Wisconsin residents can still obtain nationwide PPO insurance, even though Dane County's HealthCare.gov plans don't include PPOs. Here's how construction business owners around growing Madison are deciding what coverage works for them.
Hi, I'm Sam Jaber. My business focuses entirely on health insurance, I'm licensed in Wisconsin, and we can take care of the whole process by phone.
Picture a Verona builder who's spent years constructing houses and townhomes throughout the growing areas surrounding Madison. His projects take him to Fitchburg, Sun Prairie and Waunakee, depending on where subdivisions are being developed. Framing work slows during Wisconsin winters, so most of the business comes between the spring thaw and the first serious freeze. Remodels and basement projects help carry the colder months. He's built a profitable operation and wants good health coverage for his family. But when he searched HealthCare.gov for a PPO, he discovered the marketplace didn't offer one.
That's the first thing I want to clear up: nationwide PPO insurance is still available in Wisconsin, and I can help you get it.
If you're shopping Dane County's marketplace in 2026, you'll find 40 HMOs and 9 EPOs, but not a single medical PPO. Across Wisconsin, marketplace PPO coverage comes from only one insurance company and is available in just 15 of the state's 72 counties, primarily in the northeast and near Minnesota. HMOs and EPOs generally restrict out-of-network benefits to emergency treatment. PPOs also contribute toward care from doctors outside their networks and don't require specialist referrals. If you want a nationwide PPO, private medically underwritten plans are another route. The carrier evaluates your health before determining the premium.
The first question is whether your household qualifies for premium tax credits. If it does, HealthCare.gov generally offers the lower premium because that's where the credit applies. If your income exceeds the credit range, marketplace coverage comes at full cost. For a builder, use projected net self-employment earnings for the coverage year, not total contract revenue. Deduct lumber, subcontractors, equipment, permits, insurance and trucks. Start with a realistic estimate, and update it whenever business conditions change.
Unsubsidized premiums have increased as well. According to KFF, Wisconsin's average benchmark premium in 2026 is approximately 23.4% higher than in 2025.
Consider our Verona contractor during a profitable year. Without tax credits, his choices are full-price HMOs and EPOs. A marketplace PPO simply isn't offered, regardless of budget.
For a healthy household, I'd also price a nationwide PPO that uses medical underwriting. The application begins with questions about everyone's health. After reviewing those answers, the insurer may approve the policy, approve it while excluding one prior condition, or reject it. That process often allows healthy families to pay less than the marketplace's full premium. A nationwide network can also be useful when visiting the family's lake property Up North or spending a winter week somewhere warmer. Coverage details aren't identical from one plan to another, so I'll review the benefits with you before you choose.
Next step: Call me with your county and everyone needing coverage. I'll show you how a nationwide PPO quote compares with Dane County marketplace pricing.
Construction starts sometimes slow dramatically in winter. If your household profit falls into the premium tax credit range, HealthCare.gov usually becomes the more affordable choice because those credits aren't available privately. Then we'll focus on finding an HMO or EPO that includes your family's doctors.
Wisconsin provides another option for very low-income households. Unlike most states without Medicaid expansion, BadgerCare Plus covers adults both with and without children at incomes up to 100% of the federal poverty level. Marketplace premium credits generally begin at 100%, so a difficult financial year still leaves a possible coverage route.
Next step: Send over your previous tax return and upcoming spring construction starts. We'll calculate a reasonable income projection and choose a Dane County policy.
Straight answers, no sales pitch.
No. Dane County's 2026 marketplace offers only HMOs and EPOs. Healthy applicants can still purchase nationwide PPO coverage outside the marketplace.
For 2026, one insurer offers marketplace PPOs in 15 out of Wisconsin's 72 counties.
KFF reports an average benchmark premium increase of about 23.4% over 2025.
Not necessarily. BadgerCare Plus covers eligible adults up to 100% of the federal poverty level, where marketplace premium tax credits generally start.
Tell me which county you're in, who needs insurance and approximately how much profit your business made last year. I'll compare priced marketplace options in Dane County with a nationwide PPO and explain which one I'd choose.
The guide for every state, and other work I help with