Wisconsin health plan · 2026

Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) · 79475WI0550023

Compcare Health Services Insurance Corporation (HMO/POS-in network) offers this marketplace health insurance plan (Plan ID 79475WI0550023) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Expanded Bronze Plan type: HMO CSR: Standard Bronze Off Exchange Plan Issuer: Compcare Health Services Insurance Corporation (HMO/POS-in network)
Telehealth Data pending HSA eligible Yes Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 63.56%. Expect to pay roughly 36.44% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 63.67% (36.33% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$300 – $1178

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$10,600

$21200 per group

Review MOOP rules

Office visits

Primary care $30.00
Specialist $150.00
HSA Eligible

Drug tiers

Generic $25.00
Preferred brand $175.00 Copay after deductible

View formulary tiers

$411 / mo before subsidies

≈ $4938 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1304 / mo before subsidies

≈ $15647 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1579 / mo before subsidies

≈ $18949 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1004 / mo before subsidies

≈ $12042 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$3,000.00

Durable Medical Equipment

50.00%

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Wisconsin). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Bronze Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$3,000.00

Durable Medical Equipment

50.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 79475WI0550023
Coverage year 2026
State Wisconsin
Issuer Compcare Health Services Insurance Corporation (HMO/POS-in network)
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 79475WI0550023-00
Available variants

Standard Off Exchange Plan · 79475WI0550023-00

Standard On Exchange Plan · 79475WI0550023-01

Open to Indians below 300% FPL · 79475WI0550023-02

Open to Indians above 300% FPL · 79475WI0550023-03
Last plan update Thu, 30 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Wisconsin 28833
PCPs in Wisconsin 4296
Telehealth support Data pending
Nationwide providers 92669
28,833 doctors statewide 4,296 PCPs 136 OB/GYN

Provider network(s)

Providers Wisconsin All US states
All 28833 92669
PCP 4296 4774
Allergy 15 18
OB/GYN 136 163
Dentists 82 98

Drug coverage overview

3,511 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
TIER-FOUR 3,511
Prior authorization Drugs
Required 769
Not Required 2,742
Step therapy Drugs
Required 106
Not Required 3,405
Quantity limits Drugs
Has Limit 2,013
No Limit 1,498

Customer highlights

What stands out for members

  • Issuer: Compcare Health Services Insurance Corporation (HMO/POS-in network) · Plan ID 79475WI0550023 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 79475WI0550023-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Member is responsible for the Primary Care Physician cost share amount when service is performed by a Primary Care Physician or Chiropractor. Cost share may vary based on your place of service. Please refer to the plan policy documents for detailed information.

Diabetes Education

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

Home Health Care Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

Laboratory Outpatient and Professional Services

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

Cardiac Calcium Screenings, Carotid Intimal Medical Thickness Tests and High Sensitivity C-Reactive Protein Tests are covered with no member cost share. Cost share may vary based on your place of service. Please refer to the plan policy documents for detailed information.

Other Practitioner Office Visit (Nurse, Physician Assistant)

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Office Visits apply to copayment. Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual PCP visits from designated virtual care-only providers. If this is an HSA plan, deductible applies.

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

This plan offers a Well-being Coach to encourage healthier habits and behavior changes to reduce the risk and cost associated with chronic conditions. This program will help modify behaviors associated with obesity, tobacco use, poor nutrition, inactivitiy, poor sleep, and stress. You may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for. Covered Services also include lead poisoning screening for Dependents under age six (6), as required by state law.

Primary Care Visit to Treat an Injury or Illness

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Cardiologist office visits will follow this cost share. Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual PCP visits from designated virtual care-only providers. If this is an HSA plan, deductible applies.

Rehabilitative Occupational and Rehabilitative Physical Therapy

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

Limit: 40.0 Visit(s) per Year

20 visits each Physical Therapy/Occupational Therapy per year. Limit is combined across professional visits and outpatient facilities. Cost share may vary based on your place of service. Please refer to the plan policy documents for detailed information.

Rehabilitative Speech Therapy

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Limit is combined across professional visits and outpatient facilities.

Specialist Visit

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

Cardiologist office visits will follow this cost share. Office Visits apply to copayment. Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual PCP visits from designated virtual care-only providers. If this is an HSA plan, deductible applies.

Urgent Care Centers or Facilities

$100.00
Tier 1 in-network $100.00
Out-of-network $100.00

X-rays and Diagnostic Imaging

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

Carotid Intimal Medical Thickness Tests are covered at no member cost share. Cost share for additional services may vary based on your place of service. Please refer to the plan policy documents for detailed information.

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

$3,200.00
Tier 1 in-network $3,200.00
Out-of-network 100.00%

Excludes services related to surrogacy if member is not the surrogate.

Dialysis

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Durable Medical Equipment

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

Limited to a single purchase of a type of Durable Medical Equipment/Prosthetic (including repair and replacement) every 3 years.

Emergency Room Services

$3,000.00
Tier 1 in-network $3,000.00
Out-of-network $3,000.00

When directly admitted to the hospital, the Emergency Room copay is NOT waived.

Emergency Transportation/Ambulance

50.00%
Tier 1 in-network 50.00%
Out-of-network 50.00%

Non-emergency ambulance/transportation out of network is not covered unless authorized. Authorized out of network is limited to $50,000 per trip.

Hospice Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Inpatient Hospital Services (e.g., Hospital Stay)

$3200.00 Copay per Stay
Tier 1 in-network $3200.00 Copay per Stay
Out-of-network 100.00%

Inpatient Physical Medicine and Rehabilitation (includes Day Rehabilitation Therapy services on an Outpatient basis) – Limited to a maximum of 60 days per Member, per Calendar Year.

