How to navigate the health care marketplace as premiums rise and options shrink

Click here to read highlights from the story
- Residents choosing health insurance on the federal marketplace for 2026 will contend with hikes in premiums and other fees, the potential ending of tax credits that made payments more affordable and fewer plan options in some areas.
- But Wisconsin’s average premium hike of 17.4% next year is lower than the national average of 26%.
- The exact changes in costs and options depend on where you live.
- Insurance navigators say finding an affordable plan is still possible.
People who rely on the federal Affordable Care Act marketplace to choose health insurance for 2026 must contend with a host of challenges as the open enrollment period begins. Those include hikes in premiums and other fees, the potential ending of tax credits that made payments more affordable, and fewer options in some areas.
That’s as a growing number of residents have used the marketplace. More than 300,000 Wisconsinites, or about 5% of the state’s population, signed up for plans last year at HealthCare.gov — more than double the enrollment from about a decade ago.
If you’re feeling anxious or overwhelmed while considering your options, here is some information that might help.
How long does open enrollment last?
It began Nov. 1 and runs through Jan. 15. Choose a plan by Dec. 15 if you want coverage to kick in by Jan. 1.
How much will premiums increase?
Here’s some bad news: Premiums in Wisconsin will increase on average by 17.4% next year, a Wisconsin Watch analysis shows. If it’s any consolation, that’s less than the estimated 26% national hike as reported by KFF, a health policy nonprofit.
“Wisconsin is better than the national average,” said Adam VanSpankeren, navigator program manager of Covering Wisconsin, a University of Wisconsin-Madison Division of Extension program that helps people enroll in publicly funded health care. “Don’t be afraid to look at your plan and see what’s available because you’ll probably be able to find an affordable option.”
Premiums for most plans will increase by 9.4% to 19%. Premiums for a few outlying plans will surge by over 33.3%.
The increases depend on where you live. For example, the new benchmark plan in Milwaukee County will be 44% more expensive than the 2025 benchmark. That’s compared to an increase of just 8.13% in La Crosse and Trempealeau counties.
A benchmark plan refers to the second-cheapest Silver-tier plan, an Affordable Care Act concept used to calculate subsidies to help a marketplace enrollee pay their premiums.
Benchmark plans in Sawyer and Ashland counties will become the state’s most expensive next year, with 27-year-olds paying premiums of $637.57 per month. The two counties also stand out when comparing the average plan costs. The state’s cheapest benchmark plans will be found in Kewaunee, Brown, Door, Shawano, Oconto, Marinette and Manitowoc counties, where a 27-year-old will pay $444.58 monthly.
Statewide prices for Common Ground Health Cooperative will increase an average of 16.6% in 2026, including more noticeable hikes of at least 30% in Jefferson and Walworth counties. The company attributed the changes to rising health care costs and a changing federal landscape.
“By updating our rates, we can ensure the sustainability of our marketplace product and continue to deliver high-quality care to our members,” a spokesperson wrote in an email to Wisconsin Watch.
What is happening with subsidies?
More than 86% of Wisconsin enrollees last year received advanced premium tax credits that lowered the cost of premiums by an average of $585, according to KFF.
But one major subsidy, the enhanced premium tax credit, introduced in 2021, is set to expire at the end of 2025. Democrats in Congress have called for the credits to be extended in a debate that’s central to the ongoing federal government shutdown.
The tax credit’s expiration would result in lower reimbursements for eligible households. Households with an income of more than four times the federal poverty level will no longer be eligible for any federal tax credit.
“How much Wisconsinites’ healthcare coverage costs will increase varies depending on age, income, plan selection, and available insurers in each county, but many Wisconsinites will see their premiums increase significantly, with seniors and middle-class families seeing some of the largest increases if Republicans in Congress do not extend enhanced tax credits under Affordable Care Act,” Evers wrote in an Oct. 27 press release.
A 60-year-old couple making around $85,000 in Barron County could see premiums skyrocket over 800%, with an annual increase of over $33,000 in costs, according to calculations by the Insurance Commissioner Nathan Houdek’s office. The same couple living in Dane County could see premiums triple, paying nearly $20,000 extra a year.
VanSpankeren says to examine your options as soon as you can, with help from insurance agents or navigators such as those at Covering Wisconsin.
“That (cost increase) does not mean be scared or anxious or stay away from the marketplace,” VanSpankeren said. “It means you’ve got to look again, and you’ve got to do your homework and work with a navigator if you need to.”
If you’re looking for a marketplace plan, it’s a good time to estimate your income for the year, VanSpankeren added, even if that seems difficult. If your income changes over the year, you can report that later.
“You’re just going to do your best, and that’s all anybody can do,” he said. “But really take that extra time to calculate it, however close you can, it’s going to help you a lot in terms of making sure your plan is affordable and making sure you’re not paying back in tax credits that you shouldn’t have gotten.”
He also suggested considering how often you expect to visit the doctor’s office over the year and whether you anticipate any major procedures. That will help determine what plan makes most sense to choose.
How will changes affect plan options?
Residents in most counties will find fewer plan options as companies retreat from certain markets. Data from Houdek’s office show that 46 of Wisconsin’s 72 counties lost at least one insurance company. Up to four companies will stop serving Winnebago, Racine, Calumet, Milwaukee, Sheboygan, Outagamie, Manitowoc and Kenosha counties.
Two out of three providers currently serving Fond du Lac County have announced exits, leaving residents with just one option.
VanSpankeren worries dwindling options will push some residents out of the marketplace, leaving them unable to access any existing subsidies — potentially falling prey to providers that exploit people in need.
“This would be an opportunity for the good agents and brokers of Wisconsin to rise to meet that need and say, ‘Hey, there are these other things you’re looking for. This particular hospital, this plan actually covers it. Let’s talk about your options,’” VanSpankeren said.
Dean Health Plan by Medica, Fond du Lac’s remaining insurance provider, is “committed to being a stable presence in the community and supporting those who may need to choose a new plan,” spokesperson Ricky Thiesse wrote in an email.
The company encouraged residents to confirm whether their preferred doctors and hospitals are in-network, or if they need to select new providers to receive full benefits.
What other plan changes might we see?
A majority (61%) of the health plans in Wisconsin will feature higher deductibles next year, increasing out-of-pocket costs before insurance starts paying. The most dramatic deductible increase will be $2,800.
Some providers are also adjusting co-pays and coinsurance rates to reduce company costs. That could require enrollees to pay more per doctor’s visit or spend more on certain drugs.
Should I consider a catastrophic plan?
Catastrophic plans, a federal marketplace alternative, commonly feature low monthly premiums but very high deductibles before providers pay for care. They are seen as affordable ways to protect only against worst-case scenarios, like getting seriously sick or injured, according to HealthCare.gov. Catastrophic plans are open only to people under 30 or those who qualify for a hardship or affordability exemption.
But they are also getting more expensive next year, with premiums surging an average of 57.8%. Catastrophic plans make up the top six plans with the biggest premium increases in 2026.
VanSpankeren suggests comparing a catastrophic plan with Bronze- or Silver-tier plans that might offer more comprehensive coverage.
While individual comparisons will vary, a single 27-year-old enrolling in a catastrophic plan in 2026 would save an average of just $38 monthly compared to a Bronze-tiered plan.
“We don’t choose plans for people, and we don’t steer people towards plans. But I would say it is very rare for anybody that a navigator works with to choose a catastrophic plan,” VanSpankeren said.
Want to see how we crunched the data? Read our data analysis process here.
How to navigate the health care marketplace as premiums rise and options shrink is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.
























































