What does Wisconsin Medicaid cover?

Wisconsin Medicaid covers essential health benefits including doctor visits, hospital care, prescription drugs, lab tests, mental health services, preventive care, and maternity care. Coverage may vary — check with your state Medicaid office for details.

Wisconsin Medicaid Eligibility Calculator

Check if you qualify for Medicaid in Wisconsin (WI). Enter your household size and income to see eligibility for adults, children, and pregnant women. ✗ Not Expanded

Wisconsin Medicaid at a Glance

100%

Adult FPL Limit

306%

Child FPL Limit

1,300,000

Enrolled

4.5%

Uninsured Rate

Check Your Eligibility

Household Size

Annual Household Income ($)

Applicant Category

Monthly Income ($, optional)

⚠️ Coverage Gap in Wisconsin

Wisconsin has not expanded Medicaid. Adults earning between 100% and 100% of the Federal Poverty Level may fall into a coverage gap — earning too much for traditional Medicaid but too little for ACA marketplace subsidies. Approximately 26516K residents are uninsured.

Wisconsin Medicaid Income Limits (2026)

Household Size	Adult Limit	Child Limit	Pregnant Limit
1 person	$15,650/yr	$47,889/yr	$47,889/yr
2 people	$21,150/yr	$64,719/yr	$64,719/yr
3 people	$26,650/yr	$81,549/yr	$81,549/yr
4 people	$32,150/yr	$98,379/yr	$98,379/yr
5 people	$37,650/yr	$115,209/yr	$115,209/yr
6 people	$43,150/yr	$132,039/yr	$132,039/yr
7 people	$48,650/yr	$148,869/yr	$148,869/yr
8 people	$54,150/yr	$165,699/yr	$165,699/yr

What Wisconsin Medicaid Covers

Wisconsin Medicaid provides comprehensive health coverage including:

✓ Doctor & specialist visits

✓ Hospital inpatient & outpatient

✓ Prescription medications

✓ Lab tests & X-rays

✓ Mental health services

✓ Preventive care & screenings

✓ Emergency room visits

✓ Maternity & newborn care

✓ Dental (varies by state)

✓ Vision care (varies by state)

How to Apply for Medicaid in Wisconsin

1. Online: Visit HealthCare.gov to submit an application.

2. Phone: Call 1-800-318-2596 (TTY: 1-855-889-4325) to apply by phone.

3. In Person: Visit your local Wisconsin Department of Social Services or Medicaid office.

4. Mail: Download and mail a paper application from your state Medicaid website.

Tip: You can apply for Medicaid at any time — there is no open enrollment period. Processing typically takes 45 days (90 days for disability-based applications).

Frequently Asked Questions

What are the Wisconsin Medicaid income limits for 2026?

In Wisconsin, Medicaid income limits are 100% FPL for adults, 306% FPL for children, and 306% FPL for pregnant women. For a single adult, this means approximately $15,650/year.

Has Wisconsin expanded Medicaid?

No, Wisconsin has not expanded Medicaid. Adults must meet stricter income limits (100% FPL) and categorical requirements like being pregnant, disabled, or a caretaker of dependent children.

How do I apply for Medicaid in Wisconsin?

You can apply for Wisconsin Medicaid online at HealthCare.gov, by calling 1-800-318-2596, visiting your local Medicaid office, or mailing a paper application. Applications are accepted year-round.

What is MAGI and how does it affect Medicaid eligibility?

Modified Adjusted Gross Income (MAGI) is the income methodology used for most Medicaid eligibility determinations. It includes taxable income, tax-exempt interest, and Social Security benefits. Deductions like student loan interest and IRA contributions are subtracted. A 5% income disregard is applied to the FPL threshold.

Can I have assets and still qualify for Wisconsin Medicaid?

For most MAGI-based Medicaid categories (adults, children, pregnant women), there is no asset test — only income matters. However, elderly and disabled applicants may face asset limits, typically $2,000 for individuals or $3,000 for couples, though some states have eliminated asset tests.

What is the Medicaid coverage gap in non-expansion states?

In Wisconsin, adults earning between 100% and 100% FPL may fall into a coverage gap — too much income for traditional Medicaid but too little for ACA marketplace subsidies. This affects an estimated 117850+ residents.