Even with no PPO offered on Dane County's marketplace, I can help you find a nationwide PPO in Wisconsin. Let's look at how Madison real estate agents can choose health coverage that fits their commission income, medical needs and the BadgerCare income threshold.
Hi, I'm Sam Jaber. I help real estate agents in Wisconsin handle their health insurance over the phone, and I'm a licensed health insurance broker in 36 states.
Let's say you're a real estate agent based in Fitchburg, working throughout Dane County. One day you're showing a condo near the Capitol, the next you're helping a family buy in Verona or Sun Prairie, and occasionally you're driving toward Mount Horeb to list a farmhouse. Your clients range from graduate students becoming professors to hospital nurses and doctors, plus technology employees relocating from Chicago or Minneapolis. Most of your commissions arrive during spring and summer, while January might bring almost nothing. Since your brokerage provides no health benefits, you purchase insurance through HealthCare.gov, where Dane County offers HMO and EPO plans.
For 2026, Dane County residents can choose among 49 individual medical plans, including 40 HMOs and 9 EPOs, but not a single PPO. Across Wisconsin, the marketplace offers 16 PPO plans from just one insurance company, available in only 15 of the state's 72 counties, primarily around the Fox Valley and northwestern Wisconsin.
I can also help you apply for a nationwide PPO in Wisconsin outside the marketplace. It's private coverage with pricing based on a medical questionnaire and access to in-network physicians nationwide. That means visiting relatives or taking a winter vacation doesn't automatically leave you outside the plan's provider network.
What determines your premium credit is your household income during the year you're covered. Once that income exceeds four times the federal poverty level, the credit ends. For a real estate agent, the calculation starts with commissions after your brokerage split, then accounts for desk fees, franchise charges, MLS membership, board dues, advertising and driving expenses throughout Dane County.
Wisconsin handles lower-income coverage a little differently, and the distinction matters. Although Wisconsin never expanded Medicaid under the ACA, BadgerCare Plus still provides eligibility for adults, even adults without children, through 100% of the federal poverty level. Once income moves above that threshold, marketplace premium credits become available. Unlike certain neighboring states, Wisconsin therefore doesn't leave an income gap between these two programs.
Once your income exceeds the premium credit limit, you're paying the entire marketplace premium for coverage built around a local provider network. That's why many healthy real estate agents consider a private nationwide PPO. You'll complete a medical questionnaire, and underwriting may approve your application, approve it while excluding a particular condition, or decline coverage. When you're healthy, premiums are often lower than the marketplace's unsubsidized prices. Coverage details aren't identical across plans, so we'll examine the benefits together. And if someone in your household has an existing medical condition, tell me during our conversation. Don't automatically dismiss private coverage before I've shown you how both approaches compare.
Next step: Give me a call, and I'll put a private nationwide PPO quote alongside the unsubsidized HealthCare.gov premiums for everyone in your household.
Suppose sales slow down and your projected annual income starts approaching the federal poverty threshold. You'll want to review your eligibility again. At 100% of the poverty level or below, BadgerCare Plus might be available. Slightly above that level, marketplace premium credits can apply. There is a coverage route on either side, but your projected income determines which one fits. Keep track of contracts awaiting closing so you can adjust that projection without much trouble.
Next step: If commissions were slow this year, call me before renewing. We'll review your household income and see whether you're above or below that 100% threshold.
Enrollment for 2027 coverage begins November 1, 2026, and ends January 15, 2027. If you want your insurance effective January 1, make your selection no later than December 15.
Straight answers, no sales pitch.
No. For 2026, every marketplace medical plan offered in Dane County is either an EPO or an HMO.
No. Adults can qualify for BadgerCare Plus through 100% of the federal poverty level, with marketplace credits available above that threshold. That's why Wisconsin doesn't have a gap between them.
Yes. When you're in good health, I can help arrange a nationwide PPO privately, without going through the marketplace.
December 15 is the deadline for that coverage date, although the full open enrollment period lasts from November 1 through January 15.
Give me your location, everyone who needs insurance and an approximate figure for last year's net commissions. I'll compare the HealthCare.gov plans available to you with a personalized private nationwide PPO quote, then explain which I'd recommend and why.
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