You can still get a nationwide PPO in Wisconsin, and along the St. Croix the marketplace's own PPO is actually priced below the alternatives. Here's how western Wisconsin heating and cooling owners are choosing.
Hi, I'm Sam. I'm a Tampa-based health insurance broker, Wisconsin is one of my licensed states, and everything happens by phone.
Imagine a heating and cooling company in Hudson, across the river from the Twin Cities, with three vans covering New Richmond, River Falls and Prescott. Western Wisconsin winters keep the furnace and boiler side busy from October into April, and summers bring AC installs in the new subdivisions going up around Hudson. Plenty of jobs come across the river too. The family's health plan is the owner's to buy, and his county happens to have one of the more interesting marketplaces in the state.
One thing never changes: you can still get a nationwide PPO in Wisconsin, and I'll set one up when it's the better buy.
Here, though, I'd be shortchanging you if I didn't point out the marketplace PPO. St. Croix and Pierce each have 12 EPOs, 9 POS plans and 8 PPOs for 2026, with no HMOs. Compare silver plans for a 40-year-old with no subsidy and the least expensive PPO actually comes in 3% less than the least expensive plan of any other type; in Polk it's 4% less. That's rare. Across the 15 Wisconsin counties where a PPO is sold, it typically runs 4% more. Outside its network, an EPO pays only for emergencies; a PPO helps with ordinary visits too, at a higher share and with no referral.
Your credit is set by the household's expected income for the coverage year. For a heating and cooling company, that's what's left of revenue after equipment, parts, the vans, licensing and insurance, and it should be revised whenever a cold winter or a soft one changes the picture.
Wisconsin also runs a state reinsurance program, the Wisconsin Healthcare Stability Plan, which has been in place since January 1, 2019 under a federal waiver and is extended through 2028. It's part of how the state's marketplace is priced.
Buy on HealthCare.gov, since the credit won't apply anywhere else. And in St. Croix and Pierce the choice is unusually easy: the marketplace PPO is the least expensive silver plan before credits, so a household that qualifies gets out-of-network coverage without paying extra for it. Check that your family's doctors are in its network, but this is one of the few places I'd tell a credit-eligible family the PPO is the obvious starting point.
Next step: Give me your county, last year's profit and who's on the plan, and I'll run the St. Croix Valley PPO and EPOs with your credit in place.
Three vans and a full slate of service agreements tend to push a household over the credit range, where every marketplace plan, the PPO included, sells at list price. A healthy family should compare a medically underwritten nationwide PPO. These private plans start with your medical history, and the answer can be yes, yes minus one earlier condition, or no. Screening is the reason a healthy family can come in below the marketplace's list price, and the network doesn't stop at the river or the state line. Each plan defines its own benefits, so we'll go through them together.
Next step: Send over your zip and everyone's birth year, and you'll get a nationwide PPO price next to the full-price valley plans.
A warm winter can leave a heating company short, and Wisconsin's BadgerCare waiver covers adults without children up to and including 100% of the federal poverty level. When a spouse or child lives with a chronic illness, stay on HealthCare.gov at any income, since its plans accept everyone at the standard price. Here, the marketplace PPO may well be the best home for that care.
Next step: Share your family's doctors and medications, and I'll see which valley plans cover them.
Straight answers, no sales pitch.
Yes. For 2026, the least expensive silver PPO costs 3% less than the least expensive silver plan of another type for a 40-year-old, before subsidies.
Yes. The Wisconsin Healthcare Stability Plan took effect January 1, 2019 under a federal waiver and is extended through 2028.
No. For 2026, St. Croix County's marketplace has EPOs, POS plans and PPOs, but no HMOs.
Possibly. The BadgerCare waiver covers adults without children up to and including 100% of the federal poverty level.
Send your county, the people you want covered and last year's profit. I'll price the St. Croix Valley marketplace plans and a nationwide PPO side by side and say which one I'd choose.
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