Complete Guide to Medicare Advantage Plans in Wisconsin
Learn about plan options and how to choose the best Wisconsin Medicare Advantage Plan for your needs
Medicare Advantage provides people on Medicare with an alternative to Original Medicare. Wisconsin Medicare Advantage plans are popular—56% of people choose to enroll.
One of the key reasons people choose to enroll in Medicare Advantage plans is because they often provide extra benefits, like dental, vision, and hearing coverage. We’ll go into more detail about the pros and cons of these plans below. We’ll also share information about when to enroll and how to choose the best Wisconsin Medicare Advantage plan for your specific situation.
Key Takeaways:
56% of Wisconsin Medicare beneficiaries are enrolled in Medicare Advantage plans.
There are a total of 103 Medicare Advantage plans in Wisconsin.
Many people choose to enroll in Medicare Advantage plans because they come with extra benefits, including dental, vision, hearing, and prescription coverage.
Medicare star ratings can help you finalize your choice, but you should consider your personal health and financial needs first when choosing the right plan for you.
Curious about other Medicare options? Read our Wisconsin Medicare plans guide.
Quick facts about Medicare Advantage plans in Wisconsin
Below are some key statistics that can help you get a good overview of the Wisconsin Medicare Advantage market. It’s important to keep in mind, however, that plan availability and enrollment vary by county.
56% of Wisconsin Medicare beneficiaries are enrolled in Medicare Advantage plans.
Medicare Advantage enrollment varies by county—from 19% in Pierce County, WI, to 77% in Calumet County, WI.
There are a total of 103 Medicare Advantage plans in Wisconsin.
The number of plans available ranges from 11 plans in St. Croix County to 47 plans in Waushara County.
Medicare Advantage pros and cons
Like any health insurance plan, Medicare Advantage plans come with their pros and cons. Most of the issues with Medicare Advantage plans can be avoided if you understand these pros and cons.
Pros of Medicare Advantage plans
The two key advantages of Medicare Advantage plans are that they limit your out-of-pocket costs and provide extra benefits.
Limited out-of-pocket costs
Original Medicare doesn’t have a maximum out-of-pocket spending amount, but Medicare Advantage plans do. Your maximum out-of-pocket amount depends on the Medicare Advantage plan you choose.
Extra benefits
As we mentioned previously, many people choose to enroll in a Medicare Advantage plan because of the extra benefits they provide. The extra benefits will vary between plans but may include the following:
Hearing coverage
Vision coverage
Prescription drug coverage
Cons of Medicare Advantage plans
There are two key disadvantages to Medicare Advantage plans that can cause delays to the care you need or even limit your access to care.
Prior authorization requirements
Original Medicare doesn’t require prior authorization. Medicare Advantage plans, on the other hand, will often require prior authorization to receive coverage. This can result in delayed treatment. If your prior authorization is denied, you may face further delays as you appeal—or, worse, you may not be able to receive the treatment you need.
Provider networks
If you’re on Original Medicare, you can see any doctor who accepts Medicare. This means you can see the vast majority of doctors nationwide. Medicare Advantage plans, however, use provider networks that limit you to receiving coverage for care received from local, in-network providers.
When to enroll in Medicare Advantage
Most people first enroll in Medicare Advantage when they first start receiving Medicare benefits or during the annual Medicare Open Enrollment Period. You can also change your Medicare Advantage plan during the Open Enrollment Period. We recommend always using the Medicare Open Enrollment Period to compare plans because plans can change each year—and so can your healthcare needs.
Top-rated Medicare Advantage plans in Wisconsin
When choosing the best Wisconsin Medicare Advantage plan, it’s important to first consider your personal health and financial situation. We go into detail about how to choose the best plan for you below. Another factor that can be helpful is the Medicare Advantage star rating system. Every year, each Medicare Advantage plan is assigned a star rating from 1-5 (with 1 being the worst and 5 being the best). Remember that each county has different plans available. To provide an example of some of the top-rated Medicare Advantage plans in Wisconsin, we’ll share some plan details from Waushara County, WI, below.
Network Health is the only insurance carrier that offers 5-star Medicare Advantage plans in Waushara County, WI.
Several insurance carriers offer 4.5-star Medicare Advantage plans in Waushara County, WI:
HealthPartners
Humana
UnitedHealthcare
Aetna
Quartz
How to choose the best Wisconsin Medicare Advantage plan
As we said above, choosing the best Wisconsin Medicare Advantage plan requires thinking about your specific needs. For example, someone who doesn’t need a lot of care and doesn’t have many prescriptions may focus on finding a plan with a low premium. Someone who has a lot of prescriptions will need to focus on finding a Medicare plan that covers their prescriptions and saves them the most.
Make a note of your preferred doctors and other healthcare providers. This list will help you ensure the plan you choose has all of your preferred providers in its network.
Jot down all of the prescriptions you take, including the frequency and dose. This will help ensure that, if your Medicare Advantage plan includes prescription coverage, you’ll get the most savings from your plan.
Think through the different extra benefits that Medicare Advantage plans can provide, and make a note of those that are the most valuable to you.
Choosing from somewhere between 11 and 47 Wisconsin Medicare Advantage plans can feel overwhelming, especially if you need to consider multiple prescriptions and doctors. We make things easy by answering questions, helping you compare every option, and assisting with the enrollment process. Give us a call at (855) 900-2427 or schedule a time to talk to get Medicare checked off your list today!