Wisconsin health plan · 2026

Better Together HMO Silver 5975 Ded/5975 MOOP HSA · 94529WI0240026

Group Health of South Central Wisconsin offers this marketplace health insurance plan (Plan ID 94529WI0240026) 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: Silver Plan type: HMO CSR: Standard Silver On Exchange Plan Issuer: Group Health of South Central Wisconsin
Telehealth Data pending HSA eligible Yes Dental Not listed Vision Child

CMS AV Calculator output: 70.05% (29.95% 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

$357 – $1399

Before subsidies

Estimate after subsidies

Deductible

$5,975

$11950 per group

See deductible details

Max out-of-pocket

$5,975

$11950 per group

Review MOOP rules

Office visits

Primary care No Charge after deductible
Specialist No Charge after deductible
HSA Eligible

Drug tiers

Generic No Charge after deductible
Preferred brand No Charge after deductible

View formulary tiers

$489 / mo before subsidies

≈ $5863 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.

$1548 / mo before subsidies

≈ $18580 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1875 / mo before subsidies

≈ $22502 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1192 / mo before subsidies

≈ $14300 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

No Charge after deductible

Durable Medical Equipment

No Charge after deductible

Advertisement

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 Silver On 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

No Charge after deductible

Durable Medical Equipment

No Charge after deductible

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.

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 4280
PCPs in Wisconsin 221
Telehealth support Data pending
Nationwide providers 8990
4,280 doctors statewide 221 PCPs 24 OB/GYN
Providers Wisconsin All US states
All 4280 8990
PCP 221 239
Allergy 8 8
OB/GYN 24 25
Dentists 5 8

Drug coverage overview

4,290 drugs tracked

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

Tier Covered drugs
NON-PREFERRED-GENERIC 2,564
NON-PREFERRED-BRAND 924
SPECIALTY-DRUGS 651
MEDICAL-SERVICE-DRUGS 351
Prior authorization Drugs
Required 860
Not Required 3,430
Step therapy Drugs
Required 87
Not Required 4,203
Quantity limits Drugs
Has Limit 987
No Limit 3,303

Customer highlights

What stands out for members

  • Issuer: Group Health of South Central Wisconsin · Plan ID 94529WI0240026 · 2026 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 94529WI0240026-01 (Standard On Exchange Plan) currently displayed.
Advertisement

Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

No Charge after deductible

Diabetes Education

No Charge after deductible

Home Health Care Services

No Charge after deductible

Laboratory Outpatient and Professional Services

No Charge after deductible

Other Practitioner Office Visit (Nurse, Physician Assistant)

