Medicare plays a key role in providing health and financial security to beneficiaries residing in Wisconsin. With more than 1.1 million Wisconsin beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Wisconsin. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Wisconsin?

Medicare covers most Wisconsin residents who are 65 or older, and it also covers disabled Wisconsin residents. In general, Medicare enrollment in Wisconsin works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Wisconsin Medicare Enrollments

640,555

Original Medicare Plans
(Part A and B)

552,013

Medicare Advantage & Other Health Plans

452,193

Stand-alone Medicare
Part D (Drug plans)

1,192,568

Total Medicare Beneficiaries
in Wisconsin

Wisconsin Medicare Advantage Plans (Part C)

More than 44% of Wisconsin Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Wisconsin who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 552,013 beneficiaries enrolled in Medicare Advantage and other plans in Wisconsin. More than 44% of Wisconsin Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

As of 2020, 105 Medicare Advantage plans are available in Wisconsin. The average monthly Medicare Advantage premium changed from $36.28 in 2019 to $35.12 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Wisconsin. In 2020, there are Medicare Advantage plans available in all of Wisconsin’s counties. Depending on the county, Medicare Advantage plan availability ranges from just 20 plan to 47 plans.

Wisconsin Medicare Supplement (Medigap) Insurance Plans

Wisconsin insurers have waivers from the government, which allows them to conduct their own Medigap standardization.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

There are currently at least 33 insurers licensed to sell Medigap plans throughout Wisconsin. Medigap plans in Wisconsin aren’t the same as plans in most of the rest of the country because the state is one of just three states that have waivers from the federal government allowing them to conduct their own Medigap standardization.

Rather than having 10 different Medigap plan designs available, Medigap plans in Wisconsin are structures so there’s a basic plan. Then, beneficiaries can choose to add rides to make their coverage more comprehensive.

Wisconsin Medigap insurers are required to offer “basic benefits,” which include coverage for Part A coinsurance, Part B coinsurance, and up to three pints of blood each year. Moreover, Wisconsin Medigap insurers can choose to use attained-age rating or issue-age rating.

Wisconsin Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 452,193 Medicare beneficiaries in Wisconsin enrolled in stand-alone Part D prescription drug plans and 436,483 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 30 stand-alone Part D plans available in Wisconsin, with premiums ranging from about $13 to $124 per month. About 22% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Wisconsin

  • The Wisconsin State Health Insurance Assistance Program provides free, unbiased information and enrollment assistance to Medicare beneficiaries, their family members, and seniors who are nearing retirement. The SHIP program is federally funded and administered through the Wisconsin Department of Health Services, and SHIP workshops, outreach services, and a statewide network of vetted SHIP volunteers primarily delivers one-on-one counseling. Most SHIP volunteers work out of regional aging and disability resource centers (ADRCs), and face-to-face Medicare counseling is usually conducted at these centers.
    Contact: Call your local Area Agency on Aging. A list of the three Area Agencies on Aging is available on the Wisconsin Department of Health website.https://www.dhs.wisconsin.gov/aging/offices/regaaas.htm

  • The Wisconsin Senior Medicare Patrol (SMP) is a statewide organization that works to prevent, detect, and respond to Medicare fraud, billing errors, and issues with service delivery. SMP’s mission is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, abuse, and errors through outreach, counseling, and education. SMP is in every county across Wisconsin. Volunteers play a vital role in carrying out this mission to be in every county across Wisconsin. Volunteer involvement ranges from distributing materials, staffing a booth at fairs and outreach events, to giving group presentations.
    Contact: Call 1-888-818-2611

  • The Wisconsin Chronic Disease Program (WCDP) is a state-funded program that offers assistance to Wisconsin residents with chronic renal disease, hemophilia, and adult cystic fibrosis. The WCDP is funded entirely by state dollars. The program pays health care providers for disease-related services and supplies provided to certified WCDP members after all other sources of payment have been exhausted. There are three parts to the WCDP — the Chronic Renal Disease Program, Adult Cystic Fibrosis Program, and Hemophilia Home Care Program. These programs cover specific treatments, tests, medications, and home supplies.
    Contact: Call 800-362-3002

  • The Wisconsin Office of the Commissioner of Insurance (OCI) regulates health insurance in the state. Medicare Advantage plan members who have a specific complaint about their insurance provider should first try to resolve the issue with the insurance company.
    Contact: Call 608-266-0103 in Madison, statewide at 1-800-236-8517, or file a complaint through the OCI website.

  • SeniorLAW provides free legal assistance to Milwaukee County residents who are 60 and older. Benefit specialists provide legal information and attorneys provide representation in appropriate court cases. All services are free of charge.
    Contact: Call 855-947-2529

  • The Aging and Disability Resource Center of Brown County offers a broad range of services from activities, events, and workshops for persons looking for new things to do and learn to assistance for persons meeting the challenges of aging and disability. Seniors aged 60 and older in Brown County who require durable medical equipment, such as walkers, wheelchairs, canes, or crutches, can try out various mobility devices for free through the Assistive Equipment Loan Closet.
    Contact: Call 920-448-4300

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Wisconsin. Our process makes it easier for you to access your Medicare eligibility in Wisconsin so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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