Health Insurance

Brad offers ACA Marketplace plans (individual and family), short-term health plans, and supplemental coverage including dental, vision, and accident plans. As an independent agent, he shops multiple carriers — including Common Ground Healthcare Cooperative, Health Partners, and Network Health — to find the plan that best fits your needs and budget. His services are completely free to you; he is paid by the insurance companies.

Your premium is the monthly amount you pay to keep your insurance active — whether or not you use it. Your deductible is what you pay out of pocket before your insurance starts covering costs. A copay is a fixed dollar amount for a specific service (like $30 for a doctor visit). Coinsurance is your share of costs after you meet your deductible — for example, 20% of a hospital bill. Together, your deductible + coinsurance + copays cannot exceed your plan's out-of-pocket maximum.

The out-of-pocket maximum is the most you will ever pay in a plan year for covered services. Once you hit that limit, your insurance covers 100% of covered costs for the rest of the year. For 2026, ACA plans cap individual out-of-pocket costs at $9,200 and family costs at $18,400. This is your financial safety net against a major illness or accident.

These "metal tiers" describe how costs are split between you and your insurance company. Bronze plans have the lowest monthly premiums but higher costs when you use care — good if you're generally healthy and want protection from catastrophic costs. Silver plans are mid-range and are the only tier that qualifies for cost-sharing reductions if your income is below 250% of the federal poverty level. Gold plans have higher premiums but lower costs at the doctor. Platinum plans have the highest premiums with the lowest out-of-pocket costs. Brad can help you figure out which tier makes sense for your situation.

The enhanced premium tax credits that were put in place during the COVID-19 pandemic expired on December 31, 2025. From 2021 through 2025, those enhanced subsidies dramatically reduced what millions of Americans paid for Marketplace coverage. With their expiration, many people are seeing premium increases of hundreds of dollars per month. If your premium jumped significantly, call Brad — he may be able to find you a more affordable plan or confirm whether you still qualify for standard premium tax credits based on your income.

Yes — standard premium tax credits are still available in 2026. You may qualify if your household income falls between 100% and 400% of the federal poverty level (FPL). For 2026, that is approximately $15,060–$60,240 for an individual and $31,200–$124,800 for a family of four. The subsidy amount is based on a sliding scale — the lower your income, the larger your subsidy. Brad can run the numbers with you to see exactly what you qualify for before you enroll.

Cost-sharing reductions (CSRs) lower your deductibles, copays, and coinsurance — not just your premium. To get CSRs, you must enroll in a Silver plan and have a household income between 100% and 250% of the federal poverty level. CSRs can be extremely valuable, effectively giving you Gold- or Platinum-level benefits at a Silver price. If your income is in that range, Brad will make sure you're on the right plan to capture this benefit.

Yes — and this is a big new change for 2026. All Bronze and Catastrophic Marketplace plans are now HSA-eligible, thanks to new legislation signed into law. Previously, only plans specifically designated as High-Deductible Health Plans (HDHPs) qualified. An HSA lets you set aside pre-tax dollars to pay for qualified medical expenses, reducing your overall health care costs. If you're self-employed, a small business owner, or otherwise paying for your own insurance, an HSA can be a powerful tax-saving tool. Ask Brad about HSA-compatible plan options.

Open Enrollment for ACA Marketplace plans runs from November 1 through January 15 each year. To have coverage start January 1, you must enroll by December 15. If you enroll between December 16 and January 15, your coverage starts February 1. Outside of Open Enrollment, you can only enroll if you qualify for a Special Enrollment Period due to a qualifying life event.

A Special Enrollment Period allows you to enroll in or change a health plan outside of Open Enrollment. Qualifying events include: losing your job or employer-sponsored coverage, getting married or divorced, having or adopting a child, turning 26 and aging off a parent's plan, moving to a new state, or losing Medicaid or CHIP coverage. You typically have 60 days from the qualifying event to enroll. If you've recently had a life change, call Brad right away — he can help you enroll before the SEP window closes.

You should always shop around before renewing — especially in 2026. Auto-renewal means you stay on your existing plan at whatever the new premium is, which may be significantly higher than last year due to the expiration of enhanced subsidies. Carriers also change their plan offerings and networks from year to year, so a plan that worked well in 2025 might not be the best option in 2026. Brad can do a free side-by-side comparison of all available plans in your area so you can make an informed decision rather than defaulting to what you had.

Every plan has a network of doctors, hospitals, and specialists who have agreed to contracted rates with the insurer. Seeing an in-network provider means lower costs for you; going out-of-network often means paying significantly more — or everything, depending on your plan. Before enrolling, check the insurer's online provider directory for the specific plan you're considering. Brad always reviews network coverage with his clients before recommending a plan, especially if you have a specialist or hospital you want to keep.

Yes. All ACA Marketplace plans are required to cover a wide range of preventive services at no cost to you — even before you meet your deductible. This includes annual wellness visits, blood pressure and cholesterol screenings, mammograms, colonoscopies, flu shots, and more. To get these services with no cost-sharing, you must see an in-network provider. This is one of the most valuable benefits of ACA coverage and a great reason to stay on top of your annual health screenings.

No. Under the Affordable Care Act, health insurance companies cannot deny you coverage or charge you higher premiums because of a pre-existing condition. This applies to all ACA Marketplace plans. Conditions like diabetes, heart disease, cancer history, or mental health diagnoses cannot be used against you when applying for a plan. This protection remains in effect for 2026.

