provide essential health benefits, including ambulatory patient services, emergency services, hospitalisation, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services, and paediatric services. Insurers are prohibited from denying coverage or charging higher premiums based on pre-existing conditions, and annual and lifetime dollar limits on essential health benefits have been eliminated.
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Frequently asked questions
Major medical insurance, also known as comprehensive health insurance, covers a wide range of health benefits. This includes emergency services, maternity care, prescription drugs, and more.
Here is a list of some major medical insurance providers in Madison, Wisconsin:
- Schwarz Insurance
- Frank Insurance Group
- Informed Choice Insurance Agency
- The Health Insurance Store
- Medical Insurance Solutions for Seniors
- Covering Wisconsin
It is important to consider your health needs and budget when choosing a major medical insurance plan. Additionally, it is essential to review the available insurance plans and carriers in your area, as well as understand the enrollment periods and requirements.
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