Is Medicare an option for you? There are a few things you should know about Medicare before you choose a plan. Benzinga’s guide to getting Medicare in Wisconsin can help you understand your health care options.
Best Medicare in Wisconsin:
- Best Overall in Wisconsin: Senior Preferred
- Most Affordable in Wisconsin: Senior Preferred
- Best for Travel Coverage: UnitedHealthcare
- Best for Local Assistance: Security Health Plan of Wisconsin, Inc.
- Best for Large Network: Humana
What is Medicare?
Medicare is a health insurance program that is offered and regulated by the federal government. You may qualify for Medicare if you:
- Are 65 or older
- Have a disability
- Need dialysis or a transplant due to end-stage renal disease
Unlike other health insurance options, Medicare is broken up into several parts. You may have to enroll in more than 1 part of Medicare to receive the same coverage you would have with another health insurance option.
Part A: This is your hospital insurance. It covers inpatient hospital stays, hospice care and care in a skilled nursing facility. It may also cover some home health care.
Part B: This is your medical coverage. Part B covers your outpatient care, medical supplies, preventive care and other types of medical services.
Part C: Part C of Medicare is Medicare Advantage, an alternate Medicare option. Medicare Advantage plans combine Part A and Part B insurance. These plans are offered by private insurance companies.
Part D: Medicare Part D plans are your prescription drug coverage. This is offered as a supplemental plan to the other parts of Medicare. Some Medicare Advantage plans may already have Part D coverage included.
Legalities of Medicare in Wisconsin
Medicare is health insurance controlled by the federal government. You can see any doctor you would like as long as your doctor accepts Medicare insurance.
Medicare Advantage plans operate differently. These plans are offered by private insurance companies. Medicare approves the companies that offer Medicare Advantage plans but these plans are regulated by the federal government.
Your Medicare Advantage provider can restrict the doctors and specialists covered by your plan. You may also need to receive a referral from a primary care doctor if you require a specialist. Your Medicare Advantage plan may require you to use generic drug treatments instead of brand-name options. In some cases, your plan may cover brand-name options if the generic drug treatments did not work for you.
Private insurance companies also offer Medigap policies to fill gaps in your Medicare coverage. You are prohibited from carrying this coverage if you have a Medicare Advantage plan, also known as a Medicare Supplemental Insurance plan.
Types of Medicare Advantage Plans
As you review your Medicare Advantage plan options, you’ll notice that there are several types of plans. Here’s a quick overview of the most common options you’ll see.
HMO: Health maintenance organization (HMO) plans include both Parts A and B insurance. It also often includes Medicare Part D insurance. It may include vision, hearing, dental and other additional benefits.
Are you considering an HMO plan? Know that these plans only cover in-network doctors and hospitals. You will only receive coverage for an out-of-network visit in an emergency situation. HMO plans may also require a referral from an in-network primary care doctor before it will cover a visit with a specialist.
PPO: Preferred provider organization (PPO) plans include both Part A and Part B Medicare insurance. It will likely also include your Part D prescription drug coverage. Like HMO plans, PPO plans may offer additional benefits such as vision, hearing and dental coverage.
PPO plans handle networks differently than HMO plans. Your PPO plan will still have a network of doctors and hospitals. If you visit an in-network doctor, you can expect to pay less for your visit than you would if you saw an out-of-network doctor. Typically, PPO plans do not require a referral before you can get coverage for a specialist visit.
Here are a few terms you’ll see as you compare plans. Look for these terms:
Deductible: The deductible is one of the main numbers you see as you look at your plan options. Your deductible is the amount of money you have to pay out of pocket before your insurance company contributes toward your medical bills.
Coinsurance: Your plan may require you to start paying coinsurance for your visits after you’ve met your deductible. Coinsurance is the percentage you’ll need to pay for each medical service you receive after you’ve met your deductible. Since it is a percentage, the amount you pay depends on the total cost of your bill.
Copay: Your plan may use copays instead of coinsurance. Copays are a set amount of money that you pay for each visit after you have met your deductible. The amount you pay won’t change no matter how much your bill is. Your plan will probably have different copayment amounts for each service. For example, you may have a $10 copay for a doctor visit, but a $30 copay for a specialist visit. Pay close attention to this as you evaluate your options.