No Charge after deductible

Preventive Care/Screening/Immunization

No Charge

Primary Care Visit to Treat an Injury or Illness

No Charge after deductible

Rehabilitative Occupational and Rehabilitative Physical Therapy

No Charge after deductible

Rehabilitative Speech Therapy

No Charge after deductible

Specialist Visit

No Charge after deductible

Urgent Care Centers or Facilities

No Charge after deductible

X-rays and Diagnostic Imaging

No Charge after deductible

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

No Charge after deductible

Delivery and All Inpatient Services for Maternity Care

No Charge after deductible

Dialysis

No Charge after deductible

Durable Medical Equipment

No Charge after deductible

Emergency Room Services

No Charge after deductible

Emergency Transportation/Ambulance

No Charge after deductible

Hospice Services

No Charge after deductible

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

No Charge after deductible

Inpatient Physician and Surgical Services

No Charge after deductible

Mental/Behavioral Health Inpatient Services

No Charge after deductible

Mental/Behavioral Health Outpatient Services

No Charge after deductible

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

No Charge after deductible

Outpatient Rehabilitation Services

No Charge after deductible

Outpatient Surgery Physician/Surgical Services

No Charge after deductible

Radiation

No Charge after deductible

Skilled Nursing Facility

No Charge after deductible

Substance Abuse Disorder Inpatient Services

No Charge after deductible

Substance Abuse Disorder Outpatient Services

No Charge after deductible

Transplant

No Charge after deductible

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Hearing Aids

No Charge after deductible

Major Dental Care - Child

Coverage details pending

Prenatal and Postnatal Care

No Charge

Routine Eye Exam for Children

No Charge after deductible

Well Baby Visits and Care

No Charge

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

No Charge after deductible

Non-Preferred Brand Drugs

No Charge after deductible

Preferred Brand Drugs

No Charge after deductible

Specialty Drugs

No Charge after deductible

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

No Charge after deductible

Basic Dental Care - Adult

Coverage details pending

Dental Check-Up for Children

Coverage details pending

Infusion Therapy

No Charge after deductible

Major Dental Care - Adult

Coverage details pending

Nutritional Counseling

Coverage details pending

Orthodontia - Adult

Coverage details pending

Orthodontia - Child

Coverage details pending

Post-Cochlear Implant Aural Rehabilitation Therapy

No Charge after deductible

Prosthetic Devices

No Charge after deductible

Pulmonary Rehabilitation Therapy

No Charge after deductible

Routine Dental Services (Adult)

Coverage details pending

Weight Loss Programs

Coverage details pending

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Acupuncture

Coverage details pending

Allergy Testing

Coverage details pending

Bariatric Surgery

Coverage details pending

Cardiac Rehabilitation

No Charge after deductible

Cosmetic Surgery

Coverage details pending

Eye Glasses for Children

No Charge after deductible

Gender Affirming Care

No Charge after deductible

Habilitation Services

No Charge after deductible

Imaging (CT/PET Scans, MRIs)

No Charge after deductible

Infertility Treatment

Coverage details pending

Long-Term/Custodial Nursing Home Care

Coverage details pending

Private-Duty Nursing

Coverage details pending

Reconstructive Surgery

No Charge after deductible

Routine Eye Exam (Adult)

Coverage details pending

Routine Foot Care

Coverage details pending

Treatment for Temporomandibular Joint Disorders

No Charge after deductible

Variant attributes

Better Together HMO Silver 5975 Ded/5975 MOOP HSA · Variant 94529WI0240026-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Silver On Exchange Plan

HIOS Product ID

94529WI024

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

94529WI0240026-01

Plan Marketing Name

Better Together HMO Silver 5975 Ded/5975 MOOP HSA

Plan Variant Marketing Name

Better Together HMO Silver 5975 Ded/5975 MOOP HSA

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

94529

Issuer Marketplace Marketing Name

Group Health Cooperative-SCW

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

WIN002

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

WIS002

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

0.700525798

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$5,975

SBC Scenario, Having Diabetes, Coinsurance

$120

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$5,290

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,170

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

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

0.00%

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

$11950 per group

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

$5975 per person

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

$5,975

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

WIF006

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$50

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$10

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

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy

EHB Percent of Total Premium

0.999999

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

Yes

New/Existing Plan

Existing

Notice Required for Pregnancy

Yes

Is a Referral Required for Specialist?

Yes

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Level Exclusions

Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Specialist Requiring a Referral

Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care

Plan ID

94529WI0240026

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$11950 per group

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

$5975 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$5,975

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

No

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?

Better Together HMO Silver 5975 Ded/5975 MOOP HSA (94529WI0240026) is a Silver HMO from Group Health of South Central Wisconsin 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 Better Together HMO Silver 5975 Ded/5975 MOOP HSA 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 Better Together HMO Silver 5975 Ded/5975 MOOP HSA 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 Better Together HMO Silver 5975 Ded/5975 MOOP HSA 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 Better Together HMO Silver 5975 Ded/5975 MOOP HSA?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.

Is there out-of-country coverage for Better Together HMO Silver 5975 Ded/5975 MOOP HSA?

No, out-of-country services are not covered for this plan.

Does Better Together HMO Silver 5975 Ded/5975 MOOP HSA cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

How do I enroll in or manage payments for Better Together HMO Silver 5975 Ded/5975 MOOP HSA?

Use the issuer portal https://quote.ghcscw.com/MarketPlaceWelcome 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.
Open comparison tray

Add at least two plans to launch side-by-side comparisons.