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Medicare Plans in Wisconsin in 2022

If you live in Wisconsin and your time to enroll in Medicare is nearing, it is important that you understand your Medicare options. In Wisconsin, Medicare Supplement plans are regulated by the state, not the federal government. This means that Medigap coverage in Wisconsin is quite different than in other states. 

It is important to pay close attention to state-specific Medigap details and also have a general understanding of Medicare Advantage and Part D options in your state. That’s where we come in. Below we’ll be explaining your Medigap, Medicare Advantage, and Part D options in Wisconsin.

How To Apply for Medicare in Wisconsin

Wisconsin residents who are only interested in enrolling in Original Medicare can do so through their local Social Security office. You can sign up in-person, online, or over the phone as early as three months before your 65th birthday. 

However, if you want to enroll in a Medicare Advantage plan, Medicare Supplement Insurance, or Part D drug coverage, you should contact a licensed insurance agent. They can walk you through the process and help you to find the right plan for you. 

Reach out to an experienced insurance agent here at Medicare Plans Direct today to have all of your Medicare-related questions answered.

Medicare Supplement Plans in Wisconsin

In 2019, 308,713 Wisconsin residents were enrolled in Medicare Supplement Insurance. This figure represented a little over a quarter (26.5%) of the total of Medicare enrollees in the state that year.

In Wisconsin, Medigap plans are regulated in a way that is unique to the state. Unlike in 47 of the other states, Wisconsin Medigap plans are not federally regulated. Therefore, you can’t rely on the general Medicare Supplement guidelines when exploring your Medigap coverage options. 

Wisconsin Medigap plans are structured as follows. Each Medicare Supplement Insurance company offers a basic plan, and beneficiaries have the option to add on additional riders if they so choose.  

The Wisconsin Medigap Base Plan includes the following options:

  • Basic Benefits: Each plan includes the Basic Benefits that are also included in all other standardized Medicare Supplement plans 
  • Inpatient hospital care (Part A coinsurance) 
  • Part B coinsurance
  • Your first 3 pints of blood needed for a Medical procedure each year
  • Part A hospice coinsurance and copayments
  • Part A Skilled Nursing Facility Coinsurance 
  • 175 days of inpatient mental health coverage per lifetime on top of the Medicare benefit (additional outpatient mental health coverage as well) 
  • 40 home health care visits in addition to those paid for by Medicare
  • State mandated benefits, such as preventative services. These include: 
  • Skilled Nursing Facility Care: 30 days of care in a skilled nursing facility.
  • Home Health Care: Up to 40 home care visits per year in addition to those provided by Medicare as long as you qualify. This means that your doctor must certify you would need to be in the hospital or a skilled nursing home if the home care was not available to you. 
  • Kidney Disease: Inpatient and outpatient expenses for dialysis, transplantation, or donor-related services of kidney disease in an amount not less than $30,000 in any calendar year. 
  • Diabetes Treatment: The customary expenses incurred for the installation and use of an insulin infusion pump or other equipment or nonprescription supplies for the treatment of diabetes. Self-management services are also covered. 
  • Chiropractic Care—The customary expenses incurred for chiropractic services. 
  • Hospital and Ambulatory Surgery Center Charges and Anesthetics for Dental Care: Hospital or ambulatory surgery center charges incurred and anesthetics required for dental care for an individual with a chronic disability or an individual with a medical condition requiring hospitalization or general anesthesia for dental care. 
  • Breast Reconstruction: Breast reconstruction of the affected tissue resulting from a mastectomy.
  • Colorectal Cancer Screening: Colorectal cancer examinations and laboratory tests. 
  • Coverage of Certain Health Care Costs in Cancer Clinical Trials—Certain services, items, or drugs administered in cancer clinical trials in certain situations. 

This basic plan can be complemented by optional riders, which are as follows

  • Part A deductible
  • Additional home health care (365 visits including those paid by Medicare)
  • Part B deductible*
  • Part B excess charges
  • Foreign travel emergency
  • 50% Part A deductible
  • Part B copayment or coinsurance

Additionally, you have the option to purchase a 50% or 25% cost-sharing plan similar to federally regulated Plan K and Plan L, respectively. These plans have out-of-pocket limits that put a cap on what you have to pay for your Medicare costs: $6,220 for the 50% plan and $3,110 for the 25% plan. 

A high-deductible plan (which had a deductible of $2,370 in 2021) is also available, which gives you the option of paying a lower monthly premium. However, your plan’s benefits won’t kick in until you reach your deductible in out-of-pocket costs.

