NORTHEAST WIS. – Shopping for 2026 health insurance on Healthcare.gov this month could require more attention and a phone call to a financial planner to keep premiums low, experts said.
“Make sure your income is accurate. That income cliff is the biggest, scariest thing for people,” said Jaime Mueller, director of finance at Main Street Insurance.
Most people purchasing plans on Healthcare.gov can expect to pay more for health-care insurance in 2026 unless Congress modifies the 2025 Budget Reconciliation Act, or “Big Beautiful Bill,” signed into law July 4, said Brian Klumb, owner of Marinette Insurance and Financial Services.
The stalemate in Congress fueling the government shutdown stemmed from disagreements over whether extended tax credits for health insurance purchased on Healthcare.gov, begun during COVID-19, should end Dec. 31. Healthcare.gov is the marketplace exchange the Affordable Care Act provides to encourage people without access to employer plans to get covered.
While a compromise was reached in the Senate Nov. 9 when eight Democrats joined Republicans in a 60-40 vote to reopen the government, it didn’t resolve the health insurance tax-credit issue. As of press time for this story, the bill hadn’t been passed in the U.S. House. It also would need President Donald Trump’s signature to be enacted.
Meanwhile, local offerings will be updated on Healthcare.gov for 2026. Two of four insurance carriers available in Marinette County in 2025 aren’t participating in Healthcare.gov’s open enrollment for 2026, which began Nov. 1, Mueller said.
CommonGround/CareSource and UnitedHealthcare are the two remaining carriers, Mueller said. A Prevea Health spokeswoman recommended checking with insurance companies to confirm whether the clinic’s medical providers are in-network in Marinette County, where it operates Prevea Marinette Health Center in Marinette. The clinic accepts some UnitedHealthcare insurance plans.
Prevea360 is a separate organization from the health clinics, the spokesperson said. It offers health-insurance plans on Healthcare.gov in Oconto County.
Whether the extended health-care subsidies will be in force in 2026 likely won’t be determined before many people choose plans.
The extended tax credits Congress approved in 2020 resulted in lower premiums and helped to double the number of people who purchased insurance on Healthcare.gov, resulting in fewer uninsured Americans, according to Kaiser Family Foundation (KFF) a healthcare research nonprofit. Without an amendment to allow for the extended subsidies and other modifications to Healthcare.gov, about 8.2 million more people could drop their Healthcare.gov health insurance, KFF said.
Going without insurance puts people at greater risk of financial ruin from an unexpected health issue requiring extensive treatment, such as cancer, KFF said.
About $793 million in Medicaid cuts have compounded the issue and could lead another 7.8 million people to become uninsured, bringing the total increase in the uninsured population to about 16 million, according to a Congressional Budget Office estimate.
Healthcare.gov, or Obamacare as it also is called, was started to provide access to insurance for employees at small businesses not offering employer plans, small business owners, gig workers and early retirees not yet eligible for Medicare.
Premiums for plans offered on Healthcare.gov are based on income, with those earning less paying less for plans. However, if the household’s income were to rise to above 400% of the poverty level, members could lose the tax credit and be expected to pay more when they file their annual income tax forms, Klumb said.
Those likely to notice the largest jump in premium cost are high earners without access to employer plans, said Mueller of Main Street Health Insurance, with offices on Main Streets in Marinette, Oconto and Green Bay. The company, owned by Mueller’s grandmother, was started in 1993, Mueller said.
Mueller recommended checking with an accountant or financial planner to determine what strategies might result in a larger tax credit and lower monthly premiums.
The U.S. Department of Health and Human Services set the 2025 poverty level at $15,650 per year for an individual and $32,150 for a family of four. At the 400% level, annual income rises to $62,600 for an individual and to $120,562 for a family of four.
Above those levels, people purchasing health insurance on Healthcare.gov pay full price for the plans. The monthly premiums, which often run into tens of thousands of dollars for family coverage, has encouraged some business owners, like Jody Anderson — an owner agent at JBA Insurance in Green Bay — to seek alternatives to traditional insurance.
One alternative is Impact Health Sharing, a nonprofit with an open network that negotiates rates with medical providers and taps members to pay other members’ bills after a deductible based on age is met. The “monthly share amount” is akin to a premium, she said.
On the opposite end of the income scale, those at or near the poverty level who have been on Medicaid or BadgerCare could see their eligibility change, as the Reconciliation Act required a work requirement for Medicaid recipients and most Supplemental Nutrition Affordability Program or FoodShare recipients given EBT cards for food purchases, according to KFF.org.
Current income eligibility guidelines for BadgerCare are $1,304 for adults and $3,991 for pregnant women and children. To sign up for BadgerCare or Wisconsin FoodShare, visit Access.Wi.Gov.
Small business owners who don’t take a large salary from their business and have qualified for Medicaid could lose these benefits without an adjustment in income because of the part-time work requirement, according to the new law.
Those in high-income households might be tempted to drop their insurance if they are expected to pay the full amount of the premiums, which can rise to about $2,000 monthly for individuals and over $4,000 a month for family coverage, experts said. Many deductibles are rising to $10,600, said Brian Klumb, owner of Marinette Insurance and Financial Services.
Dropping health insurance can lead to financial disaster, as lack of health insurance is a leading cause of bankruptcy filings, experts said.
“If people try to go without insurance and something happens, it could be financially devastating,” Klumb said.
Many people will be shelling out substantial sums for plans with high deductibles, Klumb said.
“They’re going to have some large dollars out of pocket, but at least there’s a cap. It may take you a while to pay it back, as opposed to tens of thousands of dollars and no means to pay it back if you don’t have insurance,” he said.
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