You can still get a nationwide PPO in Wisconsin through me, even though Dane County's marketplace sells none. Here is how Madison agents choose coverage around commissions, health and BadgerCare's line.
Hi, I'm Sam Jaber. I'm a licensed health insurance broker in Tampa with licenses in 36 states, and Wisconsin agents can sort out coverage with me by phone.
Picture an agent who lives in Fitchburg and sells across Dane County: condos near the Capitol, family homes in Verona and Sun Prairie, the occasional farmhouse out toward Mount Horeb. Her buyers include grad students turning into professors, nurses and doctors from the big hospitals, and tech workers moving in from Chicago or Minneapolis. Spring and summer carry the year, and January can be very quiet. Her brokerage doesn't offer a health plan, so she buys her own on HealthCare.gov. In Dane County, that means an HMO or an EPO.
Dane County has 49 individual medical plans for 2026: 40 HMOs and 9 EPOs. There's no PPO on the menu. Statewide, the marketplace's 16 PPOs come from a single insurer and are sold in only 15 of Wisconsin's 72 counties, mostly in the northwest and the Fox Valley.
You can still get a nationwide PPO in Wisconsin through me. It's a private plan, priced after a health questionnaire, with doctors in network across the country, so a trip to see family or a winter getaway doesn't put you outside your plan.
Your credit is figured from the household's income in the coverage year, and it ends once income passes four times the federal poverty level. For an agent that's commission after the split, desk and franchise fees, MLS and board dues, marketing and the miles around Dane County.
Wisconsin's bottom line is unusual, and worth stating carefully. The state didn't adopt the ACA's Medicaid expansion, but BadgerCare Plus covers adults, including those without children, up to 100% of the poverty level. Above that, the marketplace credit takes over. So there's no gap between the two the way there is in some neighboring states.
Past the credit range you pay full price, and the full price buys a local network. Many healthy agents look at a private nationwide PPO instead. You answer medical questions; the underwriter approves you, approves you with one condition left out, or declines. In good health, the premium often comes in below the marketplace's full rate. Benefits differ by plan, and we read them together.
Next step: Call me and I'll compare a nationwide PPO quote with the full HealthCare.gov prices for your household.
If the market stalls and your income for the year drops toward the poverty line, check where you land. At or under 100%, BadgerCare Plus may cover you. Just above it, the marketplace credit applies. Either way you're not left without an option, but the estimate decides which.
Next step: Before you renew after a slow year, call me and we'll figure out which side of 100% your household is on.
Keep that person on a marketplace plan whatever your income. Those plans have to take every applicant, and a diagnosis can't raise the premium. In Dane County the main job is confirming the specialist and hospital are in the network you pick.
Next step: Give me your family's doctors and prescriptions, and I'll narrow the Dane County plans to those that cover them.
The window for 2027 plans opens November 1, 2026 and closes January 15, 2027. To be covered from January 1, choose a plan by December 15.
Straight answers, no sales pitch.
No. Dane County's 2026 marketplace plans are HMOs and EPOs.
No, but BadgerCare Plus covers adults up to 100% of the federal poverty level, and the marketplace credit starts there, so there's no coverage gap.
Yes. If you're healthy, I can set one up for you outside the marketplace.
December 15. Open enrollment itself runs November 1 to January 15.
Tell me where you live, who needs coverage and a ballpark of last year's net commission. You'll see HealthCare.gov's options and a private nationwide PPO priced for you, with my pick.
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