Aspirus Health Plan

What Aspirus Health Plan does

Aspirus Health Plan, Inc. is a Wisconsin-based health insurance company headquartered in Wausau, operating as a wholly-owned subsidiary of Aspirus Health Ventures, Inc., which is itself affiliated with the broader non-profit Aspirus Health system. The company offers a portfolio of health insurance products including Individual & Family HMO and POS plans, Medicare Advantage PPO plans across Essential Rx and Elite tiers, and Employer Group plans spanning small group (2-50 employees), large group (51+), self-funded (25+), and level-funded (10+) structures. It is a Qualified Health Plan issuer on the Federally Facilitated Exchanges and primarily serves Wisconsin residents.

The company distributes through direct sales teams with dedicated Medicare sales available seven days a week, an agent/broker network with online quoting and enrollment tools, and member self-service portals. Its core technology stack includes CMS-mandated interoperability APIs (Patient Access, Provider Access, and Payer-to-Payer) for Qualified Health Plan issuers, pharmacy benefit management through Optum Rx, and integrations with MDLIVE for telehealth and One Pass for wellness. Underlying network leverage comes from the Signature Network, spanning 50 Wisconsin counties with 75 primary and specialty clinics and over 7,000 providers, complemented by the parent system's 13 Wisconsin and 4 Michigan hospitals.

Revenue is generated primarily through recurring monthly health insurance premiums from members and employer groups, with additional income from administrative fees and stop-loss coverage on self-funded plans. The company holds NCQA Accreditation for both Commercial and Exchange products and earned a 4 out of 5 star NCQA Private Health Insurance Plan Rating in 2022 and 2025. As of January 20, 2026, Aspirus Health Plan announced it is no longer enrolling new members in its 2026 Medicare Advantage plans or Choice Dental plans, though existing members are unaffected — a significant strategic contraction in its fastest-growing segment.

Name

Aspirus Health Plan

Legal name

Aspirus Health Plan, Inc.

Website

https://aspirushealthplan.com

Company type

Private

Operating status

Operating

Headcount range

11–50 employees

Short description

Aspirus Health Plan, Inc. is a Wisconsin-based health insurance company offering individual, employer group, and Medicare Advantage plans through a regional network of 7,000+ providers. It operates as a subsidiary of Aspirus Health Ventures within the broader Aspirus Health non-profit system.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Self-Funded (ASO) Group Health Plans & Stop-Loss (FSAIAFAB)

akta.pro secondary industries

Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE), Small Group Health Insurance (2–50/100) (FSAIAFAD), Small Group POS Plans (HLAEAOAI), Self-Funded Employer POS (ASO/TPA-Administered) (HLAEAOAH), Individual Health Insurance Administration (TPA/ASO) (FSAIAEAK), Eligibility, Enrollment & Benefits Administration (HLAEALAH), Care Management & Population Health Program Administration (HLAEALAG)

Keywords

• Health insurance plans
• Medicare Advantage plans
• Employer group coverage
• Individual family plans
• Managed care services

Headquarters

HQ city

Wausau

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Operations, Technology or R&D, Marketing or Sales, Personnel, Infrastructure, Others

Revenue model

1. Health Insurance Premiums: Aspirus Health Plan generates revenue through health insurance premiums paid by members (individuals, families, employers) and government programs (Medicare Advantage). Premiums are collected on a recurring monthly basis from members and groups, with additional revenue from Medicare Part D prescription drug coverage.
2. Self-Funded Plan Administration: For self-funded employer groups, the company administers claims and provides administrative services while employers fund their own health plans. Revenue comes from administrative fees and stop-loss coverage arrangements.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels4 records

Core offering

Aspirus Health Plan is a Wisconsin-based health insurance company that offers Medicare Advantage PPO plans, Individual & Family HMO and POS plans, and Employer Group plans (Small Group, Large Group, Self-Funded, and Level-Funded). Its plans are built on the Signature Network covering 50 Wisconsin counties with 75 clinics and over 7,000 providers, integrated with the Aspirus Health system of hospitals and physicians. Supporting services include pharmacy benefit management through Optum Rx, MDLIVE telehealth, a 24/7 nurse line, wellness programs, and CMS-compliant interoperability APIs.

Product overview

Aspirus Health Plan is a Wausau, Wisconsin-based health insurance company offering a comprehensive portfolio of health insurance products and healthcare services. The core product portfolio includes Individual & Family Plans (HMO and POS options), Medicare Advantage Plans (Essential Rx and Elite PPO plans), and Employer Group Plans (Small Group, Large Group, Self-Funded, and Level-Funded options). These plans are built on the Signature Network, a provider network spanning 50 Wisconsin counties with 75 clinics and 7,000+ providers. Supporting services include pharmacy benefit management through Optum Rx (mail order, specialty, retail pharmacy), MDLIVE telehealth access, a 24/7 nurse line, and wellness programs. The company also offers interoperability APIs (Patient Access, Provider Access, and Payer-to-Payer) enabling third-party applications and other health plans to exchange health information in compliance with CMS interoperability requirements.