Out-of-pocket maximum: Each time you pay for a medical service out of pocket, this counts toward your out-of-pocket maximum. This includes when you pay in full and when you pay a copay or coinsurance. Once you’ve met your out-of-pocket maximum, your plan will pay 100% for your medical services.
How to Sign Up for Medicare in Wisconsin
There are 3 ways to sign up for Medicare Part A and B in Wisconsin:
- Enroll online.
- Call Social Security anytime Monday through Friday from 7 a.m. to 7 p.m. at 1-800-772-1213.
- Visit a Social Security office near you.
Are you interested in a Medicare Advantage plan? If so, you will need to find the options available to you. You can find and compare your options online. Plans can vary depending on where you live, so be sure to enter your home ZIP code to find the appropriate plans.
Once you’ve found your Medicare Advantage plan, you can enroll by:
- Visiting the company’s website to see if you can enroll in the plan online.
- Contact the company to request a paper enrollment form.
- Call 1-800-MEDICARE (1-800-633-4227).
Average Cost of Medicare Advantage Plans in Wisconsin
You will notice that the cost of each plan can be very different when comparing Medicare Advantage plans. Be sure to pay close attention to what each plan offers to find the best value for your needs. Here are some examples of Medicare Advantage plans available in Wisconsin.
Best Medicare Insurance Providers in Wisconsin
Are you considering Medicare? If so, you should become familiar with all of your options. There are several companies that offer Medicare Advantage plans in Wisconsin. Here’s a quick overview of some of the options that may be available to you.
1. Best Overall in Wisconsin: Senior Preferred
Senior Preferred offers plans that have received Medicare’s highest 5-star rating. You can take advantage of deductibles as low as $0. You can also choose whether or not you want prescription drug coverage with your plan.
Its plans may also offer vision and hearing coverage. Senior Preferred offers emergency coverage anywhere in the world so you can travel with confidence. However, your prescriptions must be obtained within the United States.
2. Most Affordable in Wisconsin: Senior Preferred
Overall, Senior Preferred plans can offer the most affordable coverage, too. As you compare affordability, you want to look at your deductibles, premiums, copays or coinsurance and the additional coverage a plan can offer.
Senior Preferred offers plans with low deductibles, low premiums and reasonable out-of-pocket maximums. It also offers copays as low as $5 per visit with your primary care doctor.
- Same day coverage available
3. Best for Travel Coverage: UnitedHealthcare
You may want to find a health insurance plan that offers coverage to you no matter where you are. UnitedHealthcare offers coverage that can be beneficial if you travel frequently. In addition to vision and hearing coverage, you may be able to receive travel coverage as a part of your plan.
UnitedHealth also offers video doctor visits and a nurse hotline that available to you if you have non-life threatening medical concerns.
4. Best for Local Assistance: Security Health Plan of Wisconsin, Inc.
Security Health Plan of Wisconsin offers a few Medicare Advantage options to meet all of your needs. Monthly premiums start at $0 and you can choose between plans that include Part D prescription drug coverage. Some plans offer additional coverage, including dental care, hearing aids and exams, vision exams and over-the-counter health products.
Best of all, this insurance provider offers personal help to answer all of your questions. You can order a free kit from this provider to review its Medicare options. You can also register for a seminar or make an appointment to meet one-on-one for help understanding and choosing your Medicare Advantage plan.
- Medicare Advantage Plans
5. Best for Large Network: Humana
Humana has offered Medicare Advantage plans since the Medicare insurance program began. This means that it’s had time to establish relationships and build a large network with doctors and hospitals across the country. Humana offers deductibles as low as $0 with affordable monthly premiums.
Humana offers vision, hearing and dental coverage to give you a more robust health insurance plan. You may also be able to receive fitness benefits and telehealth services with Humana.
Which Medicare Option Should I Choose?
Choose the Medicare option that best meets your needs. It might be a good idea to write down a list of your doctors and medications. You can then check to see which insurance covers the doctors and medications on your list.
Consider the costs associated with each plan. Some plans offer a low premium but a high deductible. This may be a good option for you if you don’t anticipate needing to use your health insurance often. But you might want to find an insurance plan with a lower deductible.
Our best advice? Take the time to consider your options so you can make the best decision for your health insurance needs.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Ashley Hart
Ashley Hart is a personal finance writer passionate about helping people feel empowered to take control of their finances. She has more than eight years of writing experience, focused on insurance.