Standard ACA health insurance plans do not include adult dental coverage — it must be purchased separately. Pediatric dental is an ACA essential health benefit, so children's dental is often embedded in or available alongside marketplace health plans. Adults must buy a standalone dental plan or an add-on rider. The good news: Wisconsin has 7 insurers offering individual dental plans through the ACA marketplace in 2026, plus additional carriers selling direct. Brad can help you find a plan that covers your dentist at a price that fits your budget.

Stand-alone individual dental plan premiums in Wisconsin's ACA marketplace range from approximately $9 to $54 per month for adults in 2026, depending on the plan type and your age. Family dental plans run higher. Most dental plans follow a 100/80/50 structure: preventive care (cleanings, exams, x-rays) covered at 100%; basic care (fillings, extractions) at 80%; major services (crowns, root canals, bridges) at 50% — after any deductible. Annual maximums typically run $1,000–$2,000. Brad shops dental plans alongside your health plan to minimize your total monthly cost.

Yes — most individual dental plans impose waiting periods before major services are covered. Preventive care (cleanings, exams) is almost always available immediately with no waiting period. Basic services like fillings may have a 3–6 month wait. Major services like crowns, bridges, and dentures often have a 6–12 month waiting period. If you enroll knowing you need significant dental work soon, look for plans with reduced or no waiting periods — some exist, especially through direct-sale carriers. Brad can identify plans that minimize your wait based on your anticipated needs.

Coverage varies significantly by plan. Dental implants are considered a major service and are covered by some plans at 50% after the deductible and waiting period — but many basic plans exclude implants entirely. Orthodontia (braces or Invisalign) for adults is typically not covered under standard plans; coverage for children is more commonly available. If implants or orthodontia are a priority, Brad can identify plans with these specific benefits before you enroll — rather than discovering the gap after you've committed to treatment.

Yes — adults and children enrolled in BadgerCare+ (Wisconsin Medicaid) are eligible for extensive dental services at little to no cost. BadgerCare+ covers diagnostic, preventive, and basic dental care including cleanings, fillings, and extractions. Major services are generally covered as well, though some require prior approval. Orthodontia is not covered for adults. If your household income qualifies for BadgerCare+, it can provide comprehensive dental coverage at no premium cost. Brad can help determine your eligibility and, if you don't qualify, find an affordable stand-alone dental plan.

Dental discount plans are not insurance — they are membership programs that give you access to reduced fees at participating dentists. You pay an annual membership fee (typically $100–$200/year) and receive 10–60% off dental services at in-network providers. There are no deductibles, waiting periods, or annual maximums. Discount plans can make sense if you need dental work quickly and can't wait out insurance waiting periods, or if your dental needs are modest. However, they offer no reimbursement — you pay the discounted rate out of pocket at the time of service. Brad can help you compare discount plans vs. insurance for your specific situation.

Standard ACA health insurance plans cover eye exams only when medically necessary — for example, monitoring a chronic condition like diabetes or glaucoma. Routine eye exams, prescription eyeglasses, and contact lenses are not covered under standard health plans for adults. Pediatric vision is an ACA essential benefit, so children's routine eye care is typically included. Adults who want vision coverage need to purchase a separate stand-alone vision plan. Brad can add vision coverage alongside your health plan during ACA open enrollment or direct through carriers year-round.

Individual vision plans in Wisconsin are among the most affordable insurance products available — typically $10–$20 per month for an adult, or $25–$45/month for a family plan. Standard vision plans usually cover one routine eye exam per year (often with a small copay), plus an allowance toward frames or lenses — commonly $130–$200 — with discounts on contacts. Some plans offer better allowances for premium frames or progressive lenses. Given that a single eye exam can cost $100–$200 without insurance, and frames can run $200–$500+, vision insurance pays for itself quickly for most people.

A standard individual vision plan in Wisconsin typically covers: one comprehensive eye exam per year (with a $0–$20 copay at in-network providers); frames allowance of $130–$200 toward glasses, with 20–40% off amounts above the allowance; lenses — single vision, bifocal, and trifocal covered in full or for a small copay; contact lens allowance in lieu of glasses, typically $130–$175; and discounts on LASIK eye surgery (15–20% off at participating providers). Higher-tier plans offer larger frame allowances and better contact lens benefits. Brad can match you with a plan that fits your prescription and eyewear preferences.

Vision plans use provider networks, and staying in-network keeps your costs lowest. Major vision networks in Wisconsin include VSP, EyeMed, Humana Vision, and Davis Vision. Most independent optometrists, LensCrafters, Visionworks, Target Optical, and Walmart Vision Centers participate in at least one major network. Out-of-network benefits are usually available at a reduced reimbursement level — you pay upfront and submit for partial reimbursement. Before enrolling, Brad can verify that your current eye doctor participates in a plan's network so you don't face a surprise bill.

Standard vision insurance does not cover LASIK as a benefit — it is considered an elective procedure. However, most vision plans include a LASIK discount program, typically 15–20% off the procedure at participating laser eye surgery centers. Some employer-sponsored vision plans offer a flat discount (e.g., $200 off per eye). Many LASIK providers also offer independent financing plans and discounts. If LASIK is a goal, Brad can identify vision plans with the strongest LASIK discount programs and help you understand your total out-of-pocket cost.

Yes — this is one of the advantages of dental and vision insurance compared to major medical health insurance. Stand-alone dental and vision plans can generally be purchased any time of year directly from the insurer, outside of the ACA open enrollment window (November 1–January 15). You don't need a qualifying life event to enroll. ACA marketplace dental plans follow the same open enrollment schedule as health plans, but off-exchange plans from carriers like Delta Dental, Humana, and others are available year-round. Call Brad at (920) 251-4969 any time to get dental and vision coverage started.