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.
Find a local Medicare plan that fits your needs
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
- Typically no-cost if you or your spouse worked 10 or more years
- You or your spouse worked between 7.5 and 10 years: $274 a month
- You or your spouse worked fewer than 7.5 years: $499 a month
- $1,556 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
- $170.10 monthly and up (income-based)
- $233 for each plan period
Copayments & coinsurance:
- Most preventative services: $0; Medicare-approved services: 20% coinsurance
Medicare in WI: Part D
- Income-based; varies by plan
- No more than $480 in 2022
Copayments & coinsurance:
- Plan- and drug-specific
Note: If you worked for a railroad, you may have to enroll in Medicare in WI through the Railroad Retirement Board (RRB). Call the RRB at 1-877-772-5772 for more information.
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.
Are you eligible for cost-saving Medicare subsidies?
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 (ESRD).
- You’re living with Lou Gehrig’s Disease, or Amyotrophic Lateral Sclerosis (ALS).
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 extra benefits and savings do you qualify for?
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.
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
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 January to March 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.
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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:
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)
Medicare Supplement Insurance, also called Medigap, are health insurance policies that provide standardized benefits alongside Original Medicare.
If you choose to add a Medigap plan, it may pay for some or all costs not covered by Part A and Part B, including deductibles, coinsurance, and copayments. If you have a Medicare Advantage Plan, you cannot add Medigap.
In WI, Medigap plans provide a different set of standard benefits. Medigap in Wisconsin offers plans known as “50% and 25% Cost-sharing Plans.” These plans are similar to standardized Plans K (50%) and L (25%). A high-deductible plan is also available.
Private insurance Medigap plans in Wisconsin are also allowed to offer:
- Part A deductible
- Additional home health care (365 visits including those paid by Medicare)
- Part B deductible
- Part B excess charges
- Foreign travel emergency
- 50% Part A deductible
- Part B copayment or coinsurance (note: if you join Medicare on or after January 1, 2020, you are not eligible for the Part B deductible)
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:
- Health Maintenance Organization (HMO) plans use provider networks to treat an insurance company’s customers. HMOs typically also require primary care physicians (PCP).
- Preferred Provider Organization (PPO) plans use PCPs but give you the freedom to see any doctor in your network without a referral.
- Private Fee-for-Service (FFS) plans pay your providers each time you receive a service.
- Special Needs Plans (SNP) are for patients with specific conditions or diseases.
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Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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.
1-608-266-3585 or 1-800-236-8517https://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.
1-608-266-1865https://www.dhs.wisconsin.gov/guide/medicare.htm TRUSTED & VERIFIED dhs.wisconsin.gov
What should I know about the Wisconsin Department of Health Services?
State department that oversees Medicaid and programs centered on healthy living in WI.
What should I know about the Wisconsin Department of Veterans Affairs?
Apply for benefits and receive health, educational and economic assistance.
Fax: 1-608-266-7882https://www.dhs.wisconsin.gov/tribal-affairs/index.htm TRUSTED & VERIFIED dhs.wisconsin.gov
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.
Speak with an insurance agent that is licensed in Wisconsin about your Medicare questions.
Mon-Fri, 7am-6pm CT
Centers for Medicare and Medicaid Services
If you have general questions about Medicare in WI, or need help with current Medicare benefits.
Social Security Administration
You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement