Wisconsin releases recent study analyzing state’s medical insurance marketplace – InsuranceNewsNet


Wisconsin’s Office of the Commissioner of Insurance (OCI) has released a report evaluating enrollment within the Reasonably priced Care Act Marketplace, other coverages, and the uninsured population.

The Wisconsin Individual Health Insurance Market Evaluation (Market Evaluation) was conducted due to funding through the State Flexibility to Stabilize the Market Cycle II Grant Program (State Flexibility Grant) administered by the Centers for Medicare and Medicaid Services.

“This report provides vital insights for health care access advocates, enrollment assistance organizations, health plans, and our agency as we prepare for the tenth annual Open Enrollment Period,” said Insurance Commissioner Nathan Houdek. “It’s the primary of three reports we have now commissioned with the State Flexibility Grant funding to assist us evaluate and monitor the medical insurance market in Wisconsin.”

The Market Evaluation highlighted several key takeaways that help discover barriers to health coverage and can inform OCI’s efforts to extend individual market enrollment:

• Wisconsin has an estimated 312,000 uninsured residents, with the statewide uninsured rate estimated at 5.5% in 2020. Individuals with lower incomes are substantially more prone to be uninsured, as are individuals of color and Hispanic/Latinos of any race.

• The Reasonably priced Care Act (ACA)-compliant individual market has grown 8% from 2018 to 2021 and shows similar growth in five of the six OCI-defined regions of the state.

• Open enrollment for plan yr 2022 resulted in 212,209 Wisconsin consumers choosing plans through the ACA Marketplace. Eighty-eight percent of those consumers qualified for premium subsidies. This enrollment increase reflects the improved premium subsidies under the American Rescue Plan Act, which were prolonged for 3 more years under the Inflation Reduction Act of 2022.

• Yet, over half of uninsured adult respondents report knowing “somewhat or nothing in any respect” about Marketplace coverage options and about Marketplace financial assistance.

• Wisconsin consumer demand for and use of Navigator services has increased substantially previously yr; Wisconsin’s Navigator agency, Covering Wisconsin, doubled the unduplicated monthly count of consumers assisted and services provided within the open enrollment months of late 2021 (for plan yr 2022) in comparison with late 2020 (for plan yr 2021).

• State survey results align with national surveys and ensure the necessity for further outreach efforts to deal with consumer knowledge and understanding of 1) coverage options, available subsidies, and enrollment assister resources; and a couple of) cost-sharing, deductibles, and other medical insurance plan design features.

Governor Tony Evers launched the DHS OCI Health Care Coverage Partnership in 2019 to enhance coordination around outreach and education, increasing enrollment and medical insurance literacy, and improving enrollment retention. Wisconsin’s unique Partnership has allowed OCI to have interaction with stakeholders working in health care access advocacy and enrollment to each inform the event of this Market Evaluation and share the outcomes widely.

“Continual outreach is a crucial component of efforts to take care of and increase health coverage in Wisconsin. We’re excited to leverage the data in OCI’s Market Evaluation in our ongoing consumer education and engagement work,” said Courtney Harris, Outreach and Partner Relations Manager at Covering Wisconsin.

State Flexibility Grant funds could be used for a wide range of planning and implementation objectives related to the chosen market reforms and consumer protections corresponding to developing actuarial and economic analyses and performing market scans of the states’ medical insurance market to enhance and expand the variety of coverage options. OCI commissioned three reports funded by the State Flexibility Grant including the Market Evaluation, a study of short-term limited duration plans, and a review of network adequacy. Wisconsin’s State Flexibility Grant has a project period that ends September 14, 2023.


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