Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Parts A and B provide a fairly comprehensive coverage option from the federal government known as Original Medicare. Some older adults in Wisconsin prefer to purchase insurance through private health insurance providers, and Medicare Advantage plans offer this option. Sometimes called Medicare Part C, this is an alternative to Original Medicare that provides the same coverage, except for hospice care, alongside additional coverage such as dental and prescription drug coverage. Some services even offer transportation to medical appointments.
Because most Medicare Advantage Plans provide prescription drug coverage, seniors on these plans don’t have to buy a supplementary prescription plan. They get the same coverage as set by the Centers for Medicare & Medicaid Services, but insurance provides set costs such as deductibles, copays, co-insurance and premiums. The insurer can also determine the rules for referrals, in-network or out-of-network providers and eligibility based on their own rules, as long as they provide the coverage in Medicare Part A and Part B. Of the nearly 1.2 million people on Medicare in Wisconsin in 2020, 543,816 have Medicare Advantage Plans. That number represents 46% of the Medicare beneficiaries, which is more than the nation’s average of 42%.
Medicare beneficiaries and seniors thinking of applying for Medicare Advantage Plans in Wisconsin can use this guide to understand more about their coverage options, which will help them choose the right plan. It outlines the top plans in the state, what they may cover, who is eligible and how to enroll.
The Top 10 Medicare Advantage Plans in Wisconsin
Older adults in Wisconsin have multiple Medicare Advantage Plans they can choose from. The table below shows the top 10 most popular choices based on the number of enrollees as of April 2022. It also lists their Medicare rating, the cost range for the policies and the types of plans they offer. Most insurance providers have more than one Medicare Advantage Plan to serve their customers, so that is why there is a range of prices. The enrollment numbers indicate the total number of that provider’s Medicare Advantage Plan customers, even if they do not all have the same coverage choice. If an older adult wants to learn more about their coverage options in Wisconsin, visit Medicare.gov to learn about the options in your part of the state.
Network Health Medicare Advantage Plans
HMO, PPO, PFFS
Security Health Plan of Wisconsin, Inc.
Anthem Blue Cross and Blue Shield
Quartz Medicare Advantage
Dean Advantage, Prevea360 Medicare Advantage
How Medicare Advantage Plans Work in Wisconsin
As you choose your Medicare Advantage Plan, you need to know how the program operates in Wisconsin. Most insurance providers have more than one plan type. They may have a preferred provider organization (PPO) as well as a health maintenance organization (HMO), and seniors need to carefully read the plans to determine which fits their needs best. Below are descriptions of the four common Medicare Advantage Plan types.
What Medicare Advantage Plans Cover in Wisconsin
Medicare Advantage Plans in Wisconsin have to cover the same services available under Original Medicare, except for hospice care. Seniors can use these plans for their day-to-day doctor’s visits, preventative exams, imaging services, hospital stays and lab testing. Many plans offer additional coverage on top of these basics to help seniors make the most out of their coverage, including coverage such as vision and medical appointment transportation.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Wisconsin
The first step in applying for Medicare Advantage Plans is enrolling in Original Medicare Part A and Part B. Seniors must be approved for this plan before applying for a Wisconsin Medicare Advantage Plan. You also must live in the service area for that plan and meet the insurance company’s eligibility requirements. All applicants have to be either qualified legal immigrants or U.S. citizens. Medicare plans are available to those age 65 and older or adults with certain disabilities. Seniors must enroll during the enrollment period, so learning the options for enrollment is important. The enrollment period is also when they can change plans if something else fits their needs and budget better. Below are all of the additional eligibility requirements for these plans.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Wisconsin
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
The Wisconsin State Health Insurance Assistance Program provides free, unbiased information and enrollment assistance to Medicare beneficiaries, their family members and seniors who are nearing retirement. The SHIP program is federally funded and administered through the Wisconsin Department of Health Services, and SHIP workshops, outreach services and a statewide network of vetted SHIP volunteers primarily delivers one-on-one counseling. Most SHIP volunteers work out of regional aging and disability resource centers (ADRCs), and face-to-face Medicare counseling is usually conducted at these centers.
To book an appointment with a SHIP counselor or learn more about SHIP workshops and outreach programs, seniors can call their local Area Agency on Aging. A list of the three Area Agencies on Aging is available on the Wisconsin Department of Health website.
The Wisconsin Senior Medicare Patrol (SMP) is a statewide organization that works to prevent, detect and respond to Medicare fraud, billing errors and issues with service delivery. The Department of Health and Human Services funds the program through grants, and a network of volunteers delivers most SMP services. SMP volunteers staff information booths at outreach events, deliver group presentations at service clubs and senior centers and distribute educational materials. The SMP also processes complaints and reports from Medicare Advantage beneficiaries and forwards information to the appropriate authorities if Medicare fraud is suspected.
To learn more about the SMP or to file a complaint, call 1-888-818-2611
Wisconsin Chronic Disease Program
The Wisconsin Chronic Disease Program (WCDP) is a state-funded program that helps Wisconsin residents pay for specific disease-related medical services and essential supplies. WCDP covers costs only once all other benefits and coverage options have been exhausted. WCDP members with annual incomes equal to or greater than 300% of the Federal Poverty Level are required to pay a percentage of their out-of-pocket costs before WCDP benefits become available. There are three parts to the WCDP — the Chronic Renal Disease Program, Adult Cystic Fibrosis Program and Hemophilia Home Care Program. These programs cover specific treatments, tests, medications and home supplies.
For more information, call the Wisconsin Chronic Disease Program office at 800-362-3002.
Office of the Commission of Insurance
The Wisconsin Office of the Commissioner of Insurance (OCI) regulates health insurance in the state. Medicare Advantage plan members who have a specific complaint about their insurance provider should first try to resolve the issue with the insurance company. If that doesn’t lead to a satisfactory outcome, MA members can file a complaint with the OCI through its website or by calling the Wisconsin Insurance Complaint Hotline.
To file a complaint about a Medicare Advantage plan or insurance company, seniors can call the Office of the Commissioner of Insurance at 608-266-0103 in Madison or statewide at 1-800-236-8517. Seniors can also file a complaint through the OCI website.
SeniorLAW is a free legal assistance program open to Milwaukee County seniors aged 60 and older, with a focus on marginalized and low-income elders. Volunteer benefit specialists provide legal information related to civil matters, including Medicare, elder abuse, long-term care and consumer issues. If a complainant requires legal representation, attorneys are available to deal with eligible court cases. SeniorLAW services are provided at no cost; however, seniors who can make a donation to cover some of the costs are encouraged to do so.
Aging and Disability Resource Center of Brown County
The Aging and Disability Resource Center of Brown County provides information, referrals and resources to help seniors remain independent and active in the community. The center operates a number of senior nutrition sites throughout the county and is the local SHIP counseling office for the region for seniors who need assistance with Medicare Advantage. Seniors aged 60 and older in Brown County who require durable medical equipment, such as walkers, wheelchairs, canes or crutches, can try out various mobility devices for free through the Assistive Equipment Loan Closet.