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Medicare in Wisconsin

What you need to know about Medicare in Wisconsin, including costs and coverages

Reviewed by: Cassandra Parker, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Who’s eligible for Medicare in Wisconsin? All legal U.S. residents who are 65 or older.

  • Original Medicare provides hospital and medically-necessary coverage. It’s made of Parts A and B. As an alternative, Medicare Advantage in Wisconsin often includes prescription drug coverage and other services.

  • The prices of Medicare plans in Wisconsin start with standardized costs but depend on several other details, including income and work history.

 

Cheese, football and staying warm — any Wisconsinite will tell you that knowing these three subjects will get you through most situations in The Badger State. But if you’re approaching the age of 65, or already there, not knowing about Medicare in Wisconsin can leave you feeling snowed under when you need answers.

Who’s eligible for Medicare in Wisconsin? What are the available Medicare plans in Wisconsin? To help you dig out, here’s GoHealth’s guide to Medicare in Wisconsin.

How Much Does Medicare Cost in Wisconsin?

When figuring out your budget, there are a few standard costs for Medicare in Wisconsin you’ll want to start with. The final amount, though, will come down to your specific needs, personal details and which plan you choose. Here’s a quick rundown of the standard charges you can expect from Medicare plans in Wisconsin:

Medicare in WI: Part A

Premium:

  • Typically no-cost if you or your spouse worked 10 or more years
  • You or your spouse worked between 7.5 and 10 years: $259 a month
  • You or your spouse worked fewer than 7.5 years: $471 a month

Deductible:

  • $1,484 each plan period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in WI: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0; Medicare-approved services: 20% coinsurance

Medicare in WI: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

What is the Cost of Medicare When You Turn 65?

As you saw earlier, finding out how much Medicare in Wisconsin costs can be a complicated process. But there is a simpler solution when it comes down to figuring out how much it’ll cost if you enroll at 65. The answer? A lot less than if you enroll later.

Medicare has some steep enrollment penalties if you miss your enrollment. Even worse, each part punishes procrastination separately, meaning late enrollment can leave you with higher premiums for Part A, Part B and Part D.

Can I Get Medicare When I Turn 65?

Who’s allowed to sign up for Medicare in Wisconsin? As with the rest of the nation, Medicare in Wisconsin is for all legal U.S. citizens aged 65 and older.

You may also be eligible if you’re younger than 65 and:

  • You’re received disability-based Social Security benefits for 24 months.
  • You’ve received Railroad Retirement Benefits for 24 months.
  • You’re living with End Stage Renal Disease.
  • You’re living with Lou Gehrig’s Disease, or Amyotrophic Lateral Sclerosis.

Do You Automatically Get Part A Medicare?

Not unless you’ve been enrolled in Social Security or Railroad Retirement Benefits (RRB) for 24 months before you turn 65. Otherwise, you’ll need to enroll yourself into a Part A Medicare plan in Wisconsin when you’re first eligible.

 

Enroll at 65: Your Initial Enrollment Period

Don’t let this common Medicare myth cause you the headache of a missed Initial Enrollment Period (IEP). This is your first chance to enroll in a Medicare plan in Wisconsin the year your turn 65. Your Initial Enrollment Period begins three months before your birth month, and closes three months after. (If you were born on the first of the month, your IEP includes the four months before your birth month).

For example, let’s say your birthday is in May. Your IEP will begin February 1 and close August 31.

What is the best Medicare policy?

There’s no right answer here. Why? Because the answer depends on your needs and your budget. And based on some details, your plan options may be as different as Milwaukee and Minocqua.

If you’re new to Medicare in Wisconsin, here’s an overview of how it’s broken down between Original Medicare and Medicare Advantage.

Original Medicare

Health insurance partially funded by the federal government through the Social Security Administration (SSA). It’s made up of:

  • Medicare Part A: hospital coverage
  • Medicare Part B: medical coverage

Medicare Advantage

Your Medicare Parts A and B coverage is provided by private insurance companies. These policies often include services Original Medicare doesn’t, like vision and dental. Also called Medicare Part C.

What are the Dates for Changing Medicare Plans?

As we mentioned above, your first chance to enroll in Medicare plans in Wisconsin is known as your Initial Enrollment Period (IEP). This is the seven-month period around your 65th birthday during which you can enroll without a late enrollment penalty.

However, your IEP is just one of several Medicare enrollment periods held each year. Each enrollment period allows you to do different things with your plan. Here are the different enrollment periods and what they’re for:

 

Medicare Part C & D Open Enrollment Period

Each year, you can swap Original Medicare for Medicare Advantage (or vice versa) or join or switch your Medicare drug plan during the Annual Enrollment Period for Medicare Advantage and Medicare drug coverage. This enrollment period is held each year from October 15 to December 7.

