Wisconsin still has nationwide PPO coverage available, but the St. Croix area offers another interesting choice. Its marketplace PPO actually costs less than competing plan types. Here's how heating and cooling business owners in western Wisconsin can weigh both options.
Hi, I'm Sam. Health insurance is my specialty, I'm licensed in Wisconsin, and we can take care of the whole process by phone.
Think about an HVAC shop in Hudson, just across the river from the Twin Cities. It operates three vans serving New Richmond, River Falls and Prescott, with additional work coming from across the river. Furnace and boiler repairs fill much of the schedule from October through April during western Wisconsin's long winters. Summer brings air conditioning installations, especially in Hudson's growing subdivisions. The owner has to arrange health coverage for the family personally. Fortunately, the county offers a marketplace selection that's rather different from what you'll find in much of Wisconsin.
You always have the option of a nationwide PPO in Wisconsin. When the numbers favor it, I'll help you get one.
But first, look at the local marketplace PPO. For 2026, both St. Croix and Pierce offer 12 EPOs, 9 POS plans and 8 PPOs, with zero HMOs. For a 40-year-old buying silver coverage without subsidies, the lowest-priced PPO costs 3% less than the lowest-priced plan of any other type. Polk's difference is 4%. That's unusual when you consider that across Wisconsin's 15 counties offering PPOs, those plans typically cost 4% more. An EPO generally limits out-of-network benefits to emergencies. A PPO can pay toward regular appointments outside its network without referrals, although your portion of the bill will be higher.
Marketplace credits are calculated using your household's projected income for the coverage year. For HVAC business owners, use revenue after deducting equipment, parts, vans, licensing and insurance. If winter turns out unusually cold or mild and changes your earnings, revise that estimate rather than leaving it unchanged.
Another factor in Wisconsin's marketplace rates is the Wisconsin Healthcare Stability Plan. This state reinsurance program began January 1, 2019, operates under a federal waiver, and has been extended through 2028.
If you qualify for a premium credit, enroll through HealthCare.gov because that's the only place to apply it. St. Croix and Pierce make the comparison especially interesting. Before credits, their lowest-priced silver plan is already a PPO. That means qualifying households can get out-of-network benefits without paying an additional premium over other silver plan types. We'd still verify your family's doctors participate, but I'd put that PPO at the top of the list for anyone eligible for credits here.
Next step: Share your household members, county and last year's profit. I'll calculate the premium credit and compare St. Croix Valley PPOs with the EPO options.
An HVAC business running three vans with plenty of maintenance contracts can easily earn enough to lose marketplace premium credits. Then every plan, including the local PPO, comes at full price. For a healthy household, I'd compare a private nationwide PPO that uses medical underwriting. The insurer examines your health history before deciding to approve, decline, or approve while excluding a previous condition. That process can give healthy applicants lower premiums than full marketplace rates, with a network extending beyond Wisconsin and across the river. Since each private policy has different benefits, we'll review the coverage details together.
Next step: Give me your ZIP code and the birth year of each person needing coverage. I'll compare a nationwide PPO premium with the valley's full-price plans.
When winter stays warm, heating work can drop off sharply. Wisconsin's BadgerCare waiver may help adults without children whose income is at or below 100% of the federal poverty level.
Next step: Tell me your doctors and prescriptions, and I'll check the valley plans for coverage.
Straight answers, no sales pitch.
Yes. In 2026, a 40-year-old can buy the lowest-priced silver PPO for 3% less than the lowest-priced silver plan of another type, before subsidies.
Yes. Established through a federal waiver, the Wisconsin Healthcare Stability Plan began January 1, 2019, and its extension runs through 2028.
No. St. Croix County offers marketplace PPO, EPO and POS plans for 2026, without any HMOs.
You may qualify. Under the BadgerCare waiver, adults without children can be covered when their income doesn't exceed 100% of the federal poverty level.
Tell me your county, last year's business profit, and who needs insurance. I'll compare a nationwide PPO with St. Croix Valley marketplace coverage and tell you which I'd personally favor.
The guide for every state, and other work I help with