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Medicare in Wisconsin

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More than a million people are on Medicare in Wisconsin (1,152,127), according to a 2018 report from the Centers for Medicare & Medicaid Services. We’ll walk through the various options you may have for Medicare coverage in Wisconsin.

What is Original Medicare in Wisconsin?

The federal Medicare program is called Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). This is the health insurance program for eligible American citizens and legal residents aged 65 or over, or certain younger people who qualify through disability.

Medicare Part A and Part B both have annual deductibles you may need to pay before Medicare covers your medical services. They also have copayments and/or coinsurance amounts for you to pay for many services.

Each of these “parts” also has a monthly premium, but many Wisconsinites don’t have to pay the Part A premium. If you’ve worked at least 10 years while paying Medicare taxes, you generally don’t have to pay a premium for Part A. But most people pay a Part B premium.

There are other Medicare coverage options that you may be able to add to your coverage, or through which you can get Medicare coverage.

Medicare Supplement in Wisconsin

Medicare Part A and Part B do come with some costs, as mentioned above. If you have a lot of doctor visits, or you have health problems that may result in some hospital stays, you might want to look into Medicare Supplement insurance.

Basically, Medicare Supplement in Wisconsin (as in other states) may help pay for your Medicare Part A and Part B out-of-pocket costs. For example, some Medicare Supplement insurance plans in Wisconsin usually pay your coinsurance for doctor visits under Part B, and all standardized plans may pay your inpatient hospital costs for up to a year after your Part A coverage is used up. Learn more about Medicare Supplement in Wisconsin.

Medicare Advantage in Wisconsin

There’s an alternative way to get your Original Medicare (Part A and Part B) benefits. Instead of getting them directly through the government, you may be able to sign up for a Medicare Advantage plan in Wisconsin. First, you need to enroll in Medicare Part A and Part B. Many people get enrolled in Part A and Part B automatically, without having to do anything.

You should do what’s best for you. Some people prefer Medicare Advantage plans because they usually include prescription drug coverage, and may offer other benefits as well. For example, some Medicare Advantage plans in Wisconsin may offer membership in fitness programs.

Some Medicare Advantage plans may have premiums as low as $0. Still, plans are likely to have coinsurance and/or copayments, and may have annual deductible amounts you have to pay before the plan covers your medical services.

Medicare Prescription Drug Plans in Wisconsin

Here’s another thing you might need to think about when it comes to Medicare coverage in Wisconsin. If you take medications – either now or in the future – you should know that Original Medicare won’t typically cover medications you take at home. Part A usually covers prescription drugs used to treat you as a hospital inpatient. Part B may cover prescription drugs given to you as an outpatient, but those are usually medications (such as infusions) that you wouldn’t give yourself.

Medicare Part D is prescription drug coverage – it’s optional, and if you want it, you need to sign up with a private, Medicare-approved insurance company. Be aware that if you don’t sign up for prescription drug coverage when you’re first eligible for it, you might have to pay a late enrollment penalty if you choose to sign up later on. There are two ways you can get coverage under Medicare Part D in Wisconsin.

  • One way is through a Medicare Advantage Prescription Drug plan in Wisconsin, described above.
  • The other way is through a stand-alone Medicare Part D Prescription Drug Plan in Wisconsin.

Read more about Medicare Part D in Wisconsin.

If you’re curious to see the Medicare coverage options in your part of Wisconsin and start comparing them, you can type your ZIP code in the box on this page and then click the button.

The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

Source: Statistical data from the Centers for Medicare & Medicaid Services (CMS) “Medicare Enrollment Dashboard,” from the CMS Office of Enterprise Data & Analytics, February 2019.

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