Differentiator

Problem solved

Functional benefit

Products and services

• Essential Rx (PPO) Medicare Advantage PPO plan with $0 monthly premium offering Medicare Part D prescription drug coverage as well as preventive care, inpatient/outpatient hospital, emergency care, dental, vision, hearing, OTC allowance, and fitness program access. Designed for individuals 65+ or those with qualifying disabilities seeking comprehensive Medicare Advantage coverage.
• Elite (PPO) Medicare Advantage PPO plan featuring a $25 monthly Medicare Part B premium giveback, comprehensive medical coverage with a $3,200 out-of-pocket maximum, and enhanced benefits including fitness program and OTC allowance. Targeted at Medicare beneficiaries seeking richer benefits and Part B premium savings.
• Individual & Family HMO Plans Health Maintenance Organization plans offering in-network coverage with 100% coverage for preventive services when completed by in-network providers. Designed for individuals and families seeking affordable, network-based healthcare coverage through the Signature Network.
• Individual & Family POS Plans Point-of-Service plans allowing members to access in-network and out-of-network providers. Available in Bronze and Silver tiers with cost-sharing reduction variants for Marketplace eligibility. Targeted at individuals and families who want flexibility in provider choice.
• Small Group Plans Health insurance plans designed for employer groups of 2-50 employees, offering fully insured options with affordable coverage and wide provider networks. Targeted at Wisconsin small businesses seeking employee health benefits.
• Large Group Plans Health insurance plans designed for employer groups of 51+ employees, including HMO and POS options with customizable coverage to meet diverse workforce needs. Targeted at Wisconsin larger employers.
• Self-Funded Group Plans Self-funded health plans for groups of 25+ employees allowing businesses to fund the health plan directly while Aspirus handles administration. Features flexible deductible options, competitive discounts, and a variety of stop-loss coverage options. Aspirus earns revenue from administrative fees and stop-loss coverage.
• Level-Funded Group Plans Level-funded health plans for groups of 10+ employees providing effective health insurance with capped risk and the ability to minimize costs by funding some claims. Includes designated account manager and employer portal access. Targeted at smaller employers seeking predictable costs with self-funded flexibility.

Quantifiable outcome

• 4 out of 5 NCQA star rating
• +1 more outcomes

Named customers1 record

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature3 records

Partnerships

Six partnerships are on record, tiered core and supporting.

• Optum RxcoreTechnology or IntegrationPharmacy Benefit Manager partnership. Optum Rx handles prescription drug benefits including mail order service, specialty medications, and pharmacy network management. Members can access retail pharmacy search, cost comparison, and medication history through the Optum Rx portal.
• TruHearingsupportingTechnology or IntegrationHearing aid provider partnership for Medicare Advantage plans, offering discounted hearing aids and routine hearing exams through TruHearing specialists.
• One PasssupportingStrategic or Co-development PartnerFitness and wellness program partner offering Medicare Advantage members access to gym memberships at 24,000+ locations nationwide, online classes, brain training, and social events.
• MDLIVEsupportingTechnology or Integration24/7 online clinic partnership providing members access to virtual care visits for non-emergency medical conditions.
• Aspirus Health SystemcoreStrategic or Co-development PartnerParent nonprofit health system providing integrated care network including 13 Wisconsin hospitals, 4 Michigan hospitals, 75+ clinics, 800+ physicians, home health, hospice, pharmacies, and helicopter transport services. The health plan is designed to improve population health through this local collaboration.
• First HealthsupportingTechnology or IntegrationNetwork partner extending provider access beyond Wisconsin for self-funded plans through the Freedom Network.

Scale indicators6 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• Quartz Health Solutions: Wisconsin-headquartered regional health plan offering commercial group, individual, and Medicare Advantage products with a provider-owned heritage. Directly comparable in scale, geography, and product mix to Aspirus Health Plan.
• MercyCare Health Plan: Wisconsin-based health plan affiliated with Mercyhealth, offering commercial, individual, and Medicare Advantage plans. Comparable regional carrier serving southern Wisconsin and northern Illinois.
• Security Health Plan: Wisconsin-based health plan affiliated with Marshfield Clinic Health System, offering HMO, POS, and Medicare Advantage plans. Closely mirrors Aspirus's provider-affiliated regional carrier model.
• Network Health: Wisconsin-based regional health plan affiliated with Froedtert & MCW, offering individual, family, group, and Medicare Advantage products. Directly competes with Aspirus in southeastern and central Wisconsin.
• Dean Health Plan: Madison, Wisconsin-based health plan owned by SSM Health, offering commercial, individual, and Medicare Advantage plans. Direct competitor within Wisconsin's provider-owned plan segment.
• Gundersen Health Plan: Wisconsin-based regional health plan affiliated with Gundersen Health System, offering individual, family, and group plans in western Wisconsin. Comparable regional provider-affiliated carrier.
• Common Ground Healthcare Cooperative: Wisconsin-based nonprofit health insurance cooperative offering individual and small group plans. Comparable as a Wisconsin-focused individual/small-group issuer competing on the ACA Marketplace.
• Prevea Health Plan: Wisconsin-based health plan partnered with Prevea Health and Hospital Sisters Health System, offering HMO, POS, and Medicare Advantage. Regional provider-affiliated competitor in overlapping geographies.

Broad incumbents

• UnitedHealthcare: Largest U.S. health insurer offering Medicare Advantage, individual, and group plans in Wisconsin. Represents the national-scale competitor that Aspirus must benchmark against on premium, network breadth, and broker economics.
• Anthem Blue Cross Blue Shield of Wisconsin: Wisconsin licensee of Anthem/Elevance Health, offering commercial, individual, Medicare, and large group plans at scale. National incumbent with overlapping product set and the dominant carrier in many Wisconsin employer segments.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/aspirushealthplan
• LinkedInlinkedin.com/company/aspirus-arise
• Xx.com/aspirus_health

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Aspirus Health Plan