Milwaukee County offers only HMOs through its marketplace, but nationwide PPO plans are still available privately in Wisconsin. Here's how local plumbers can sort through their choices.
Hi, I'm Sam Jaber. Health insurance is my specialty, and Wisconsin is one of the states where I'm licensed. We handle everything by phone, so nobody has to make an extra trip during a Milwaukee January.
Imagine a Bay View plumber operating two trucks throughout Milwaukee and its nearby suburbs. Most calls take him into older duplexes and bungalows, where galvanized plumbing, cast-iron drain stacks and basement drains have seen years of makeshift repairs. Once freezing weather rolls in from the lake, burst pipes and frozen lines across homes and rental properties keep both trucks busy nonstop. When summer arrives, he shifts toward renovations and water heater replacements around Wauwatosa and West Allis. He's always purchased the family's medical insurance himself, but this year he wants a clearer picture of what he's paying for.
Here's what hasn't changed: Wisconsin residents can still purchase nationwide PPO coverage, and I can help you arrange it.
Milwaukee County's HealthCare.gov marketplace offers 35 medical plans for 2026, all HMOs. There are no EPOs, POS plans or PPOs, and Racine and Kenosha have the same restriction. The PPOs Wisconsin offers through its marketplace are limited to 15 counties outside southeastern Wisconsin. HMOs generally cover participating providers only, except in emergencies. PPOs also pay toward out-of-network treatment without requiring referrals, though your cost sharing is higher. Private nationwide PPO coverage is another option, with premiums determined through medical underwriting.
Your premium credit depends on what you expect the household to earn during the coverage year. For a plumbing business, we look at what's left after expenses such as vehicles, pipes, fittings, fixtures, thawing equipment, the jetter, insurance and licensing. If that income projection changes, you're responsible for updating the marketplace.
HealthCare.gov enrollment for 2027 coverage opens November 1 and continues through January 15. December 15 is your deadline if you want the plan active at the beginning of the year. Since Milwaukee's freezing weather starts around the same period, I'd reserve an hour in early November to handle it.
A severe winter or several profitable years can push a two-truck plumbing business beyond premium credit eligibility, leaving the family paying full HMO premiums. Healthy households should compare private nationwide PPO coverage with medical screening. The insurer reviews health history and may approve the application, approve it with a previous condition excluded or decline it. Healthy applicants often pay less than HealthCare.gov's unsubsidized premiums. The nationwide network also follows you when visiting family in Chicago or spending time at a cabin Up North. I'll compare the benefits carefully before you decide.
Next step: Call with your county and everyone's birth year. I'll show you how a nationwide PPO quote stacks up against Milwaukee's HMOs without credits.
Straight answers, no sales pitch.
No. Milwaukee County's 2026 marketplace has 35 HMOs and no other plan types. Healthy households can still purchase nationwide PPO coverage privately.
HealthCare.gov handles Wisconsin enrollment. The 2027 window runs November 1 through January 15, and December 15 is the cutoff for coverage beginning January 1.
Usually not, unless the care is for an emergency.
You may qualify. BadgerCare Plus covers eligible adults, including people without children, earning up to 100% of the federal poverty level.
Give me your county, the people who need coverage and last year's shop profit. I'll compare Milwaukee HMO prices with a nationwide PPO and explain which I'd choose in your situation.
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