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Medicare in Wisconsin: How to Apply, Costs, and More

May 8, 2022

Medicare in Wisconsin: How to Apply, Costs, and More

Residents in Wisconsin can find the insurance they need for services like in-patient care and prescriptions. You might come across plans like Medicare Advantage and Medigap. The costs for the policies can depend on the provider, however, some parts of Medicare have no premiums. When you are searching for a plan, it’s important to understand when and how to apply for Medicare. In this article, we’ll answer the most common questions about Medicare in Wisconsin.

Medicare in Wisconsin

Medicare is a federal program that can help people over 65 or individuals with qualifying disabilities pay for healthcare. If you are a Wisconsin resident who has worked in the United States and contributed to Medicare through payroll taxes and are eligible because of age or a specific disability, you can apply for Medicare coverage.

You can apply ahead of your birthday 65th birthday. You can also apply if you are under 65 years old and have been on disability for 24 months or if you are diagnosed with ALS or end-stage renal disease. You also may choose private providers of Medicare Advantage in Wisconsin. Some parts of the Medicare program may require copayments and have deductibles. Learn more about Medicare costs in this guide.

  • Medicare Part A is known as hospital insurance. It offers coverage for inpatient hospital care, lab tests, and surgery, as well as home health care and skilled nursing facilities. These services must be deemed medically necessary to be covered by Medicare. You may have to pay a deductible or coinsurance.
  • Medicare Part B covers physician visits for medically necessary and preventative services. Each Medicare participant pays a monthly premium for Medicare Part B and there may also be deductibles and coinsurance that apply, depending on the care you receive.
  • Medicare Part D is prescription drug coverage. It helps you pay less for both brand-name and generic drugs, depending on your needs. The drug plans for Medicare are offered by insurance companies and other approved private companies. If you choose Medicare Part D, you will have a separate Part D premium each month.
  • Medicare Part G or K is also called Medigap insurance because it pays for the gap between what Medicare covers and what it does not. 
  • Part C, Medicare Advantage, is a private, full replacement of Medicare, and many insurance companies offer various policies from which to choose. Some policies include coverage for fitness programs and vision services. Most Medicare Advantage policies require you to find healthcare providers who are in their specific network. A Medicare Advantage plan does set a limit for how much you need to pay out-of-pocket annually.

 Does Wisconsin Have Medicare Advantage Plans?

Wisconsin’s Medicare Advantage plans are popular. More than 5.5 million people in Wisconsin have a Medicare Advantage plan. Each area in the state may have different policies available, so you will need to search for one by using your zip code. An online agent can also give you a list of providers. 

Each Medicare Advantage plan can provide the same benefits as Original Medicare and you select from a menu of other coverage, including prescriptions, fitness, and vision programs. Many of the plans do not cover treatment from doctors outside the network.

Medicare Advantage plans in Wisconsin offer many different options. Each one may have different rules for how you can get care, and the rules may change every year. Not only should you check a policy before you enroll, but you should keep an eye on it every year to learn of any modifications. Your health needs can change over time as well. You can decide to drop Medicare Advantage or switch policies if you need to do so.

  • Health Maintenance Organizations (HMO) under Medicare Advantage plans require you to select in-network providers unless you need emergency services. 
  • Preferred Provider Organizations (PPO) allow a broader choice of providers by agreeing to pay non-preferred providers, sometimes at a higher cost. Some plans provide prescription coverage; if not, you may select coverage from Medicare Part D plans. Learn more about the difference between Medicare Advantage HMO and PPO plans.
  • Point of Service plans (POS) are a hybrid variation of HMOs and PPOs. 
  • Private Fee-for-Service (FFS) plans establish care providers who will accept agreed-upon fees for service.
  • Special Needs Plans (SNP) serve people with shared diseases or characteristics.

Several Medicare Advantage plans in Wisconsin also provide people with prescription drug coverage. You can choose to opt-out of Medicare Advantage prescription coverage and Medicare Part D (prescription coverage) is an option. 

How Do I Apply for Medicare in Wisconsin?

