Medicare Advantage Plans in Wisconsin
Do you live in Wisconsin and want to enroll in a Medicare Advantage plan? Then you must have Original Medicare (Part A and Part B) first. You have the option of getting Part A and Part B benefits and even more coverage if you choose a Medicare Advantage (Part C) plan.
Original Medicare is the federal government program; Medicare Advantage is offered by Medicare-approved private insurance companies.
More Benefits: Medicare Advantage plans are required to cover at least the level of coverage that Original Medicare does, and they often provide more benefits such as prescription drugs. Knowing this will help when you compare plans.
Limited Costs: Medicare Advantage plans have a yearly limit (sometimes called a “cap”) on your out-of-pocket costs. After you reach this yearly limit, you won’t have to pay anything for covered services. Yearly limits vary by plan so be sure to ask. Original Medicare does not have a yearly limit, so remember that when you choose coverage.
Overview of Medicare Advantage benefits
Keep in mind that the benefits and costs may vary depending on the plan, insurance company, and the county in Wisconsin where you live,
Medicare Advantage plans cover:
- Hospital services (Medicare Part A)
- Medical services (Medicare Part B) – including preventive care
Most Medicare Advantage plans may also cover:
- Prescription drugs (Medicare Part D)
- Routine vision, hearing and dental care
- Health, fitness and wellness programs
Medicare Advantage options in Wisconsin
You have lots of different Medicare Advantage options. Compare the kinds of plans to see what’s right for you.
- Health Maintenance Organization (HMO) plans: HMOs cover your health care through their network of doctors, specialists and hospitals. You select a primary care doctor from the network, and this doctor will coordinate your care and refer you to specialists if needed. For medical emergencies, you will be covered even outside the network.
- Preferred Provider Organization (PPO) plans: PPOs are different than HMOs in a few key ways. With a PPO plan, you don’t need to choose a primary care doctor. Also, you don’t need referrals to see specialists. Your share of costs is usually lowest if you see doctors in the network. You also can visit providers outside of the network – you just may have to pay higher copays and/or coinsurance.
- Private Fee-for-Service (PFFS) plans: Generally you can get covered care from any doctor, specialist or hospital as long as they contract with the PFFS plan. Check first to make sure they accept the plan’s payment terms. Read more about PFFS plans here.
- Medicare Savings Account (MSA): You may also choose this high-deductible plan that includes a medical savings account. You use the savings account for your covered costs until you reach your deductible. Read more about MSA plans here.
- Special Needs Plans (SNPs): These Medicare Advantage plans are for people who have chronic conditions or special health needs, including people who live in an institution. The benefits, providers and covered prescription drugs are carefully chosen for these unique needs. Read more about SNPs here.
Hospital, Medical and Prescription Drug coverage all in one plan
Many Medicare Advantage plans combine prescription drug coverage along with hospital and medical benefits. These are called Medicare Advantage Prescription Drug plans. This may be an easy option for you, because you can get all your Medicare benefits through just one plan.
Keep in mind that if you decide to enroll in Medicare Part C and want prescription drug benefits, you should get them through a Medicare Advantage Prescription Drug plan, not a separate stand-alone Medicare Prescription Drug plan (Part D).
Comparing Medicare Advantage plans in Wisconsin
When comparing plans, look for your ideal balance of covered benefits and out-of-pocket costs. Medicare Advantage costs like premiums, copays and coinsurance do vary. All Medicare Advantage plans have a yearly limit on your out-of-pocket costs, which is something to think about. To find what works best for your health and budget, read your enrollment materials and talk with a Medicare expert.
Your Medicare Advantage plan choices may depend on your county or ZIP code.
Enrolling in Medicare Advantage in Wisconsin
You can enroll in a Medicare Advantage plan during the Initial Enrollment Period and the Open Enrollment Period. Remember you must have Original Medicare, Part A and Part B, in order to enroll in a Medicare Advantage plan.
Initial Enrollment Period: If you’re not automatically enrolled in Original Medicare, you can first enroll during the 7-month Initial Enrollment Period. This begins three months before you turn 65, your birthday month, and three months after you turn 65. You can also enroll in a Medicare Advantage plan during this time period
You can also join, change or leave your Medicare Advantage plan during the Open Enrollment Period. This happens every year starting on October 15 and ends on December 7.
Things to remember:
- Benefits and costs vary by the plan you choose and where you live.
- With any Medicare Advantage plan, you must continue to pay your Original Medicare Part B premium.
- Hospice care is covered by Part A
- Review the information and talk with a Medicare specialist
How to sign up for a Medicare Advantage plan
- Visit Medicare.gov
- Search the plans you want, choose one and enroll on their website
- Call the plan you’re interested in for a paper form to fill out
- Call 1-800-MEDICARE (1-800-633-4227) (TTY: 711)