WPS Health Insurance Review & Complaints: Health Insurance (2023)

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Wisconsin-based WPS Health Insurance provides a range of major medical and supplemental plans. Individual and family plans, group plans, and Medicare supplement are among their lineup offered to residents of their home state.

About WPS

Wisconsin Physicians Service was founded in 1946, created by the State Medical Society to assist people who were unable to afford insurance. The not-for-profit was born in Milwaukee but moved its headquarters to Madison in 1950. As of 1977 they are no longer associated with the State Medical Society but continue to operate as a not-for-profit insurer across Wisconsin.

WPS is one of the largest providers of health insurance in the state. They are a government contracted Medicare administrator as well as offering a range of Medicare Supplement plans, and also administer VA health programs. Their individual and family plans include both standard PPO and HSA choices.

Some plans are offered through subsidiaries, such as EPIC Specialty Benefits. Additional health plan options can be explored through Arise Health Plan, which began serving Wisconsin residents in 2017 as Aspirus Arise after a merger.

WPS individual plans are available in specific counties, with a variety of networks choices, including local and statewide.

WPS Health Plans

As we have already reviewed WPS Medicare Supplement plans, this review will focus on their individual and family coverage options. WPS only appears to offer individual plans at the Bronze and Catastrophic levels according to their 2018 plan listing. All plans are PPO, offering in and out of network coverage. In network care will provide the most affordable medical care.

Bronze Plans

There are four Bronze plans with different deductible options available. The lowest deductible at this level is $4,500 individual. This plan has a 20% coinsurance amount that applies to nearly all services after the deductible is met. This is the only plan that has a higher out of pocket maximum than the deductible.

The next level is a high deductible plan with a $5,500 individual deductible and the same 20% coinsurance. The main difference with this plan is a lower maximum out of pocket cost.

The $6,650 and $7,350 deductible plans both offer 100% coverage after the deductible is met, with no coinsurance.

All of the Bronze plans have a $0 copay for preventative prescriptions, with all others subject to the deductible and coinsurance amounts.

Catastrophic Plan

Available only to those under 30, this plan has a $7,350 individual deductible, after which all services are covered in full. The same prescription drug benefits offered with the bronze plans also apply to the catastrophic plan.

Dental and Vision

All of the plans have the option to add on dental coverage offered through Delta Dental and EyeMed vision coverage at an additional cost. None of the plans include these benefits otherwise.

Rates

We ran a quick quote for one of the counties WPS covers – Monroe County – for a single 30-year-old non-smoker. The lowest rate returned by the search was for the PPO Bronze 7350 plan, with a monthly rate of $613.77.

This is far and away one of the highest rates we have seen in any state for a single person with a relatively high deductible plan. For comparison, another Wisconsin insurer, Dean Health Plan, offers a Bronze plan at $268 a month with a lower deductible (although it does have a 20% coinsurance). While county and the available network may not be comparable for these two quotes, there is a vast price difference that is difficult to account for. Again, competitor Dean Health offers a Gold plan that is still nearly $200 per month cheaper, and their most expensive plan comes in at $439 a month. Looking at those numbers, WPS rates are shockingly high.

Claims

Like most health insurance companies, WPS handles claims directly with the provider. Some services, particularly if they are out of network, may require that the insured is involved in the claims process, but this is unusual. Any time you receive health care services through your policy, from either your primary care physician or any other medical provider, you will receive an explanation of benefits describing what costs are covered and what you are responsible for paying.

Ratings and Consumer Reviews

WPS Health Solutions has an A+ rating with the Better Business Bureau (BBB), and there are only two complaints on file in the past three years. There are no complaints closed in the past 12 months.

The National Committee for Quality Assurance gives WPS an overall 4.0 ranking, although there are some low rankings in the underlying categories. Of particular interest is the 2.5 rating for satisfaction with health plan services. They also scored poorly in mental and behavioral healthcare rankings.

We were unable to find much in the way of consumer reviews for this health plan on any of the usual websites, so it is difficult to assess their quality of customer service.

The Bottom Line

WPS offers a limited selection of mainly Bronze plans with high deductibles. Their rates are much higher than what we have seen for other plans in the state, and are particularly high for the type of plan they offer. Although WPS ratings are generally good, there are plenty of highly rated plans with lower rates. Those looking for reasonably priced plans with a good choice of options might want to research other Wisconsin health insurance options and their rates.