 

Medicare General Enrollment Period

Did you miss your Initial Enrollment Period? You can sign up for Medicare in Wisconsin during the General Enrollment Period (GEP). The GEP is open each year from Jan. to Mar. 31. The bad news? You’ll have to pay an enrollment penalty unless you qualify for a Special Enrollment Period.

 

Medicare Advantage Open Enrollment Period

Not happy with your choice of Medicare Advantage in Wisconsin? Held annually from January 1 to March 31, this is the time to enroll in a different Medicare Advantage plan, or switch back to Original Medicare.

What do the Different Medicare Plans Cover?

As we explained above, Medicare in Wisconsin is broken down into Original Medicare and Medicare Advantage. But that’s far from all you need to know. Here are the different parts of Medicare and what they cover:

 

Original Medicare

Again, Original Medicare is made up of Parts A and B. But what does that mean?

  • Part A: This can include inpatient hospital stays, hospice, skilled nursing and nursing home facilities and some home health care.
  • Part B: This covers the medically necessary and preventive services you receive from a doctor or other provider.

 

Medicare Advantage (Part C)

Medicare Advantage (Part C) is a private insurance alternative to Original Medicare. The Parts A and B you get from Medicare Advantage in Wisconsin replace Original Medicare. These plans often include Part D along with hearing, vision and dental.

Additional Coverage for Medicare in Wisconsin
If you’re enrolled in an Original Medicare plan in Wisconsin, Prescription Drug Plan (Part D) and Medicare Supplement Insurance (Medigap) can provide drug coverage and help with out-of-pocket costs, respectively.

 

Medicare Part D (Prescription Drug Plan)

Part D: Medicare Prescription Drug Plan (Part D) provides prescription drug coverage as a stand-alone plan. Many Medicare Advantage plans in Wisconsin include Part D, but Original Medicare enrollees will need to sign up separately.

 

Medicare Supplement (Medigap)

Medigap: Medicare Supplement Insurance, or Medigap, are policies that are designed to work as add-ons to Original Medicare. Wisconsin offers different options than the rest of the nation; residents of The Badger State can choose from cost-sharing, high deductibles and other Medigap plans. [1] Call GoHealth to see what Medigap options you have to help with your Original Medicare in Wisconsin.

What is the Best Medicare Advantage?

Each enrollee will answer this question differently. But to assess the different Medicare Advantage plans in Wisconsin, you’ll need to know how they operate, especially when it comes to your preferred doctors. Here are the four different kinds of Medicare Advantage:

Medicare in Wisconsin by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,102,819  people are enrolled in Medicare in Wisconsin. The total number of beneficiaries enrolled in Medicare Advantage in Wisconsin is 494,480. The previous year, 464,673 enrolled in Medicare Advantage. Medicare Advantage participation in Wisconsin went from 43.25% to 44.84% year over year. If you’d like to dive deeper into how Medicare in Wisconsin breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Wisconsin
1,102,819
Beneficiaries with Part A & Part B
494,480
Medicare Advantage Beneficiaries
44.84%
Medicare Advantage Participation Rate
54.18%
% Female
45.82%
% Male
0.95
Average HCC Score
$9,082.01
Actual Per Capita Costs
19.91%
% Eligible for Medicaid
31.64%
% of Beneficiaries with an Emergency Department Visit
16.57%
Hospital Readmission Rate
89.80%
% Non-Hispanic White
3.48%
% African American
1.83%
% Hispanic
4.90%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Wisconsin Medicare Resources & Contacts

Beneficiaries spend an average of $9,082.01 each year on Medicare in Wisconsin. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Wisconsin-based resources, like these, may be able to help:

Wisconsin Office of the Commissioner of Insurance

1-608-266-3585 or 1-800-236-8517

https://oci.wi.gov/Pages/ConsumersHome.aspx

What should I know about the Wisconsin Office of the Commissioner of Insurance?

Check here to research insurance companies or file a complaint.

Wisconsin Department of Health Services

1-608-266-1865

https://www.dhs.wisconsin.gov/guide/medicare.htm

What should I know about the Wisconsin Department of Health Services?

State department that oversees Medicaid and programs centered on healthy living in WI.

Wisconsin Department of Veterans Affairs

1-800-947-8387

https://dva.wi.gov/Pages/Home.aspx

What should I know about the Wisconsin Department of Veterans Affairs?

Apply for benefits and receive health, educational and economic assistance.

Tribal Affairs Office

Fax: 1-608-266-7882

https://www.dhs.wisconsin.gov/tribal-affairs/index.htm

What should I know about the Tribal Affairs Office?

Find out how the Wisconsin Department of Health Services works with Wisconsin’s 11 tribes to encourage healthy habits.

Nationwide Resources

Speak with an insurance agent that is licensed in Wisconsin about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in WI, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

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