Licensed Wisconsin health insurance guidance for individuals, families, Medicare, and employer groups.

Plan Overviews

Ambetter from Superior HealthPlan provides quality healthcare solutions that help residents of Wisconsin live better. With a variety of affordable coverage options, they make it easier to stay healthy.

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Prestige Bronze Essential Prestige Bronze Standard Prestige Bronze 20 HDHP
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 40% 50% 20%
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. 

(Individual/Family)

$5,500/$11,000 $6,650/$13,300 $5,500/$11,000
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) $7,150/$14,300 $7,150/$14,300 $6,550/$13,100
Preventative Care $0 $0 $0
Virtual Visit $20 $35 20% after deductible
Primary Care Doctor Visit $30 after deductible First 3 visits – $45

Then 50% after deductible

20% after deductible
Specialist Visit $80 after deductible 50% after deductible 20% after deductible
Hospital Stay 40% after deductible 50% after deductible 20% after deductible
Maternity Care 40% after deductible 50% after deductible 20% after deductible
Emergency Room $400 after deductible 50% after deductible 20% after deductible
X-ray, Lab and Pathology $75 after deductible 50% after deductible 20% after deductible
Ambulance 40% after deductible 50% after deductible 20% after deductible
PET scans, MRIs, MRAs, CT scans and stress tests $75 after deductible 50% after deductible 20% after deductible
Chiropractic 40% after deductible 50% after deductible 20% after deductible
Urgent Care $75 after deductible 50% after deductible 20% after deductible
Preventative Drugs 30-Day Supply $0 per prescription or refill $0 per prescription or refill $0 per prescription or refill

 

Prestige Silver Essential Prestige Silver 0 Prestige Silver Standard Prestige Silver 20 HDHP
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 30% No charge after deductible 20% 20%
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. 

(Individual/Family)

$2,500/$5,000 $4,000/$8,000 $3,500/$7,000 $2,600/$5,200
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) $7,150/$14,300 $7,150/$14,300 $7,150/$14,300 $6,550/$13,100
Preventative Care $0
Virtual Visit $10 per visit No charge after deductible $20 per visit 20% after deductible
Primary Care Doctor Visit $20 per visit No charge after deductible $65 per visit 20% after deductible
Specialist Visit $55 per visit No charge after deductible $65 per visit 20% after deductible
Hospital Stay 30% after deductible No charge after deductible 20% after deductible 20% after deductible
Maternity Care 40% after deductible No charge after deductible 20% after deductible 20% after deductible
Emergency Room $350 No charge after deductible $400 after deductible 20% after deductible
X-ray, Lab and Pathology $55 per service No charge after deductible 20% after deductible 20% after deductible
Ambulance $250 per trip No charge after deductible 20% after deductible 20% after deductible
PET scans, MRIs, MRAs, CT scans and stress tests 30% after deductible No charge after deductible 20% after deductible 20% after deductible
Chiropractic 30% after deductible No charge after deductible 20% after deductible 20% after deductible
Urgent Care $75 No charge after deductible $75 20% after deductible
Preventative Drugs 30-Day Supply $0 per prescription or refill $0 per prescription or refill $0 per prescription or refill $0 per prescription or refill

 

Prestige Gold Essential Prestige Gold Standard
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 20% 20%
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. 

(Individual/Family)

$500/$1,000 $1,250/$2,500
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (Individual/Family) $7,150/$14,300 $4,750/$9,500
Preventative Care $0 $0
Virtual Visit $5 per visit $10 per visit
Primary Care Doctor Visit $15 per visit $20 per visit
Specialist Visit $35 per visit $50 per visit
Hospital Stay 20% after deductible 20% after deductible
Maternity Care 20% after deductible 20% after deductible
Emergency Room $250 $250 after deductible
X-ray, Lab and Pathology $35 per service 20% after deductible
Ambulance 20% after deductible 20% after deductible
PET scans, MRIs, MRAs, CT scans and stress tests $35 per service 20% after deductible
Chiropractic 20% after deductible 20% after deductible
Urgent Care $50 $65
Preventative Drugs 30-Day Supply $0 per prescription or refill $0 per prescription or refill

