Wisconsin Medicare Guide

Get personalized advice from liecensed Medicare advisors who put your interests first. Get started by scheduling a free consultation with one of our Wisconsin Medicare Advisors or calling us at (888) 604-0055. 

In this guide, we break down the basics of Medicare in Wisconsin to help you understand your options and make informed decisions about your health insurance. 

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Wisconsin

• Medicare Eligibility and Enrollment Steps

• Wisconsin Medicare Advantage Plans

• Wisconsin Medicare Supplement Plans

• Wisconsin Medicare prescription drug Plans

• Get help paying for Medicare in Wisconsin

A Snapshot of Medicare in Wisconsin

There are 1.2 million Wisconsin Medicare beneficiaries, making up 21% of the state’s total population. Most Medicare recipients in Wisconsin are enrolled due to age, but about 12% are on Medicare due to disability. 15% of Medicare recipients in Wisconsin are also on Medicaid.

When they first enroll, Medicare beneficiaries sign up for Original Medicare. They have an option to either stay on Original Medicare or enroll in a Medicare Advantage plan. In Wisconsin, 51% of beneficiaries stay on Original Medicare and 49% choose to enroll in a Medicare Advantage plan. 

Wisconsin Medicare Eligibility and Enrollment Steps

Every US citizen who meets one of the following criteria is eligible for Medicare:

• You’re 65 or older

• You have certain disabilities, including ALS and End-Stage Kidney Disease

Medicare Enrollment Steps for Wisconsin Residents

1. Enroll in Original Medicare (Part A & Part B) 

As we mentioned before, most Wisconsin Medicare beneficiaries are on Medicare due to age. If you age into Medicare, you’ll likely enroll during your Initial Enrollment Period (IEP). Your IEP is a seven-month period that starts three months before the month you turn 65 and ends three months after. In some cases, people choose to delay Part B enrollment because they’re still working. If you delay Part B enrollment, just be sure you qualify for a Special Enrollment Period or you may incur a late enrollment penalty! 

2. Compare additional coverage options

Medicare has options. After you enroll in Original Medicare, you can choose to stay on it or switch to Medicare Advantage. If you stay on Original Medicare, you can add a Medigap plan and/or a prescription drug plan to your total Medicare insurance package. The decision can have long-term consequences, so it’s important to fully understand your options. We’ll explain your options in more detail below, and we’re also here to help! Our licensed Wisconsin Medicare Advisors can help you understand your options and give you advice on the right path for your health and financial needs.

3. Set yourself up for success

Once you’ve chosen from your Medicare options, we recommend you continue to review your coverage each year during Medicare’s Open Enrollment Period (OEP). OEP occurs every year from October 15 - December 7, and it’s the perfect time to change from one Medicare Advantage plan to another or from one prescription drug plan to another. You should shop around during this time because these Medicare plans can change, and your healthcare needs may change too! While many people choose to stay on their existing plans, in some cases, shopping around saves Medicare enrollees thousands! 

Wisconsin Medicare Advantage Plans

There are 100 Medicare Advantage plans in Wisconsin, although exact pricing and availability varies by county. For example, in 2023, Milwaukee County has 33 Medicare Advantage plans with monthly premiums ranging from $0 to $187. La Crosse County has 20 plans with premiums from $0 to $230. 

One of the reasons Medicare Advantage plans are popular is because many of them offer additional coverage and benefits with $0 or low premiums. These plans provide the same coverage as Parts A & B, and often also provide Part D coverage along with various health-related benefits, like fitness perks and vision, dental, and hearing benefits.

Unfortunately, it’s commonly misunderstood that Medicare Advantage enrollees still need to pay their Medicare Part B premiums! Still, more benefits at no extra cost sounds nice…so, what’s the catch? Medicare Advantage plans have their downsides:

• Network limitations

• Frequent preauthorization requirements

• Higher out-of-pocket costs (compared Original Medicare + Medigap)

To hear about and compare pricing and benefits for Medicare Advantage plans to you, give us a call at (888) 604-0055 or schedule a free consultation with one of our licensed Wisconsin Medicare Advisors.

Wisconsin Medicare Supplement Plans

Medicare Advantage plans replace Original Medicare. Medicare Supplement (also called Medigap) plans stack on top of Original Medicare to help cover the 20% of costs that Medicare doesn’t pay. While Medigap plans don’t provide additional coverage or benefits, they significantly reduce your out-of-pocket costs. They also come with some big benefits, especially in comparison to Medicare Advantage plans. 

• They don’t limit which providers you can see

• They don’t require prior authorization for covered services

Three states, Wisconsin, Massachusetts, and Minnesota, don't have the standard ten Medigap plans that the other 47 states offer. Wisconsin has four types of Medigap plans:

• Medigap Basic Plan
• Medigap 25% Cost Sharing Plan (similar to Medigap Plan L)
• Medigap 50% Cost Sharing Plan (similar to Medigap Plan K)
• Medigap High-Deductible Plan

Each of these plans covers:

• The Part A coinsurance or copayment
• 175 days of inpatient mental health care per lifetime (in addition to what Original
• Medicare already covers)
• 40 home health care visits (in addition to what Original Medicare covers)
• Part B coinsurance
• 3 pints of blood each year
• Wisconsin state-mandated benefits

Insurance companies can also add more coverage to Medigap policies. You can choose from the following coverage options to create the best Medigap policy for your needs:

• 100% or 50% of the Part A deductible
• Additional home health care (365 visits including those covered by Original Medicare)
• Part B deductible
• Part B excess charge
• Foreign travel emergency care

When you enroll in a Medigap plan matters, and the best time to enroll is during your Medigap Open Enrollment Period, which lasts for six months after your Part B effective date. During this time, insurance companies cannot ask you questions about your health history and you are guaranteed acceptance into any Medigap plan. Outside of this period (and a handful of other special guaranteed issue periods), insurance can ask questions about your health history and deny you coverage.

Wisconsin prescription drug (Part D) Plans

Original Medicare doesn’t cover prescriptions, which comes as a shock to many people coming from employer-linked coverage! Luckily, Medicare introduced Part D to ensure beneficiaries can get their prescription needs (which tend to increase as we age) met. Medicare beneficiaries can get Part D coverage either through a Medicare Advantage plan or through a stand-alone Part D plan. There are 23 Wisconsin Part D plans, but plan availability varies by county.

Even if you don’t need prescription coverage when you first enroll in Medicare, we generally recommend that you enroll in one of the lower-cost plans to avoid the Part D enrollment penalty later.

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Wisconsin Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in Wisconsin

Healthcare costs can add up. To help low-income individuals receive the healthcare they need, the government has three programs to assist.

Wisconsin Medicaid for Medicare beneficiaries

Medicaid is a joint federal and state program to help low-income individuals get access to healthcare. Each state runs its own Medicaid program, and therefore, each program is a little different. Wisconsin has various Medicaid programs for seniors. Some of these programs are Medicare Savings Programs (MSPs), which help Medicare beneficiaries pay their Medicare premiums, deductibles, and copays. 

Wisconsin has four Medicare Savings Programs:

• Qualified Medicare Beneficiary (QMB) Program

• Specified Low Income Medicare Beneficiary (SLMB) Program

• Specified Low Income Beneficiary Plus (SLMB+) Program

• Qualified Disabled and Working Individual (QDWI) Program

Medicare Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from Wisconsin

• Wisconsin pays your Part B premium

• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you may still be eligible! Talk to one of our licensed Wisconsin Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.