*Part B deductible coverage will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may still qualify for this benefit.

Medigap Premiums in Wisconsin

What your Wisconsin Medigap premium will cost you depends on a number of factors. Which riders (if any) you add to your plan, whether you enroll in a cost sharing plan, and if you choose a high-deductible plan will all impact what you pay per month for your Medigap coverage. 

Additionally, insurers in Wisconsin can elect whether they want to use attained-age rating or issue-age rating. With attained-age rating, premiums are based on the age of the beneficiary. This means that your premium can increase over the years.

When it comes to issue-age rating, the price of the monthly premium is determined by the age of the beneficiary when they enrolled in the plan.

All of your coverage details can have a significant impact on how much you end up paying for your Medicare Supplement Insurance coverage. That’s why we recommend consulting with a knowledgeable insurance agent before deciding on a Medigap plan. 

Medigap Enrollment in Wisconsin

If you want to sign up for Medicare Supplement Insurance in Wisconsin, you will probably want to do so during your Medigap Open Enrollment Period (OEP).

This occurs when you first become eligible for Medicare and enroll in Part B, and it lasts for 6 months. During this time, you can enroll in any Medigap plan offered in your area regardless of your health history

Beneficiaries under the age of 65 who qualify for Medicare because of a disability can also enroll in Medigap during their 6 month Medigap OEP. These individuals will have another OEP during the 6 months following their 65th birthday.

Medigap enrollees under the age of 65 in Wisconsin are only guaranteed the right to enroll in the basic plan. However, monthly premiums tend to be significantly higher for individuals who sign up for Medicare Supplement Insurance before they turn 65. 

Medicare Advantage Plans in Wisconsin

Another coverage option for people looking for more benefits than those offered by Original Medicare is Medicare Advantage. Also known as Medicare Part C, these plans provide the coverage that you get under Original Medicare. They often also include additional benefits, such as drug coverage, hearing coverage, vision coverage, dental coverage, and more

Medicare Advantage participation in Wisconsin is quite popular, and almost half (48.6%) of Medicare beneficiaries were enrolled in a Medicare Advantage plan in 2021. 

In 2022, there are 115 Medicare Advantage plans available in Wisconsin. Additionally, all Wisconsin Medicare beneficiaries have access to at least one Medicare Advantage plan in 2022. 

But you should be aware that which Medicare Advantage plans you can enroll in depends on where exactly you reside, as plan availability varies from county to county.

For example, there are 58 plans available in Winnebago County in 2022. However, residents of Rusk County only have 12 plans available to them. 

You should also keep in mind that what you pay for your Medicare Advantage plan depends on where you live, the plan that you choose, and more. In 2022, the average Part C monthly premium for Wisconsin enrollees is $29.87. Some good news is that 100% of Medicare beneficiaries in Wisconsin have access to at least one plan with a $0 monthly premium. 

Deciding which is the right Medicare Advantage plan for you is best done with the help of an experienced insurance agent. Here at Medicare Plans Direct we help you make the best Medicare choices possible at no extra cost to you. Don’t hesitate to reach out to us today to receive free Medicare advice.

Medicare Part D in Wisconsin

Another thing for Wisconsin Medicare beneficiaries to keep in mind is their Part D prescription drug coverage options. In 2022, there are 24 stand-alone drug plans available to Wisconsin Medicare enrollees

How much your Part D plan premium will cost you depends on a number of factors, such as where you live and which insurance company you purchase your plan through. In 2022, the average Wisconsin Part D premium is $50.10

You can also find Medicare prescription drug plans with $0 deductibles, though these plans tend to have higher monthly premiums. In 2022, there are five plans with no deductible available to Wisconsin beneficiaries. The lowest cost stand-alone drug plan with a $0 deductible has a monthly premium of $45.00

You will probably want to enroll in prescription drug coverage when you are first eligible for Medicare. Even if you don’t need it when you turn 65, you will likely need it in the future. If you don’t sign up for Medicare Part D when you are first eligible and don’t have some other form of creditable drug coverage, you could face late enrollment penalty fees down the line

You can get prescription drug coverage through some Medicare Advantage plans, but if you are enrolled in Original Medicare and/or a Medigap plan, you will need a stand-alone prescription drug plan to cover your prescription medication costs. 

As you can see, your Medicare coverage options depend on a number of factors, one of the most important ones being where you live. That’s where we come in. Our expertise can help you to make the best possible Medicare decisions, so reach out today to speak with a licensed insurance agent. 

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