Medicare Plan Options

If you live in Wisconsin, you have a variety of Medicare programs available. If you have basic health care needs, you can select Original Medicare. More extensive health care coverage means you should check out Wisconsin’s Medicare Advantage program since Medicare Advantage Plans often include extra coverage not available in Original Medicare. Finally, you can select a Medicare plan that provides prescription drug coverage or supplemental coverage.

Original Medicare

This is the basic Medicare program. It consists of two parts: Part A, which provides insurance for inpatient hospital care, lab tests, surgery, hospice care, and stays in a skilled nursing facility; and Part B, which covers visits to the doctor’s office, home healthcare, and some medical equipment. Medicare Part B also covers most preventative services. Under Original Medicare, you’ll first pay a set deductible before Medicare pays its part. Medicare pays, then you’ll pay your share such as a copayment. There is no limit on what you will pay out-of-pocket under Original Medicare.

Medicare Advantage Plans

Also known as Medicare Part C, Medicare Advantage Plans are Medicare coverage provided by private health insurance companies. These plans must include Medicare Part A and Part B, and often include Medicare Part D (prescription drug coverage). Medicare Advantage Plans, however, also offer additional coverage in areas like vision, fitness programs, dental, and hearing. Medicare Advantage Plans often have different rules than Original Medicare. Some plans require referrals to see a specialist or only allow you to see their in-network providers. Plans often have different out-of-pocket health care costs than Original Medicare.

Medicare Prescription Drug Coverage Plans

While Original Medicare doesn’t cover prescription drugs, you can add this coverage to Original Medicare for a fee. Although you will be offered prescription drug coverage when it’s time to enroll in Original Medicare, you may have to pay a penalty if you delay your enrollment after this initial period. However, many Medicare Advantage Plans provide prescription drug coverage as part of their packages. Before you enroll in a prescription drug plan, make sure you see how that plan works with other drug coverage from your workplace, your union, or military TRICARE.

Medicare Supplemental Insurance Programs

Original Medicare doesn’t cover everything, and you may not find a Medicare Advantage Plan that suits you. You might want to purchase a Medicare Supplemental Insurance plan. These plans are known as Medigap. They plug holes that exist in the coverage offered by Original Medicare and can also provide medical coverage when you venture out of the country on a business trip, visit family members, or while you’re on vacation. Original Medicare will pay its share of a health care bill, and then Medigap will pay the difference.

Medicare In Wisconsin By The Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
644,242 Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
$8,763 -13%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in Wisconsin

With so many choices about Medicare coverage, including Original Medicare, Medicare Advantage, and Medigap, you might be a little confused about your choices. Fortunately, Wisconsin has many organizations that may help with your health care decisions and provide the opportunity to speak with trained counselors. These resources include organizations like Area Agencies on Aging, Wisconsin health care officials, and other nonprofit agencies in the state.

Wisconsin Area Agency on Aging

Operated through the Wisconsin Department of Health Services, the state’s Area Agencies on Aging provide many important resources and information for seniors in the state. Established nationally by the federal government in the early 70s, the state offices of the Area Agency on Aging work with local agencies to coordinate, improve or provide services for Wisconsin seniors. This includes advising seniors on their health care choices.

Contact Information: Website | 608-266-1865

Wisconsin Department of Healthcare Services

The department offers several important resources, including access to elder benefit specialists. These specialists work with Wisconsinites aged 60 and older and answer their questions about issues like Medicare, Medicare Advantage, Social Security, and other public benefits available to seniors in the state. Every county in Wisconsin has an elder benefit specialist available to answer your questions. The department also has a listing of available Wisconsin Medicare counseling resources.

Contact Information: Website | 608-266-1865

The Medigap Helpline

Operated by the Wisconsin Board on Aging and Long-Term Care, The Medigap Helpline offers free, objective assistance to seniors in Wisconsin who want to know more about their health care insurance options. The Medigap Helpline answers questions about Medicare Supplemental Insurance and Medigap policies. The Helpline’s advisors can also provide information on topics like long-term healthcare policies, issues related to employer-sponsored care, and how to get a policy that will provide you with prescription drug coverage when traveling in other countries.

Contact information: Website | (800) 242-1060

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