Medicare in Wisconsin
- Medicare in Wisconsin is available to many seniors and some people with disabilities. Find out more about plan options and how to apply.
What Wisconsin Medicare Plans Are Available?
Wisconsin offers Medicare Part A, B, D and Medicare Advantage (also known as Part C) plans to eligible residents. Most of the funding for Medicare comes from Social Security, but it is important to understand how your plan works and what your financial responsibilities will be regarding your medical needs. Following are the key differences between each plan.
- Medicare Part A: This plan covers inpatient care and services, emergency room treatment and extended hospital stays. It also covers nursing home stays, home health care and hospice.
- Medicare Part B: This plan covers the cost of most preventative care, mental health care, medical equipment and supplies and the cost of medical transport services, which would include the cost of an ambulance in an emergency.
- Medicare Advantage: In 2006, Medicare Part C came into effect, which allows you to choose a private insurance company to administer your benefits. Medicare Advantage plans are similar to private policies but are required to cover all of the things that traditional Part A and B plans cover. You may be able to obtain coverage for dental care, vision and other services not covered by Parts A or B by selecting a Medicare Advantage plan.
- Medicare Part D: All of your prescription medications are covered under Medicare Part D. Some Medicare Advantage plans offer coverage for prescription drugs while others do not. If these items aren't covered by your Medicare Advantage plan, you may add Part D to your coverage.
Medicare plans in the state are pretty evenly distributed. Around 649,000 Wisconsinites were enrolled in traditional Medicare in 2020 compared with 543,000 who elected to enroll in Medicare Advantage plans. While it is possible to also obtain Medicare Supplement Insurance (Medigap) coverage in Wisconsin, the state standardizes this coverage differently than the rest of the country.
Who Is Eligible for Wisconsin Medicare?
You need to be 65 years of age to qualify for Medicare and you may be enrolled automatically when you become eligible if you have been receiving Social Security benefits for at least 4 months. Some people do need to apply for their Medicare plans, so make sure that if you are not receiving Social Security benefits that you inquire about your status. Signing up shortly before or upon turning 65 years old helps ensure that you avoid any penalties for not signing up when you needed to do so.
Medicare Part A is free for those who have paid into Social Security for at least 10 years during their lifetime. If you do not meet this requirement, you are still able to access Medicare but may be required to pay a monthly premium for your benefits. Medicare Part B plans cost up to $150 per month as of 2021, and this premium is usually automatically deducted from your pension or government retirement benefits.
It is possible to get a Medicare Advantage plan for little to no money, depending on the coverage that you seek. You may be required to pay additional premiums for services not covered by traditional Medicare. Medicare Part D plans also require monthly premiums, so be sure to check the cost of your plan prior to enrollment.
The initial enrollment period (IEP) begins 3 months before your 65th birthday. You have from the start of the IEP until 3 months after your birthday to enroll for benefits without any penalties. If you do miss this window, the General Enrollment period begins on January 1 of each year and ends on March 31. Another way to avoid penalties is to sign up during a Special Enrollment Period.
To qualify for special enrollment, you must be enrolled in a group health plan provided by an employer or you or a loved one must suffer from a disability or be volunteering or serving abroad.
How Do I Enroll for Medicare in Wisconsin?
Enrolling in Medicare is a fairly simple and straightforward process. Medicare allows you to learn more about each plan and enroll online on its website: medicare.gov. If you were enrolled automatically, you can also use Medicare’s website to change plans.
Contact Information for Wisconsin Medicare, Medicaid and Insurance Help
For more information about Medicare and other health coverage benefits offered by the State of Wisconsin, please refer to the following.