Inpatient Physician and Surgical Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

$3200.00 Copay per Stay
Tier 1 in-network $3200.00 Copay per Stay
Out-of-network 100.00%

Mental/Behavioral Health Outpatient Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Outpatient Rehabilitation Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

20 visit limit for each Physical Therapy, Occupational Therapy and Speech Therapy. Cost share may vary based on your place of service. Please refer to the plan policy documents for detailed information.

Outpatient Surgery Physician/Surgical Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Radiation

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Skilled Nursing Facility

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 30.0 Days per Admission

Substance Abuse Disorder Inpatient Services

$3200.00 Copay per Stay
Tier 1 in-network $3200.00 Copay per Stay
Out-of-network 100.00%

Substance Abuse Disorder Outpatient Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Transplant

$3,200.00
Tier 1 in-network $3,200.00
Out-of-network 100.00%

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

1 hearing aid per ear every 3 years.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Benefits are covered under preventive care.

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$25.00
Tier 1 in-network $25.00
Tier 2 in-network $40.00
Out-of-network 100.00%

Cost share reflects a 30 day retail supply. $0 Select Drugs: We offer a $0 cost share for a select set of tier 1 (Generic) prescription drugs. Certain low-cost drugs, on Tier 1, may be available to Members at no Cost Share. These drugs are listed on Our Prescription Drug List (formulary).

Non-Preferred Brand Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Tier 2 in-network 55.00% Coinsurance after deductible
Out-of-network 100.00%

30 day supply retail.

Preferred Brand Drugs

$175.00 Copay after deductible
Tier 1 in-network $175.00 Copay after deductible
Tier 2 in-network $190.00 Copay after deductible
Out-of-network 100.00%

30 day supply retail.

Specialty Drugs

45.00% Coinsurance after deductible
Tier 1 in-network 45.00% Coinsurance after deductible
Tier 2 in-network 60.00% Coinsurance after deductible
Out-of-network 100.00%

30 day supply retail.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

Limit: 3000.0 Dollars per Episode

Limited to $900 per tooth.

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

Limit is applicable to a single purchase of a type of prosthetic device. Limit does not apply to prosthetics required by the Women’s Health and Cancer Rights Act of 1998.

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Habilitation Services

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

20 visit limit for each Physical Therapy, Occupational Therapy and Speech Therapy. Cost share may vary based on your place of service. Please refer to the plan policy documents for detailed information.

Imaging (CT/PET Scans, MRIs)

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Cardiac Calcium Screenings are covered with no member cost share. Cost share for additional services may vary based on your place of service. Please refer to the plan policy documents for detailed information.

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

$3,200.00
Tier 1 in-network $3,200.00
Out-of-network 100.00%

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Treatment for Temporomandibular Joint Disorders

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Covered Services include removable appliances for TMJ repositioning and related surgery, medical care, and diagnostic services. Covered Services do not include fixed or removable appliances that involve movement or repositioning of the teeth (braces), repair of teeth (fillings), or prosthetics (crowns, bridges, dentures).

Variant attributes

Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) · Variant 79475WI0550023-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Bronze Off Exchange Plan

HIOS Product ID

79475WI055

Metal Level

Expanded Bronze

Plan ID (Standard Component ID with Variant)

79475WI0550023-00

Plan Marketing Name

Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)

Plan Variant Marketing Name

Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

63.56%

Issuer ID

79475

Issuer Marketplace Marketing Name

Anthem Blue Cross and Blue Shield

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

WIN001

Out of Country Coverage

No

Out of Country Coverage Description

Urgent/Emergency Coverage Only

Out of Service Area Coverage

No

Out of Service Area Coverage Description

TRAD/PAR network

Service Area ID

WIS012

State Code

WI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.636692197

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

45.00%

Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

45.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

50.00%

Medical EHB Deductible, In Network (Tier 2), Default Coinsurance

50.00%

SBC Scenario, Having a Baby, Coinsurance

$2,000

SBC Scenario, Having a Baby, Copayment

$4,100

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,600

SBC Scenario, Having Diabetes, Deductible

$2,900

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$600

SBC Scenario, Treatment of a Simple Fracture, Copayment

$1,400

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$21200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$10600 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$10,600

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group

$21200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person

$10600 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual

$10,600

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

WIF516

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$5800 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$2900 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$2,900

Drug EHB Deductible, In Network (Tier 2), Family Per Group

$5800 per group

Drug EHB Deductible, In Network (Tier 2), Family Per Person

$2900 per person

Drug EHB Deductible, In Network (Tier 2), Individual

$2,900

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management

EHB Percent of Total Premium

1

First Tier Utilization

28%

Import Date

10/30/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

Yes

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$0

Medical EHB Deductible, In Network (Tier 2), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 2), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 2), Individual

$0

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

HMO

QHP/Non QHP

Both

Second Tier Utilization

72%

Source Name

HIOS

Plan ID

79475WI0550023

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Wisconsin?

Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) (79475WI0550023) is a Expanded Bronze HMO from Compcare Health Services Insurance Corporation (HMO/POS-in network) in Wisconsin for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) HSA-eligible and does it include dental or vision coverage?

It is HSA-eligible, so you can pair it with a Health Savings Account to lower taxes.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management.

Is there out-of-country coverage for Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)?

No, out-of-country services are not covered for this plan. Details: Urgent/Emergency Coverage Only

Does Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: TRAD/PAR network

How do I enroll in or manage payments for Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)?

Use the issuer portal https://payment.anthem.com/sales/payment/exchange?state=WI to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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