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Medicare in Wisconsin
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Finding Medicare Plans in Wisconsin

We don’t think that selecting the right Medicare coverage should feel overwhelming. The good news is that Wisconsin offers a wide variety of Medicare plans to choose from, and we here at MedicareMatchup can help you find the right level of coverage that best fits your needs and your budget.

Who’s Eligible for Medicare in Wisconsin?

To qualify for Medicare, you must be eligible for Social Security benefits. Most people first become eligible for Medicare when they turn 65 years old.

If you’re 65 or older, you may qualify for Medicare if:

  • You are a citizen or permanent resident (having lived in the US for at least 5 years), and
  • You or your spouse worked at a job that paid towards your Medicare through Social Security deductions for at least 10 years.

If you’re under 65, you may qualify for Medicare if you have:

  • been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)
  • received Social Security Disability Insurance (SSDI) for at least 24 months

If you’re unsure about your eligibility or will be turning 65 within the next six months, we’re here to help. You can view local plans online or call us to speak with a licensed insurance agent.

What Medicare Plans are Available in Wisconsin?

Original Medicare (Parts A and B)

Original Medicare is the federal component of Medicare, which has two parts:

Part A (Hospital Insurance) covers inpatient services, like hospital care, hospice, skilled nursing facility care, and nursing home care (as long as custodial care isn’t the only care needed).

Part B (Medical Insurance) covers outpatient  services and supplies, like mental health, ambulance services, and durable medical equipment (blood sugar monitors, walkers, canes, etc). Part B also covers certain services that prevent or detect illnesses early, like flu shots, cardiovascular and diabetes screenings.

Original Medicare doesn’t cover everything. Services generally not covered by Original Medicare include:

  • Long term care (custodial care)
  • Most outpatient prescription drugs
  • Hearing aids
  • Eye exams and eyeglasses
  • Most dental care and dentures
  • Routine foot care
  • Cosmetic surgery
  • Acupuncture

Medicare doesn’t cover everything and isn’t intended to pay 100% of your medical bills. Medicare beneficiaries typically pay a portion of medical expenses in the form of deductibles, coinsurance, and copayments. For this reason, there are many additional Medicare plans available in Wisconsin to choose from and expand your coverage.

Medicare Advantage Plans (Part C)

Medicare Advantage plans, offered by Medicare-approved private insurance companies, work as an alternative to the coverage provided by Original Medicare (Parts A and B). These plans provide the same coverage as Original Medicare and can also include additional benefits, like dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans.

You must be enrolled in both parts of Original Medicare to enroll in a Medicare Advantage plan. Premiums can start at $0 and increase depending on the level of coverage selected. You’ll continue paying your Part B premium in addition to your Part C premium.

Learn more about Medicare Advantage Plans »

Medicare Prescription Drug Plans (Part D)

Prescription drugs are not covered by Original Medicare (Parts A and B) or Medigap plans. Stand-alone Medicare Prescription Drug plans, offered by Medicare-approved private insurance companies, work alongside Original Medicare to limit your out-of-pocket costs for medications. Medications are put into tiers, each tier with a certain copay or coinsurance. Each Medicare Part D plan provides a formulary, so you can see what the coinsurance/copay would be for each drug.  This way, you can select the plan that best matches your prescription needs.

Learn more about Medicare Prescription Drug Plans »

Medicare Supplement Plans (Medigap)

As mentioned earlier, Medicare beneficiaries are still responsible for paying a portion of their medical bills. This is where Medicare Supplement plans come in. These plans are available through private insurance companies, approved by Medicare, and work alongside Original Medicare to cover certain costs, like copayments, coinsurance, and deductibles. If you plan to stick with Original Medicare, a Medigap plan can help reduce your out-of-pocket costs.

Learn more about Medicare Supplement Plans »

When Can I Enroll In A Plan?

Medicare Advantage and Medicare Prescription Drug Plans

Your Initial Enrollment Period (IEP) is your first opportunity to enroll in Medicare. This IEP is a seven-month period, starting three months before your 65th birthday month.

You can then make changes to your Medicare Advantage or Medicare Prescription Drug coverage during the Annual Election Period (AEP). This period runs from October 15th to December 7th every year.

Medicare Initial Enrollment

Key Fact: The General Enrollment Period offers another chance to enroll in Original Medicare, in case you missed your IEP. This period occurs each year from January 1st to March 31st. If you want to enroll in a Medicare Advantage plan, you can do so from April 1st to June 30th every year.

Medicare Supplement Plans

The best time to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period. This six-month period begins at the start of your 65th birthday month, assuming you’ve enrolled in Medicare Part B. Otherwise, your Medigap Open Enrollment Period would start the same month as your Medicare Part B coverage.

Important Note: You are guaranteed the Medigap plan of your choice if you enroll during this period. But if you don’t enroll within this period, you could be charged higher premiums or be denied coverage entirely.

Special Enrollment Periods

If you’ve recently experienced a qualifying life event, you may be eligible for a Special Enrollment Period. Special Enrollment Periods allow you to make changes to your Medicare coverage outside of the periods discussed above. Qualifying life events include moving outside of your plan’s coverage area, moving into or out of a care facility, and more. Our licensed insurance agents can help determine whether you qualify for a Special Enrollment Period.

How Do I Find the Right Medicare Plan?

If you’d like to compare your Medicare options or need help deciding, we’re here to help!

Call us today to speak with a licensed insurance agent. You can also get plan information online by using our simple request form below.

Additional Medicare Resources in Wisconsin

The State Health Insurance Counseling and Assistance Program (SHIP) provides help with questions or concerns about Medicare-related issues to those 65 and over or those with disabilities.

The Wisconsin’s Medicare Savings Program, or Medicare Premium Assistance, is available to Medicare beneficiaries in Wisconsin whose income falls beneath a certain amount to help pay for Medicare costs, like premiums and deductibles.

Sources: Medicare.gov; www.dhs.wisconsin.gov

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Disclaimers: Outside of the Medicare Annual Enrollment Period, members can enroll in a plan only if they meet certain criteria. A licensed insurance agent can help you determine whether you are eligible. Plan availability varies by region and state. Callers will be directed to a licensed insurance agent with a third-party partner of Medicarematchup.com who can provide more information about Medicare Advantage plans offered by one or several Medicare-contracted carrier(s). Enrollment in any plan depends on contract renewal. Medicare has neither reviewed nor endorsed the information contained in this advertisement. Not connected with, or endorsed by, the U.S. government or the federal Medicare program. This information is not a complete description of benefits. For a complete listing of Medicare plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week, or consult www.medicare.gov.