Wisconsin | 2021 | Health Plan Analysis (Event Driven)

Despite new Gov. Tony Evers’ campaign to expand Medicaid, Republican opposition still has to be overcome. The state’s ACA marketplace continues to see large carrier participation, with COVID-19 impacting enrollment. Wisconsin’s insurer pool is highly linked to health systems in state, making Wisconsin a state with many regional carriers. Overall commercial enrollment in the state is led by national carriers like UnitedHealth and Anthem, though some markets like Madison remain wholly controlled by local and regional stakeholders. While the state was en route to begin implementation of work requirements, mandatory health screenings, lifetime benefits, and premiums for some childless adults, the state accepted federal funding during the COVID-19 pandemic and CMS requires no change be made in terms of disenrollment or premium changes in Medicaid during the course. Thus, Medicaid has gone from possible membership loss to growing enrollment owing to pandemic-related job loss. Medicare continues to provide an opportunity for enrollment gains for carriers operating in the state, as Wisconsin’s baby-boomer population continues to age into the program, but competition in the managed Medicare sector remains as fierce as ever, particularly after the largest health system in the state, Advocate Aurora Health, announced the launch of the new MA plan in partnership with Quartz.