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When you reach age 65 in Wisconsin, you become eligible for Medicare, the federal government’s health insurance program for those 65 and older. If you have certain qualifying conditions, like as a qualifying disability, you may be eligible for coverage prior to turning 65.

More than 20% of Wisconsin’s population is enrolled in Medicare as of July 2020. Medicare enrollment becomes a concern for people who reach retirement. However, Medicare also covers Americans under the age of 65 who are incapacitated and receiving disability benefits, as well as those with end-stage renal disease or amyotrophic lateral sclerosis. The percentage of Medicare recipients under the age of 65 is 15% nationwide and 14% in Wisconsin.

With healthcare costs surging every year, you need to make sure you keep your expenses low while getting the care you need. Find out more about different Medicare plans in Wisconsin and learn why you need the services of a licensed Medicare insurance agent.

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However, it is important to note that Wisconsin’s Medicare Supplement coverage is not standardized the same as the ten plans offered in most states. This state’s program offers a Basic Plan with add-ons called “riders”. Insurance companies offering Medigap policies are obligated by state law to provide certain benefits beyond those provided by the primary (Part A) plans. Here’s more on these plans:

Basic Plan

The Basic Plan includes not only the federally mandated benefits including Medicare Part A coinsurance for skilled nursing facilities, but also covers preventive services. It provides 175 days of psychiatric inpatient coverage beyond what Medicare provides. The Basic Plan includes 40 home health care sessions in addition to what Medicare offers.

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Medicare Advantage Plans in Wisconsin

Medicare Advantage plans are provided by private companies that contract with Medicare and offer the same coverage as Original Medicare. The market for Medicare Advantage in Wisconsin is thriving. Private Medicare enrollment in Wisconsin reached 1,236,425 by January 2022.

Medicare Advantage plans varies across states, and in some cases, the deductibles and copayments/coinsurance amounts of your plan may not apply to the Wisconsin Medicare supplement policies. The Wisconsin Office of the Commissioner of Insurance (OCI) does not oversee Medicare Advantage plans. Your plan is not guaranteed permanently renewable like Medicare Supplement policies, and it is not required to include Wisconsin mandated coverage.

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Comparing Medicare Advantage Plans in Wisconsin

Every county in Wisconsin offers at least 11 different Medicare Advantage plans, and several offer more than 20. Waukesha and Brown counties have 47 Part C plans available. With all the options on the market, you need to make sure you’re picking a plan that fits your individual requirements and budget.

Here are some factors to consider while weighing your options:

Provider Network

Depending on your Medicare Advantage plan, the network of doctors and hospitals you can visit may be geographically limited. Consider enrolling in Original Medicare with a Medigap plan and Part D coverage if you have concerns about the size of the provider network or if you intend to do a lot of traveling within the country during retirement.

Even if you have a specific insurer in mind, it’s still a good idea to compare your choices before committing to a plan. Some Medicare Advantage programs have contracts with physicians who aren’t in the regular Medicare network.

Perks and Benefits

Do you need a plan that also includes health insurance, a retirement savings account, and a gym membership? These are typically covered under Medicare Advantage plans but are not by Medigap policies. To find the best Medicare plan for your needs, talk to a licensed Medicare insurance agent in Wisconsin.

Plan Ratings

Medicare Part C and Part D plans can be compared on the CMS website, so make sure you check those before enrollment begins.

Out-of-Pocket Expenses

Enrollees are responsible for covering their own “out-of-pocket costs” which include things like deductibles, copayments, and coinsurance. Using a provider network helps keep these costs down. You can use our plan finder tool to compare costs among available options.

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Monthly Premium

Your monthly cash flow will increase by the amount of your Medicare Advantage or Supplement plan premium, so you need to find a way to keep this expense down. Even if you don’t use your benefits, you still have to pay these costs. It is helpful to have access to at least one zero-premium plan that provides reasonable prescription coverage in your area.

Drug Coverage

Look into Medicare Part C programs if you need help paying for your prescriptions. Prescription drug coverage, known as Part D, is typically bundled with Medicare Advantage plans. Medicare Part D is optional, but highly recommended, if you opt for Original Medicare and a Medigap policy.

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Medicare Enrollment in Wisconsin

You will be automatically enrolled in Medicare if you have received at least four Social Security or Railroad Retirement Board payments before turning 65. Otherwise, you can apply for Social Security at your local office or apply online.

Medicare enrollment is available during the following periods:

Initial Enrollment

The IEP runs from three months before your 65th birthday to three months after it. People who are eligible for Medicare but have never enrolled previously should apply during this period. You can also change or improve your Medicare coverage if you began receiving benefits at an earlier age.

General Enrollment

For those who were not able to enroll during the initial window, a second window opens up on January 1 and closes on March 31. Parts A and B of Original Medicare, Medicare Advantage, a Medigap coverage, and Medicare Part D are all available for enrollment during this time.

Open Enrollment

You can make changes to your Medicare Part C plan over the three months beginning on October 15 and ending on December 7.

Special Enrollment

If you experience a change in your coverage or eligibility due to a life event, such as the loss of your employment or a move to an area not covered by your plan, you may be eligible for a special enrollment period.

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A Medicare insurance agent

Why Should You Choose Medicare Hope Insurance Agents?

Integrity Now Insurance Brokers ensures that all of their Medicare insurance brokers renew their AHIP certification on annually. Our team is well-versed in Medicare Insurance and can help you with any questions or problems you may have. We serve individuals of all ages, from the elderly to the disabled youth, who are having trouble affording the medical care they need.

Every year, new Medicare health insurance providers and plans enter the market, increasing the variety of choices available to consumers. Plans that are already in place might be updated or revised as well. We are here to help you keep track of these changes and find the right plan for you.

Simply tell us your financial and individual requirements, any goals you want to achieve with your plan, and we’ll find a plan that fits your objectives. Our client-specific offerings are what make us special. We’ll help you compare quotes to find the most affordable plan that carries all the benefits you need.

Get in touch with us today, and we’ll connect you with a Medicare insurance agent in Wisconsin who can help you get started right away.

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