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The Ultimate Guide to Wisconsin Medicare

There are more than 1.1 million Medicare beneficiaries in Wisconsin. It’s no surprise that every beneficiary won’t fit into the same plan. There is an abundance of options on the market, and trying to find the best Wisconsin Medicare plan can be overwhelming. Fortunately, Medicare Plan Finder makes understanding Original Medicare, Medicare Advantage, Medicare Supplements, and Part D plans that much easier.

Click below to learn more about Wisconsin Medicare:

What does Wisconsin Medicare Cover?

Original Medicare (Part A and Part B) is the same regardless of which state you live in. Part A, hospital coverage, includes hospital services, some home health care, nursing home care, and hospice. Part B, medical coverage, includes preventative doctor visits, outpatient care, ambulance services, screenings and tests, and some medical equipment.

Turning 65 New to Medicare

Types of Wisconsin Medicare Plans

After you enroll in Original Medicare, you can enroll in a Medicare Advantage, Medicare Supplement, or prescription drug plan. You should enroll in some form of prescription drug coverage to avoid a late-enrollment penalty down the road. You can enroll in one of the following combinations:

  • Medicare Advantage with prescription drug coverage
  • Original Medicare + Part D
  • Original Medicare + Medigap
  • Original Medicare + Part D + Medigap

Wisconsin Medicare Supplement Plans

Most states have the same eight types of Medigap plan options, but three states are different: Massachusetts, Minnesota, and...you guessed it...Wisconsin!

Medigap in Wisconsin starts with a “Basic Plan,” which covers:

  • Part A coinsurance for inpatient hospital care
  • Part B coinsurance for medical costs
  • First 3 pints of blood per year
  • Part A hospice coinsurance/copayments
  • Part A skilled nursing coinsurance
  • 175 days of lifetime inpatient mental health
  • 40 additional home healthcare visits
  • Other state-mandated benefits:
    • At least $30,000 for kidney disease treatment (dialysis, transplants, etc.)
    • Insulin pumps, self-management training, and other diabetes care

50% and 25% cost-sharing plans are also available, which are similar to Medigap Plan K and Medigap Plan L (which would be available in other states).

Wisconsin Medigap plans are allowed to add additional benefits other than what is in the basic plan. That's why you may have a few different "basic plans" to choose from, and the costs can vary. Companies are allowed to add the following benefits:

  • Part A deductible
  • 365 additional home care visits
  • Part B deductible (no longer available in 2020)
  • Part B excess charges
  • Foreign travel emergency
  • 50% Part A deductible
  • Part B copayments/coinsurance
medicare supplements | Medicare Plan Finder

Wisconsin Medicare Advantage Plans

Medicare Advantage plans are great if you are looking for additional benefits beyond Original Medicare. They must cover everything that Original Medicare does, but many plans also offer prescription drug coverage, vision, dental, and hearing coverage, OTC pharmacy allowances, non-emergency transportation, group fitness classes like SilverSneakers, and so much more! These plans have grown in popularity every year and more than 39% of Wisconsin Medicare beneficiaries are enrolled in Medicare Advantage. Our licensed agents can show you all the plans that are available in your area and help you enroll in the plan with the benefits you want at the price you need. Fill out this form or give us a call at 833-438-3676.

medicare advantage | Medicare Plan Finder

Wisconsin Medicare Cost

If you were employed and paid Medicare taxes for at least 39 quarters, you will not have a premium for Part A. If you only paid Medicare taxes for 30-39 quarters, you’ll pay $240/month in 2019. If you did not pay Medicare taxes for at least 30 quarters, you’ll pay $437/month in 2019.

The standard Part B premium is $135.50/month in 2019, but this can change based on your income. Since Medicare Advantage, Medicare Supplements, and Part D plans are sold through private insurance companies, plan costs will vary based on carrier, location, and benefits.

Wisconsin Medicare Eligibility

Most beneficiaries become eligible for Medicare by turning 65, but aging-in isn’t the only way you can qualify. If you are under 65, you can still qualify if you are diagnosed with ESRD (End-State Renal Disease) or ALS (Lou Gehrig’s Disease). You will also be automatically enrolled in Medicare if you have been receiving SSDI (Social Security Disability income) for over 24 months.

Prescription Savings Card

Senior Resources in Wisconsin

The Department of Aging in Wisconsin offers programs that provide places where seniors, family members, caregivers, and healthcare professionals can find Wisconsin resources for the elderly and disabled. These programs include:

Transportation: Getting around gets harder with age, and transportation is a large factor. The Department of Aging offers several transportation programs to help seniors get around.

Caregiver Support: The Caregiver Support Program provides caregivers a break from respite care and can even help with reimbursement of caregiving-related supplies, education, and training. This program is administered through your local Area Agency on Aging.

Health & Wellness Workshops: Wisconsin’s Department of Aging Health & Wellness Program promotes healthy lifestyles to improve quality of life and cut back on health care expenses. They help teach seniors how to self-manage chronic conditions and provide powerful tools for caregivers.

Legal Assistance: The SeniorLAW Program helps older adults with legal issues including age discrimination, utilities, abuse, guardianship defense, Social Security, Medicaid, and Medicare.

Elder Abuse: The Milwaukee County Department on Aging has an Elder Abuse Unit that investigates all abuse allegations regarding financial exploitation, neglect, physical abuse, emotional abuse, and sexual abuse. To report abuse call 414-289-6874.

Emergency Planning: How you respond in an emergency situation depends heavily on how well you prepare. The Department on Aging provides a Guide to Emergency Planning to seniors and families. This guide helps you stay informed, make a plan, and develop an emergency kit.

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Can I Have Medicare and Medicaid in Wisconsin?

Medicare and Medicaid are both regulated by the federal government but are entirely different programs. Medicare was designed for adults over 65 and people with specific disabilities while Medicaid was designed for low-income families and individuals. However, you can qualify for both programs.

If you qualify for both programs, you are eligible for a Dual Eligible Special Needs Plan (DSNP). DSNPs are a special type of Medicare Advantage plan that provides extra benefits at lower costs. If you qualify for a DSNP, you may qualify for a Special Enrollment Period (SEP) too. SEPs allow you to enroll year-around without the need to wait for the Annual Enrollment Period. This means you can get extra benefits at lower costs as soon as possible. Plus, if you qualify for a DSNP, you may be eligible for other programs like Medicare's prescription drug program Extra Help, or other Medicare Savings Programs. To find out if you are eligible, contact one of our licensed agents by filling out this form or call us at 833-438-3676.

How do I Sign up for WI Medicare?

You can apply for Wisconsin Medicare through Social Security. There are three main places where you can apply. You can go to www.SocialSecurity.gov, call 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday from 7 AM to 7 PM, or apply in person at your local Social Security office. If you are interested in enrolling a Medicare Advantage, Medicare Supplement, or Part D plan, we can help! Fill out this form or give us a call at 833-438-3676.

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