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Health Insurance Competition and Market Share in Wisconsin

 

December 7, 2023 

Insurance companies provided medical coverage for nearly 5.6 million people in Wisconsin, as of June 30, 2023, based on enrollment reported in Mark Farrah Associates’ (MFA’s) County Health CoverageTM. As a mix of national, regional, and local insurance carriers do business in its 72 counties, Wisconsin is an ideal state to examine, with its diverse and growing populations. While Milwaukee is the most populous county in Wisconsin, the focus of this brief is Dane County, home to Madison, the state capitol and fastest growing city in the state. [i]

Competition and Market Share

In Wisconsin, UnitedHealthcare and Elevance Health, large national insurance carriers, cover nearly 43% of the state’s health insurance market, combined. However, much of these national carriers’ enrollment is focused in the Milwaukee area, the largest metropolitan area in the state. Looking at Dane County, the second largest county in the state, regional carriers, such as Medica Group and University Health Care/Gundersen Lutheran Group, lead the market.

 

 

  • Medica Group, headquartered in Minnesota, first entered Wisconsin via its western counties in 1998. Medica offers a range of products across several midwestern states, providing individual and family, employer-provided, Medicaid, and Medicare health insurance plans. After merging with Wisconsin-based Dean Health Plans in December of 2021, Medica is now the largest health insurer in Dane County with a total share of 26%. Statewide, Medica covers 9% of insured people in Wisconsin.
  • University Health Care/Gundersen Lutheran Group, majority owners of Quartz Health Plan Corporation, markets managed healthcare products in 40 counties covering south central and southwestern Wisconsin. The group provides coverage to 24% of the insured in Dane County, but only 6% of those covered statewide.
  • In Dane County, UnitedHealthcare and Elevance together cover less than 19% of the market.
  • Other more local plans, such as Group Health Cooperative of South-Central Wisconsin, Dane County’s first health maintenance organization (HMO), and Wisconsin Physicians Service, formed in 1946, have been gaining market share since December 31, 2021, the last time MFA last analyzed this market. Other plans have gained 3% for both state and county shares. Elevance, Medica and University Health Care/Gundersen Lutheran Group are all losing share in Dane County.

About County Health CoverageTM

County Health CoverageTM provides reliable estimates of health insurance enrollment and market share at the state, county, and Metropolitan Statistical Area (MSA) levels. Product features include company market share by county, company, and state for the Private Risk, Private Administrative Services Only (ASO), Medicaid, Medicare Advantage, and stand-alone Prescription Drug Plan (PDP) segments. Breakdowns by product type (HMO, PPO, etc.) are also presented, as well as population demographics and interactive, visual mapping tools. To learn more, visit the product page - County Health CoverageTM.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health PLUS, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

Healthcare Business Strategy is a FREE brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email to the "Subscribe to MFA Briefs" section at the bottom of this page.

 

[i] Demographic Services Center’s 2023 Population Estimates: Wisconsin’s Population Increases Modestly | State of Wisconsin Department of Administration | https://doa.wi.gov/DIR/Final_Ests_Summary_2023.pdf

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