Medicare Advantage Plans in Wisconsin

When you become eligible for Medicare coverage, there are two approaches open to you, one of which is signing up for a Medicare Advantage plan in Wisconsin. The other option is Original Medicare, to which you can add a Medicare supplement plan and Medicare Part D.

Either way, signing up for Original Medicare is the first step. If you choose a Medicare Advantage plan in Wisconsin, your Medicare Part A and Medicare Part B benefits will be provided through the insurance company that sells you the Medicare Advantage plan. Other terms for Medicare Advantage are MA and Medicare Part C.

What you need to know about Medicare Part C:

  • Medicare Advantage is purchased from a private insurance company approved by Medicare.
  • There are different types of MA plans, and many offer additional coverage unavailable through the traditional Medicare program.
  • With a Medicare Advantage Prescription Drug (MAPD) plan, you don’t have to purchase a separate Part D plan.
  • In most cases, full benefits will hinge upon your usage of network providers.
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Popular Medicare Advantage Plan Types in Wisconsin

Though there is no one best plan, an insurance agent can help you choose the one best for you based on your situation. Most Medicare beneficiaries hone in on the plan that addresses their highest concern. Your primary focus may be out-of-pocket costs, network limitations, severe health conditions, or financial constraints.

Best for minimal out-of-pocket expenses: Medicare Advantage HMO plan

  • HMO’s often available for zero monthly premium
  • Coverage outside the network is allowable for emergencies only – this network model enables the plan to keep your costs to a minimum
  • Referrals are required with few exceptions, such as mammogram screenings

Best plan for minimal network restrictions: Medicare Advantage PPO

  • PPOs offer some wiggle room to use out-of-network healthcare providers if you are willing to pay more for their services
  • Network typically more extensive than HMO plan
  • Can see specialists without having to secure referrals from your primary care physician

Best for people with low income or serious health conditions: Medicare Advantage D-SNP

  • Membership limited to beneficiaries with singular diseases and chronic conditions
  • Eligibility includes people covered under Medicare and Medicaid who qualify for help with copays, coinsurance, and deductibles
  • Adherence to the network is a must, but provider options can be tailored to the beneficiary’s health care needs

Wisconsin Enrollment Facts:

1. Number of participants in Medicare Advantage plans in Wisconsin: 543,816

2. Number of Medicare Advantage plan participants by type:

  • Local HMO: 224,809
  • Local PPO: 141,409
  • Regional PPO: 13,283

3. Percentage of participants in Medicare Advantage in Wisconsin: 45%

4. Number of participants in Medicare Advantage nationwide: Expected to reach 29.5 million in 2022

5. Percentage of participants in Medicare Advantage nationwide: 42%

How much does Medicare Advantage in Wisconsin cost?

Wisconsin ranks among the best states for MAPD plans in terms of affordability, availability, quality, and popularity.

The average monthly premium for a MADP in Wisconsin is $81.50. Depending on your county of residence, the price may be higher or lower.

Generally, HMO plans require no monthly premium.

The premium for PPO plans can range from 0 to as high as $100 per month.

How much do Advantage Plans cost in Wisconsin?

PPO Plan $0.00 to $81.50

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Initial Enrollment Period

You can apply for a Wisconsin Medicare Advantage plan when you first become eligible for Medicare Part A and B. This is a seven-month window that starts three months before the month of your 65th birthday. The Initial Enrollment Period extends three months after that month, but it is best if you sign up as soon as you qualify.

Open Enrollment Period – aka Annual Election Period

Every year, from October 15 through December 7, you have an opportunity to enroll in a Wisconsin Medicare Advantage plan. If you are already an MA plan member, you can change to a different MA plan or drop your plan and pick up Original Medicare. You can apply for a Medigap policy within the first 12 months of leaving MA.

Medicare Advantage Open Enrollment Period

This is a special enrollment period exclusively for existing MA plan members. Between January 1 and March 31, you can switch or drop your MA plan.

Special Enrollment Periods – Special Circumstances

Due to special circumstances, some beneficiaries qualify for a Special Enrollment Period. This may apply if you:

  • Relocated to a service area your plan does not cover
  • Moved to a location where you have new coverage options
  • Have group health insurance that is coming to an end
  • Have an opportunity to enroll in one of the private insurance plans offered by your employer or union

5-star Special Enrollment Period

To help beneficiaries comparison shop for Medicare health plans, Medicare awards star ratings for MA and Medicare Part D. If you find a five-star plan in your service area, you can make a one-time switch between December 8 and November 30.

Special Enrollment Periods if you get “Extra Help”

Extra Help is a program to help low-income Medicare recipients get health care and prescription drug coverage. In addition, extra Help beneficiaries may qualify for a Special Enrollment Period.

Special enrollment timing and allowable changes will vary depending on eligibility for other programs. For example, if you qualify for both Medicare and Medicaid, you can join, switch or drop an MA or Part D plan once during the first three quarters of the year.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

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