 

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When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance. So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.
Network Health Wisconsin Coverage Map

 

 

Contact Us
New Enrollments

Phone: (855) 847-7020
Email: help@ihealthagents.com

 

Mailing Address

Network Health
1570 Midway Place
Menasha, WI 54952
800-826-0940 or 920-720-1300

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2026 Network Health plans & member ratings

Network Health Plan sells individual HMO plans on its Prestige network in northeastern and east-central Wisconsin (Appleton, Green Bay, Fond du Lac) on HealthCare.gov. Below are representative 2026 plans with verified fixed cost-sharing and member ratings; premiums vary by age and county.

Prestige Gold 50 + Dental + VisionPopular

Gold HMO with a $1,000 deductible and a very low $4,300 out-of-pocket max, plus dental and vision.

Metal level
Gold
Network
Network Health Prestige (HMO)
Plan type
HMO
Deductible (single)
$1,000
Out-of-pocket max (single)
$4,300
HSA-eligible
No

Rate this plan

Rate all four categories - Cost, Plan Value, Customer Service and Network Size - to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.

Baseline: 3.4 / 5 - seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.

Cost3 baseline
Plan Value4 baseline
Customer Service3.5 baseline
Network Size3 baseline
Thanks - your rating was recorded.

Prestige Gold Essential + Dental + Vision + 3 Free PCP Visits

Gold HMO with a $1,750 deductible, dental, vision and three free PCP visits.

Metal level
Gold
Network
Network Health Prestige (HMO)
Plan type
HMO
Deductible (single)
$1,750
Out-of-pocket max (single)
$8,950
HSA-eligible
No

Rate this plan

Rate all four categories - Cost, Plan Value, Customer Service and Network Size - to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.

Baseline: 3.2 / 5 - seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.

Cost3 baseline
Plan Value3.5 baseline
Customer Service3.5 baseline
Network Size3 baseline
Thanks - your rating was recorded.

Prestige Silver Essential + Dental + Vision + 3 Free PCP Visits

Silver HMO with added dental, vision and three free PCP visits.

Metal level
Silver
Network
Network Health Prestige (HMO)
Plan type
HMO
Deductible (single)
$4,600
Out-of-pocket max (single)
$9,100
HSA-eligible
No

Rate this plan

Rate all four categories - Cost, Plan Value, Customer Service and Network Size - to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.

Baseline: 3.4 / 5 - seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.

Cost3.5 baseline
Plan Value3.5 baseline
Customer Service3.5 baseline
Network Size3 baseline
Thanks - your rating was recorded.

Prestige Bronze $0 Medical Deductible + Dental + VisionLowest premium

Bronze HMO with a $0 medical deductible, dental and vision.

Metal level
Bronze (Expanded)
Network
Network Health Prestige (HMO)
Plan type
HMO
Deductible (single)
$0
Out-of-pocket max (single)
$9,200
HSA-eligible
No

Rate this plan

Rate all four categories - Cost, Plan Value, Customer Service and Network Size - to unlock submit. Comment optional. A first name or county are shown with your review; leave them blank to stay anonymous.

Baseline: 3.2 / 5 - seeded from CMS quality ratings and public member reviews; updates as visitor ratings come in.

Cost3.5 baseline
Plan Value3 baseline
Customer Service3.5 baseline
Network Size3 baseline
Thanks - your rating was recorded.

Wisconsin individual-market rate history

Plan yearWI individual market (avg approved)
2019-4.2%
2020-3.2%
2021-3.4%
2022-0.3%
2023+7.7%
2024+6.8%
2025+8.2%
2026+22.8%

Sources: Wisconsin OCI filings and ACA Signups WI 2026 summary. The column is the Wisconsin individual-market average approved change; per-carrier figures were not separately published for citation. Wisconsin's 2026 increase reflects medical trend plus the scheduled expiration of enhanced premium tax credits.

Network Health is strong in northeast Wisconsin.

Network Health's Prestige plans bundle dental and vision and are well rated around the Fox Valley and Green Bay. A licensed agent can confirm it serves your ZIP and compare it, free. Call (855) 847-7020.

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