Learn what family health insurance plans in Madison, WI typically cover.

What Do Family Health Insurance Plans in WI Cover?

Most family health insurance plans in Wisconsin offer all essential health benefits if they are an Affordable Care Act (ACA) compliant plan. Because of the ACA, insurance plans in Wisconsin generally must cover the same essential health benefits. These benefits may be very good news for people looking for family health insurance plans and include –

  • Maternity and Childbirth Care
  • Certain Preventive Services
  • Prescription Coverage
  • Emergency Services
  • Services for Mental Health & Substance Use
  • Outpatient Care (doctor visits, lab tests, etc.)
  • Inpatient Care (hospital stays, surgery, etc.)
  • Rehabilitation Services

ACA-compliant family health plans also cover a specific set of preventive services for children without charging you a copayment, coinsurance or deductible. This list includes –

  • Autism Screening
  • Developmental Screenings
  • Hearing and vision checks
  • Certain Vaccinations
  • Obesity Screening

When looking for family insurance plans in WI, be sure to find out if the plan offers wellness programs.  Some insurance plans offer great programs for families that actually provide cash rewards for healthy activities and prizes for children who participate. For example, Unity offers Fitness FirstSM & More and Fitness FirstSM for Kids that reward families for many types of wellness activities.

 

What do family health insurance plans cost?

Health plans for families and individuals are usually offered in five basic categories – bronze, silver, gold, platinum and catastrophic. These “metal level” plans may cover the same kinds of benefits in Wisconsin. What generally differs is how much they pay, on average, toward the out-of-pocket costs of healthcare services. Here’s how it works –

  • Bronze Plan: Lowest premium cost and highest out-of-pocket costs
  • Silver Plan: Moderate premium cost and moderate out-of-pocket costs
  • Gold Plan: Higher premiums with lower out-of-pocket costs
  • Platinum Plan: Highest premiums with lowest out-of-pocket costs
  • Catastrophic  Plan:  For people who are under 30 or who have a hardship exemption.  These plans may cost less up front, but they generally don’t give you as much coverage. They usually require you to pay more out-of-pocket costs

Costs for family insurance plans vary based on your age, where you live and your tobacco use*. You cannot be charged more because of your gender or any health conditions.

 

What type of insurance plan is the best fit for my family?

Growing families tend to use a lot of health care services, so it could make sense to choose a plan with a higher premium and lower out-of-pocket costs (platinum and gold level).  Be sure to check if your family health insurance offers robust wellness programs and other programs that help growing families.  For instance, Unity offers 9 Months & MoreSM to help moms through pregnancy and beyond.


Gold and Platinum level plans may feature higher premiums, but may offer lower copayments, deductibles and coinsurance. This helps you budget and know what you may be paying month-to-month to provide health insurance for your family. It also offers the security of knowing you have some protection from financial risk if you or your children require specialized care.


Now that you know what to look for, browse our family health insurance plans in WI and get a quote right now. With a plan from Unity, your family will get access to American Family Children’s Hospital and referral-free access to the specialists and physicians of UW Health.





  1. https://www.healthcare.gov/preventive-care-benefits/children/
  2. http://www.webmd.com/health-insurance/wi/wisconsin-health-insurance-marketplace

*Tobacco Surcharge: Wisconsin allows health insurance companies to charge tobacco users 50 percent more than non-tobacco users.