Medicare Advantage in Wisconsin

Many older Americans are eligible for health insurance through Medicare, a federal government program. It offers hospital coverage (Part A) and medical coverage (Part B). Seniors can qualify for free Part A if they or their spouse paid enough payroll taxes; otherwise, they can purchase it. Part B coverage requires a payment. Medicare also provides the option of a Part D prescription drug plan. Additionally, Medicare Advantage, (Part C) bundles health care coverage, including Parts A and B services (except hospice care), for a monthly fee. 

Medicare Advantage Plans generally include some prescription drug coverage, largely eliminating the need for seniors to take out separate Part D cover. Many providers offer extra services beyond those provided by regular Medicare. These may include vision, hearing and dental care, wellness and nutrition programs and transportation to nonemergency medical appointments. While Medicare enrollees generally have a wide choice of service providers, Medicare Advantage insurers often limit recipients to using approved network- or location-specific providers.

Medicare is a pay-per-use program, with no limits on personal annual health care spending. In contrast, Medicare Advantage policies usually cap yearly expenses, which may help seniors budget more effectively for medical care. This can also lower overall health care expenditure for enrollees. Insurance companies can set their own rates for co-pays, co-insurance and deductibles, as well as deciding their own eligibility criteria.

In 2022, 48% of all Medicare-eligible individuals in Wisconsin enrolled for private plans through Medicare Advantage. The percentage growth of eligible candidates enrolled in Medicare Advantage increased by 7% in 2023, resulting in 52% of qualifying Wisconsinites taking out a Part C policy. Nationwide, preference for Medicare Advantage is a little lower than in Wisconsin, with 51% of all those eligible for Medicare signing up for Medicare Advantage.

Wisconsin seniors and Medicare beneficiaries can use this guide to understand and choose Medicare Advantage Plans that suit their needs. It highlights top state plans, coverage, eligibility and enrollment.

The Top 10 Medicare Advantage Plans in Wisconsin

Many insurance companies provide Part C policies for Wisconsin’s seniors. Individual insurers may also offer a choice of plans that vary in price and coverage. The below table details Wisconsin’s 10 most popular Medicare Advantage providers, listed in order of the most enrollees. Note: Enrollment figures combine all enrollees across each provider’s diverse plans. Prices are also given as a range because of differing policies. All information is correct as of July 2023. Seniors can get more insights and data from Medicare.gov.

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.

*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.

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.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources