You can still get a nationwide PPO in Wisconsin, even though HealthCare.gov doesn't offer one in Dane County. Here's how builders riding Madison's growth are choosing coverage.
Hi, I'm Sam Jaber. I sell health insurance and nothing else, my office is in Tampa, Wisconsin is one of the states I'm licensed in, and I do every bit of it by phone.
Think of a builder based in Verona who has spent the last several years putting up houses and townhomes on the edges of Madison: Fitchburg, Sun Prairie, Waunakee, wherever the next subdivision is going in. Winter slows the framing, so the year runs hard from spring thaw to the first deep freeze, with remodels and basements filling the cold months. The business does well. When he went looking for a PPO on HealthCare.gov for his family, though, there wasn't one to find.
So let me start there: you can still get a nationwide PPO in Wisconsin, and I'm the one who can set it up for you.
Dane County's 2026 marketplace offers 40 HMOs and 9 EPOs and no medical PPO. Wisconsin's marketplace PPOs all come from one insurer, which sells them in just 15 of 72 counties, mostly in the northeast and along the Minnesota line. An HMO or EPO generally pays outside its network only in an emergency, while a PPO also pays part of the bill for doctors outside its network, with no referral. The nationwide kind comes from private plans that review your health before naming a price.
The fork is the premium tax credit. If the household qualifies, HealthCare.gov usually wins on price; if it earns past the credit range, every plan there is full price. For a builder, the figure that matters is net self-employment income for the coverage year: profit after lumber, subs, equipment, permits, insurance and the trucks. You estimate it and revise it when the year changes.
Full price has climbed, too. KFF's numbers show Wisconsin's average benchmark premium about 23.4% higher in 2026 than in 2025.
That's our Verona builder in a good year. With no credit, he'd pay the full premium for an HMO or EPO, and no PPO is available at any price.
For a healthy family, the comparison is a medically underwritten nationwide PPO. You fill out a health questionnaire first, and the company then writes the policy, writes it with one earlier condition excluded, or declines. That screening is why a healthy household frequently comes in under the marketplace's unsubsidized price. It also means a network that reaches the family's lake place Up North or a winter week somewhere warm. Benefits vary from plan to plan, so we read them together.
Next step: Ring me with your county and who's on the plan, and you'll see a nationwide PPO price set against Dane County's marketplace.
Some winters the starts dry up. If that pulls the household's net into credit range, HealthCare.gov is usually the most affordable place to be, because the credit applies nowhere else, and the task becomes picking the HMO or EPO your family's doctors belong to.
Wisconsin also handles the very bottom differently from most states that didn't expand Medicaid. BadgerCare Plus takes adults, with or without kids, whose income is at or below 100% of the federal poverty level, and the marketplace credit generally picks up from 100%. A lean year doesn't leave you without a path.
Next step: Pass me last year's return and the list of spring starts, and we'll pin down an estimate and a Dane County plan.
If anyone you cover manages a chronic illness or takes a daily medication, stay on HealthCare.gov whatever the company earns. Marketplace plans have to accept you and can't charge more for health history. In Dane County that means choosing among HMOs and EPOs, so check carefully that every specialist and the hospital you'd use are in the network.
Next step: Tell me the doctors and prescriptions your family relies on, and I'll find the Dane County plans that keep them.
Straight answers, no sales pitch.
Not for 2026; the county's plans are HMOs and EPOs. Healthy households can still buy a nationwide PPO privately.
In 15 of the state's 72 counties for 2026, all from one insurer.
KFF's figures put the state's average benchmark premium about 23.4% above 2025.
Not at the very bottom. BadgerCare Plus reaches up to 100% of the federal poverty level, the same point where marketplace credits generally begin.
Share your county, the people you want covered and roughly what the company cleared last year. I'll lay out Dane County's marketplace plans next to a nationwide PPO, priced, and tell you which I'd pick.
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