You qualify for Medicare coverage if you are a legal resident, you or your spouse worked and paid Medicare taxes and you meet one of these requirements:

  • You are over age 65
  • You or your spouse worked and paid Medicare taxes
  • You have a qualifying disability
  • Federal law also provides Medicare coverage for individuals who have ALS or end-stage renal disease

To assure continuous coverage when transitioning to Medicare, you should consider signing up at least three months before you turn 65. You have another three months after you turn 65 to enroll. Enrollment periods are different for Medicare and Medicare Advantage

  • Your Birthday. When you first sign up for Medicare, apply at least three months before your birthday to assure you’ll be covered as soon as you are eligible. You have another three months to enroll after you turn 65.
  • Medicare General Enrollment Period. You can apply for benefits during the general enrollment period as well, which runs from January 1 to March 31 every year.
  • Medicare Advantage has a different enrollment period, Annual Enrollment (AEP) from October 15 to December 7. 

 If you want to enroll in a Medicare Advantage plan, you need to already be covered by Medicare Part A and Part B. Once you meet the criteria, you have to wait for enrollment to start. 

To sign up for Medicare, you can apply online at the Social Security Administration's website or search for plans in your area. The process is usually simple to complete. For Advantage plans, look online for insurance companies that offer Medicare Advantage. Alternatively, you can enroll by phone or visit your local Social Security office. Some people choose to complete an application form for Part B and mail it to the office.

 What Is the Medicare Savings Program in Wisconsin?

Like other healthcare programs, Medicare comes with premiums, deductibles, and copayments. If you have limited income or resources to pay some or all of these costs, you can get help from Medicare Savings Programs. You must be qualified for Part A and earn below the monthly income limit. The limit may be different for singles and married couples. You can apply online for the  Medicare Savings Program that best suits your needs.

Wisconsin has multiple levels of Medicare savings programs, based on your assets and monthly income limits. 

  • The Qualified Medicare Beneficiary (QMB) program helps cover the costs of the premiums and deductibles for Parts A and B. Providers cannot bill you for covered services, and pharmacists have a maximum amount they can charge you. 
  • The Specified Low-Income Medicare Beneficiary program (SLMB) pays for Part B premiums if you are entitled to Part A coverageSLMB+. Specified Low-Income Medicare Beneficiary Plus programs help individuals with slightly higher income and you are not enrolled in full-benefit Medicaid, Family Planning Only Services, or Tuberculosis-Related Only Services 
  • The Qualified Disabled and Working Individual (QDWI) program can pay Part A premiums for up to three months prior to your application date. You need to have a disability and employment to be eligible.

How Much Does Medicare Cost in Wisconsin?

Costs for Parts A, B, D, and Medicare Advantage (Part C) each vary by policy, but generally, most Wisconsin residents do not have to pay anything in monthly premiums for Part A after the stated deductible.

  • Part B premiums vary according to your income. 
  • Part D coverage is selected by the prescription drugs your physician prescribes routinely.
  • Medicare Advantage policies vary by the level of coverage you select. 

This Medicare cost guide outlines what you can generally expect to pay by Medicare Part policy. All Medicare plans should be reviewed annually against your actual needs and expenses. Also, as premiums change, they may change which plan is best for your current needs. For example, when you need inpatient care, your coinsurance payment may increase over the time you receive such care.

Is Medicare Plan G Available in Wisconsin?

Medicare  Plans G or K, known as Medigap coverage, are supplemental insurance policies for the costs that Medicare Parts A, B and D do not cover. For instance, the insurance helps pay for copayments and coinsurance. Around 21% of beneficiaries have a Medigap plan. Other plans from private companies offer coverage for travel outside the United States.. If you have  Medicare in Wisconsin, you have access to a Medigap policy
Wisconsin uses its own standardized Medigap policies with different names. You might not find a Plan G specifically in your area, but you might discover one similar to it. One option is the Basic Plan, which pays for Parts A and B along with hospice care. You choose to go with either the 25% Cost-Sharing Plan or the 50% Cost-Sharing Plan. The plans cover a portion of the price for five Medigap benefits or the full cost of one benefit. Medigap riders can customize policies in Wisconsin as well. 

Contact Us to Learn More About Medicare in Wisconsin

There is a lot of general information about Medicare, so it can become confusing to figure out which plans best suit your needs. If you are ready to apply for Medicare or Medicare Advantage Plan or to consider a different plan, compare plans or speak with a licensed insurance agent. When you enter your zip code, we can help you find healthcare coverage that meets your needs at an affordable price.

The process is easy, and you can stay in the comfort of your own home. Feel free to browse our website to learn more about Medicare options in Wisconsin.


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