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    v1.0.28
    OpenPayerStatesWisconsin
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    Wisconsin Health Insurance Market Analysis: Market Share, Payer Mix, and Coverage Trends

    Wisconsin's health insurance market is led by UnitedHealth Group, with other major payers including Elevance Health Inc Group and Humana Group. The state features a concentrated insurance landscape, with employer-based coverage as the predominant form of private insurance.

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    State Overview

    • Total population: 5.85M

    • Number of counties: Data not available.

    • Private insurance penetration rate: 73.45%

    • Estimated members covered by UnitedHealth Group: 1.11M

    Insurance Market

    RankInsurerPremium WrittenEstimated Members CoveredMarket Share
    1UnitedHealth Group$7.17B1.11M25.96%
    2Elevance Health Inc Group$3.29B513K11.94%
    3Humana Group$2.43B378K8.79%
    4University Health Care & Gundersen Lutheran$2.17B338K7.86%
    5Medica Group

    Frequently Asked Questions

    References

    1. 1.S2703: Private Health Insurance Coverage by Type and Selected Characteristics. U.S. Census Bureau, 2024 American Community Survey 5-Year Estimates. Retrieved Aug 11, 2026.Annual estimates of private health insurance coverage rates by state, broken out by age, income, and plan type — the basis for this page's coverage-rate figures.
    2. 2.2024 Market Share Reports for the Top Accident and Health Insurance Groups and Companies by State and Countrywide. National Association of Insurance Commissioners (NAIC). Retrieved Aug 11, 2026.Ranks the largest accident and health insurance carriers by direct premiums written in each state, used to identify the dominant payers operating there.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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    $2.01B
    312K
    7.27%
    6Security Health Plan of WI Inc$1.48B231K5.38%
    7Network Health Group$1.37B212K4.95%
    8Molina Healthcare Inc Group$1.23B191K4.44%
    9CVS Group$526M82.5K1.91%
    10Group Health Coop of S Central WI$483M75.2K1.75%

    Wisconsin's health insurance market is dominated by UnitedHealth Group, which holds the largest share and covers the most privately insured members. Elevance Health Inc Group and Humana Group also play significant roles, but their market shares are notably smaller than UnitedHealth Group's. The top five insurers collectively control a majority of the market, indicating a concentrated payer landscape.

    Premiums written by these insurers reflect their scale and reach, with UnitedHealth Group leading by a wide margin. The estimated member counts further illustrate the dominance of the top payers, with substantial coverage provided to Wisconsin residents. Smaller insurers, while present, account for a much lower proportion of the market, reinforcing the competitive advantage held by the leading groups.

    Insured Population Demographics

    Coverage TypeCountShare of Privately Insured
    Employer-Based3.03M70.56%
    Direct-Purchase315K7.34%
    TRICARE26.5K0.62%
    CHIP/Subsidized111K2.59%

    The majority of privately insured individuals in Wisconsin are covered through employer-based plans, accounting for over two-thirds of the privately insured population. Direct-purchase coverage represents a smaller segment, while TRICARE and CHIP/subsidized programs cover a modest proportion of residents.

    Wisconsin's privately insured population is distributed across all age bands, with the largest groups found in the 6-18, 35-44, and 55-64 ranges. The presence of CHIP/subsidized coverage highlights the state's support for children and lower-income families, while TRICARE coverage reflects the population of military-affiliated individuals.

    Market Dynamics

    Wisconsin's health insurance market is characterized by a high degree of concentration among a few dominant payers. UnitedHealth Group leads the market with a substantial share, followed by Elevance Health Inc Group and Humana Group. The top five insurers collectively account for over 60% of the market, indicating limited competition among smaller payers.

    The estimated number of privately insured residents covered by UnitedHealth Group alone exceeds 1.11M, underscoring its significant influence in the state's insurance landscape. Other major players, such as Elevance Health Inc Group and Humana Group, also maintain large membership bases, but none approach the scale of UnitedHealth Group.

    Employer-based insurance remains the primary coverage type, reflecting Wisconsin's robust employment and benefits environment. Direct-purchase and subsidized programs play a secondary role, with CHIP/subsidized coverage supporting children and families who may not have access to employer-sponsored plans.

    The age distribution of the privately insured population is broad, with notable concentrations in working-age adults and children. This demographic profile suggests a stable insurance market with coverage extending across all life stages, supported by both private and public programs.

    Top 10 Health Insurers by Market Share in Wisconsin
    Privately Insured Population by Age Band in Wisconsin