Wisconsin citizens age 65 and older are eligible for Medicare. Medicare is a national health insurance program run by the federal government for American citizens over the age of 65 and those with specific disabilities. Medicare plans can also be purchased through private insurance companies.
Wisconsin Medicare Insurance Trends
According to the Centers for Medicare & Medicaid Services (CMS), the Medicare coverage plans for 2021 include the following:
- Around 640,000 people in Wisconsin are enrolled in Medicare.
- Currently Wisconsin residents have 72 different Medicare Advantage plans available depending on the county you’re in.
- All Wyoming residents have access to purchase a Medicare Advantage plan, including plans with $0 premiums.
- There are at least 32 Medigap insurers in Wisconsin in 2021.
Medicare Offered in Wisconsin
Wisconsin offers two insurance options for Medicare plans. Original Medicare and Medicare Advantage. They both have specific options within each plan. Here are the components:
Wisconsin Medicare Part A Plans
Medicare Part A coverage includes the following:
- Inpatient hospital care and support: Any tests, treatments, or care for patients in the hospital.
- Short-term nursing home: If you require care from a health aide at home after hospital release, Medicare covers this while you recover.
- Hospice care: If you have chosen hospice care, Medicare will cover most healthcare costs.
- Part-time at-home healthcare: If you require skilled nursing facility assistance, Medicare will cover the stay and services for a certain duration.
Medicare Part A only covers the costs of an emergency room visit if you’re admitted to the hospital to treat the illness or injury that brought you to the ER.
Medicare Part A coverage does not include the following:
- First three pints of blood: If a hospital receives blood from the blood bank, you may not be required to pay anything. However, if the hospital must get specific blood for you, you may be required to pay for it out-of-pocket.
- Private hospital rooms: Inpatient care does include a stay in a semi-private room. However, you are not necessarily entitled to a private room during your hospital stay.
- Long-term care: Medicare Part A is designed to provide care for injury or acute illness. If you require long-term care, such as a nursing home, you will likely have to pay for residential care out of pocket.
Wisconsin Medicare Part B Plans
Medicare Part B covers outpatient care, including medical services required to treat a medical condition. It also covers certain preventative care measures, including screening, specific vaccines, and mental health services.
Medicare Part B coverage includes the following:
- Most essential doctor visits if they are from a Medicare-approved supplier
- Medically vital outpatient hospital care, including emergency hospital services and same-day surgical services
- Certain vaccines, including the annual flu shot and pneumonia shot
- Hepatitis B vaccine for those at medium or high risk
- Screenings and tests for:
- Hepatitis C
- Heart disease
- Lung cancer and other cancers
- Pap smears, X rays, blood tests, mammograms
Medicare Part B coverage does not include the following:
- Long-term hospital or custodial care
- Dental care and dentures
- Eye exams
- Cosmetic surgery
- Foot care
Wisconsin Medicare Advantage
Medicare Advantage Part C is an alternative to Part A and Part B Medicare. There are a variety of these types of plans with various premiums and coverage. Part C plans may offer some or all of the following:
- All Original Medicare coverage
- Prescription drug coverage
- Dental and vision coverage
- Gym memberships or fitness programs
- Adult day-care programs
Medicare Supplement Plans
Original Medicare cannot cover all healthcare services. Medicare supplement (Medigap) plans in Wisconsin help cover certain gaps in Original Medicare coverage. They can be purchased in addition to having the part A and B plans. In 2021, here are some of the companies offering Medigap plans:
- Dean Health Plan Inc.
- Blue Cross and Blue Shield
Wisconsin Medicare Enrollment
Unless you meet the qualifications for automatic enrollment, you need to sign up for Medicare during an enrollment period. Use Medicare’s online eligibility tool if you are unsure if you qualify.
- You are 65 or older.
- A legal U.S. citizen for five years or more
- Have received Social Security or Railroad Retirement Board benefits for 24 months at least.
- You are younger than 65 and have a qualifying disability.
- You have ESRD or ALS.
Enrollment Period Dates
Initial Enrollment Period
This is a seven-month window that allows you to sign up for a plan
- Begins 3 months before the month you turn 65
- Ends 3 months after the month you turn 65
Medicare Open Enrollment Period
This is when you can sign up for a plan, switch a plan or leave a plan
- Begins Starts October 15th
- Ends December 7th
Special Enrollment Period
Special enrollment periods allow you to enroll outside the regular enrollment periods under specific circumstances.
General Enrollment Period
This is when you can sign up for Medicare Part A and/or Part B if you didn’t sign up when first eligible or if you’re not qualified for a Special Enrollment Period.
- Starts January 1st
- Ends March 31st
Medicare Advantage Open Enrollment Period
This is when you can switch or leave a Medicare Advantage Plan
- Starts January 1st
- Ends March 31st
Wisconsin Enrollment Tips & Advice
- Costs: You may be required to pay higher monthly premiums for Wisconsin Medicare plans that offer drug coverage or have additional dental and vision benefits. Consider each plan’s out-of-pocket coverage maximum as well.
- Coverage Types: Medicare Advantage in Wisconsin can offer dental, vision and hearing coverage for residents. Look into the coverage you desire prior to enrolling.
- Network Provider: Those with Original Medicare can visit any doctor who accepts Medicare. However, Medicare Advantage plans usually have a provider network. Ask your doctor about this.
- Check CMS star rating: Medicare provides a 1 to 5 rating of how effective each Part C and Part D plan was in the previous year.
How Do I Enroll In A Medicare Plan?
Before applying, consider the various types of Wisconsin Medicare plans. Coverage Haven helps residents find the best coverage for themselves. These three steps will help you prepare:
- Determine whether you were enrolled in Medicare Part A, Part B, or Original Medicare
- Decide whether you want Part B or want to defer
- Review Medicare Advantage plans in the area
- If you choose Original Medicare, consider Part D options or Medigap
If you have any questions about Wisconsin Medicare and your eligibility for supplement or advantage plans, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you.