Know your options for Medicare plans in Wisconsin, whether you’re looking for Original Medicare or Medicare Advantage.
Medicare plan options include:
You may also elect to add a Medicare Supplement Plan (Medigap) to go along with Original Medicare to help with additional out-of-pocket expenses.
Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.
To qualify for Medicare, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability and receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may qualify for Medicare at a younger age if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be enrolled in Medicare automatically. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
Wisconsin has several Medicare options available to U.S. citizens or permanent residents at least age 65. You are eligible if under age 65 and you have ESRD, ALS, or have been disabled for at least 24 months and draw SSDI.
Original Medicare is the standard coverage for Medicare beneficiaries and has two parts: Part A (hospital insurance) and Part B (medical insurance). Here’s a look at the details about Original Medicare:
Who Original Medicare is best for: Original Medicare is a good option if you want more flexibility. It has a broad coverage area throughout the U.S. If you have several health conditions, you may want to pair your Medicare with a Medigap. Because Original Medicare does not cover prescriptions, enrolling in a stand-alone drug plan is important. If not paired with a Medigap, the out-of-pocket cost is a drawback to the plan.
|Part A premium||Standard Part B premium|
|Usually free||$164.90 per month|
An alternative to Original Medicare, Medicare Advantage Plans – also known as Part C – cover everything Part A and Part B do, but typically offer additional coverage.
Wisconsin Medicare Advantage programs have networks and may only be available in certain areas of Wisconsin. Plan options are based on ZIP code. These plans usually consist of copayments, deductibles, and out-of-pocket maximums that you are responsible for. However, plans can start at a $0 premium and go up from there. The average monthly premium in Wisconsin is $27.28 (in 2023).
The Wisconsin Medicare Advantage Program is made up of four types of plans:
The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. Wisconsin has 115 plans available in 2022. Medicare Advantage has continued to rise in popularity with Wisconsinites.
Who Medicare Advantage Plans are best for: This type of plan is best if you are on a fixed income or you are in good health and don’t want to overpay for coverage you don’t use very often. Having one card to use and the additional benefits bundled in the plan can be attractive. To be eligible, you need to be enrolled in Medicare Part A and Part B.
The downsides to Medicare Advantage Plans are mostly related to a limited choice of providers and service areas. Prior authorizations and referrals may also be necessary before receiving certain procedures.
|Plan name||Monthly premium||Yearly drug and premium cost||Deductibles|
|AARP Medicare Advantage Open Plan 1 (PPO)||$45||$540||Health: $0
|AARP Medicare Advantage Open Plan 2 (PPO)||$33||$396||Health: $0
|Humana Gold Plus H6622-034 (HMO)||$0||$0||Health: $0
Plans calculated based on Madison ZIP code 53702.
Medicare Part D is offered by private insurance but is regulated by Medicare. Part D can be purchased as a stand-alone PDP or as part of a Medicare Advantage Plan (MA-PD).
Wisconsin Part D premiums start at $6.60 a month.
Currently, there are 23 stand-alone PDPs in Wisconsin. Eight of the stand-alone plans and 55 Medicare Advantage Plans with prescription drug coverage participate in the Senior Savings Model, which lowers the cost of insulin out of pocket.
Who Part D plans are best for: PDPs are always best even if you don’t take any medications. If you do not enroll when becoming eligible, you will be penalized for every month you do not have one.
|Plan name||Monthly premium||Yearly drug and premium cost||Deductible|
|SilverScript SmartSaver (PDP)||$6.60||$79.20||$505|
|Wellcare Value Script (PDP)||$9.60||$115.20||$505|
|Humana Walmart Value RX Plan (PDP)||$31.20||$374.40||$505|
Plans calculated based on Madison ZIP code 53702.
Medigap plans are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. There are four standardized plans available in Wisconsin. However, a Medigap High Deductible Plan is only available to those who became eligible for Medicare prior to Jan. 1, 2020.
A Medigap High Deductible Plan for a 65-year-old nonsmoking female in Madison ranges from $45 to $75 per month. You may also be responsible for the Part B deductible of $233.
Who Medigap plans are best for: Medigap is a good fit if you utilize benefits frequently, do not want to be restricted to a small coverage area, and prefer to choose your own provider. You should not choose a supplement if you cannot afford the monthly premium and you want extra benefits available with Medicare Advantage, such as having the PDP, dental, vision, and hearing benefits included.
If you are considering purchasing a supplement, always check to see if the company offers additional discounts for having people that live in your household or for nonsmoking.
|Plan name||Monthly premium range||Copays/coinsurance||Deductibles||Plan benefits|
|Medigap 25% Cost Sharing Plan||$108 to $165||5%
Generally your cost for approved Part B services up to $3,310. Then, you’ll pay $0 for the rest of the year
|$389 hospital (Part A)
$233 medical (Part B)
|Medigap 50% Cost Sharing Plan||$85 to $132||10% Generally your cost for approved Part B services up to $6,620. Then, you’ll pay $0 for the rest of the year||$778 hospital (Part A)
$233 medical (Part B)
|Medigap Basic Plan||$81 to $337||$0||$1,556 hospital (Part A)
$233 medical if eligible (Part B)
|Medigap High Deductible Plan||$45 to $75||$0||$0 hospital (Part A)
$0 medical if eligible (Part B)
Calculated based on a nonsmoking 65-year-old female in Madison ZIP code 53702.
Wisconsinites have many plan options available. It is always good to make a list of pros and cons of the plans. Important things to consider are out-of-pocket costs, provider network, coverage area, insurance company ratings and the overall ability of the plan to meet your specific need.
|People enrolled in Original Medicare||Average plan cost||Annual Wisconsin spending per beneficiary||Spending per beneficiary compared to the national average|
|645,403||Part A: $0 to $506 per month*
Part B: $164.90 **
*Most people pay no premium but this can vary depending on how long they paid Medicare taxes.
**This is the average number but it can vary based on income.
Making Medicare decisions can be overwhelming at times. It is good to utilize the resources and tools available in Wisconsin. The organizations have people knowledgeable in the programs specific to your state. Most of the services provided are free. An example is the Wisconsin Department of Health Services’ State Health Insurance Assistance Program (SHIP), which helps seniors with Medicare eligibility, enrollment, costs, and more.
Never be afraid to ask questions. Get started with these Wisconsin Medicare resources:
|Organization||How you can get help||Contact Information|
|Disability Rights Wisconsin||Disability Rights Wisconsin is a nonprofit organization that provides legal advocacy, rights protection, and assistance with Medicare for people with disabilities.||Website | (800) 928-8778|
|Senior Medicare Patrol (SMP)||Wisconsin’s SMP helps Medicare beneficiaries and their advocates prevent, detect, and report health care fraud, errors, and abuse.||Website | (888) 818-2611|
|Wisconsin Department of Health Services – SHIP||Wisconsin Medicare beneficiaries and their caregivers can get free and unbiased help with Medicare through SHIP. Counselors assist with Medicare eligibility, enrollment, plan options, programs that can lower costs, and more.||Website | (800) 242-1060|
|Wisconsin Department of Health Services (DHS)||DHS oversees Medicaid and other health and social service programs. DHS ensures that the care provided to Wisconsin residents is in accordance with state and federal law, and that Wisconsin taxpayer dollars are being used effectively and efficiently by preventing and detecting waste, fraud, and abuse.||Website | (608) 266-1865|
|Wisconsin Office of the Commissioner of Insurance (OCI)||OCI was created to protect and educate Wisconsin consumers by maintaining and promoting a strong insurance agency. The office assists consumers with insurance problems.||Website | (608) 266-3585|
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