Many Wisconsinites obtain health insurance by signing up for Medicare insurance coverage. Medicare is a federal national health insurance program for people who are 65 and over, as well as people with certain disabilities and health conditions. The Wisconsin state government also offers various assistance programs to assist Medicare beneficiaries.
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Wisconsin Medicare Insurance Trends
The Centers for Medicare & Medicaid Services (CMS) reported the following information on 2024 Medicare trends in Wyoming:
- Currently, 1,273,287 residents of Wisconsin are enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased from $27.59 in 2023 to $26.15 in 2024.
- There are 129 Medicare Advantage plans available in Wisconsin.
- All Wisconsin residents with Medicare have access to Medicare Advantage, including plans with $0 premiums.
- There are 21 stand-alone Medicare prescription drug plans offered in Wisconsin for 2024.
- The lowest monthly premium for a Medicare prescription drug plan is $0.
Medicare Offered in Wisconsin
Medicare is a government-sponsored health care program that offers financial help to Americans ages 65 and over or Americans with disabilities.
Original Medicare
The primary coverage available comes from Original Medicare, Part A, and Part B. Medicare Part A covers inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. Hospice care and some other types of home health care are included as well.
Medicare Part B covers doctor services and outpatient hospital care, and some health care services that are not covered in Medicare Part A. These include physical therapists and durable medical supplies.
Medicare Part A does not typically require premiums, although it may be required in some cases. Medicare Part B does require premiums based on the beneficiary’s income.
Both Medicare Part A and Part B may also require the beneficiary to pay for out-of-pocket expenses. These include deductibles, copays, and coinsurance costs.
Medicare Advantage
Also known as Medicare Part C, these Medicare Advantage Plans can take the place of Original Medicare. The plans are also available from private carriers with approval from Medicare. These plans provide the primary benefits included in Original Medicare, plus additional benefits like coverage for health care services that are not covered by Medicare Part A and Part B.
In 2024, companies offering Medicare Advantage plans in the state, with ratings, include:
- AARP Medicare Advantage Patriot Plan 1 (PPO) – 5/5 stars
- Dean Advantage Harmony (HMO-POS) – 5/5 stars
- Essence Rx (HMO-POS) – 4.5/5 stars
- Esteem Rx (HMO-POS) – 4.5/5 stars
- Molina Medicare Choice Care (HMO) – 3.5/5 stars
- Spirit (HMO-POS) -4.5/5 stars
- UW Health Quartz Med Advantage Value (HMO) – 5/5 stars
These Medicare Advantage plans are based on medicare.gov and their overall rating of plan quality and performance, found here. The choices for your plan vary depending on the county you live in.
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Medicare Supplement Plans
Medicare authorizes some private health insurance companies in Wisconsin to provide supplemental plans for Original Medicare. These plans, also referred to as Medigap, can cover extra health care services that Original Medicare does not include. Medigap plans are different in Wisconsin than in other states, as Wisconsin mandates 3 types of Medicare supplemental plans with original Medicare:
- Medigap (helps cover costs for parts A and B)
- Medicare SELECT (covers costs for parts A and B so long as you go to a provider in the plan’s network)
- Medicare Cost (basic and enhanced policy options pay for your costs)
Wisconsin Medicare Enrollment
Citizens of Wisconsin are eligible for Medicare if they are a U.S. citizen and above 65 years old, or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis. Use Medicare’s online eligibility tool to see if you qualify.
Requirements
- You are 65 or older, and you or your spouse worked and paid Medicare taxes for at least 40 quarters.
- You are under age 65 and collect benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months.
- 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
- Starts January 1st
- Ends March 21st
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 21st
Medicare Advantage Open Enrollment Period
This is when you can switch or leave a Medicare Advantage Plan
- Starts January 1st
- Ends March 21st
Wisconsin Enrollment Tips & Advice
You can enroll online, by phone (800-772-1213), or in-person for Medicare in Wisconsin. Review available plans to ensure they cover your specific needs, include doctors and facilities in their network that you want to use, are affordable to you, and have good ratings.
Additional resources:
How Do I Enroll in a Medicare Plan?
If you’re not sure about your Medicare coverage, talk to one of our licensed agents today. We’ll find a plan that suits your needs and your budget.
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