COBRA & Under-65 Health Insurance Guidance
Reviewed by Prodest Insurance Group, a licensed insurance agency (NPN 19515569) · Updated 20 October 2026 against Office of the Commissioner of Insurance guidance and federal sources.
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| Federal COBRA | Wisconsin continuation | |
|---|---|---|
| Employer size | 20 or more employees | Any size |
| Where you live | No requirement | You may live outside Wisconsin and still qualify if the employer is in the state |
| Plan type | Insured and self-funded | Not self-funded plans. Not specified disease or accident-only policies |
| How long | 18 months, up to 36 for some events | 18 months |
| Prior coverage needed | None | Three months continuously covered |
| If you quit | Covered | Covered. Voluntary or involuntary loss of eligibility, except discharge for misconduct |
| Dental, vision, prescription | Continued | Not required to continue if offered as separate policies |
| Single coverage | Family coverage | |
|---|---|---|
| Average full annual premium in Wisconsin | $9,557 | $27,309 |
| Estimated COBRA cost per month (102%) | $812 | $2,321 |
Estimate = average total employer premium in Wisconsin × 1.02 ÷ 12, from the federal Medical Expenditure Panel Survey (2025). These are averages. Your exact premium depends on your former employer's plan and is listed on your COBRA election notice. If you are on state continuation instead of federal COBRA, the premium rules described on this page apply.
About $812 a month for single coverage and $2,321 a month for family coverage, based on Wisconsin's 2025 average employer premium plus the 2 percent administrative fee federal COBRA allows. Your actual premium depends on your former employer's plan and appears on your COBRA election notice.
Wisconsin uses the federal Health Insurance Marketplace. Losing job-based coverage opens a 60-day Special Enrollment Period, and you can enrol up to 60 days before coverage ends so a new plan starts as the old one stops. Wisconsin did not adopt the ACA Medicaid expansion, but it took a different route from most non-expansion states. BadgerCare Plus covers adults with income up to the federal poverty level, so Wisconsin does not have the coverage gap found in states that neither expanded nor extended eligibility. Households above that threshold move to marketplace coverage with premium tax credits.
No. It applies to group policies issued to employers of any size, so many people are covered by both federal COBRA and Wisconsin law.
The Office of the Commissioner of Insurance states that the law more favourable to the insured should apply.
Yes. Employees who live outside Wisconsin but work for an employer located in Wisconsin are eligible.
18 months, after voluntary or involuntary loss of eligibility, except discharge for misconduct.
When the leave ends, or when coverage would otherwise end, not when the leave began.
Not if they were offered as separate policies. Self-funded plans and specified disease or accident-only policies are also outside the state law.
Wisconsin's Medicaid program covers adults with income up to the federal poverty level, and there is no enrolment window.
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This website provides educational information about health insurance and is a solicitation for insurance. It is a non-government website operated by Prodest Insurance Group, a health insurance agency that presents health plans, which may include Affordable Care Act (ACA) plans, private health insurance, short-term medical insurance, or supplemental insurance based on the consumer's selection. Qualified ACA plans must meet or exceed the essential benefit requirements of the Affordable Care Act; non-ACA plans are not required to provide all of the essential benefit requirements contained in the Affordable Care Act. Pre-existing condition provisions, benefit availability, limitations and exclusions vary by plan type and state. You should review all plan details and product brochures before purchase. To qualify for ACA health insurance coverage outside of the open enrollment period, you must meet special enrollment requirements.
*Eligibility for Affordable Care Act (ACA) Advance Premium Tax Credit (APTC) and cost-sharing reductions is based on annual federal income thresholds, household size, and plan availability within the applicable service area. Premium rates, plan availability, and subsidy amounts vary by state and marketplace. Final eligibility and premium obligations are determined by the Health Insurance Marketplace under Internal Revenue Code Section 36B and applicable federal regulations.
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