Updated October 29, 2021
Reading time: 6 minutes
From Packer games, lighthouse tours of Door County, and visits to State Fair Park to stops at cheese factories, breweries, and specialty shops in between, a retiree could make an encore career of exploring their home state. Don’t let shopping for your Medicare Advantage plan keep you from your travels.
We’ve put together everything you should know about Medicare Advantage in Wisconsin. From the Open Enrollment Period to details about the best insurance company, we have the info you need. So go ahead and plan that weekend trip to Door County, or take your grandkids to the Dells for fun and sun. We are here to help you save time and money.
Ready to compare the Medicare prescription drug plans that are available to you? Use Insurify’s comparison tool to find a plan that’s right for you. Enter your ZIP code, and you’ll instantly get plans that offer basic preventive network care, plus additional benefits like nursing home and long-term care.
Wisconsin has some great Medicare Advantage plans. Of the top eight, they all have a five-star rating. Three of them are premium-free, and four have monthly premiums of $100 or less. Here’s a closer look at these plans from top healthcare providers: Aurora Health, Gundersen, and UW Health.
1. Aurora Health Quartz Med Advantage Core
2. Aurora Health Quartz Med Advantage Elite
3. Aurora Health Quartz Med Advantage Value
4. Gundersen Quartz Med Advantage Core
5. Gundersen Quartz Med Advantage Elite
6. Gundersen Quartz Med Advantage Value
7. UW Health Quartz Med Advantage Core
8. UW Health Quartz Med Advantage Elite
Here are some of the plans that are highly rated:
This plan has a tiered prescription drug plan with affordable rates. Dental, vision, hearing, and mental health services are covered. Doctor visits are $0 for your primary care physician and $50 for a specialist.
Monthly Premium: $0
Out-of-Pocket Max: $5,900
This plan offers low-cost fees and low coinsurance for lab fees and diagnostic tests. There’s a $0 co-pay for tier-one prescription drugs. Hearing, dental, vision, wellness, and mental health services are covered.
Monthly Premium: $70.90
Out-of-Pocket Max: $3900
With a low monthly premium and deductible, this plan offers many benefits, including $0 doctor visits, $35 co-pay for specialists, and $265 per day for inpatient hospital care for days one through seven (from day eight to 90, there is no charge). Like most plans, dental, hearing, vision, wellness, and mental health services are covered.
Monthly Premium: $31
Out-of-Pocket Max: $4900
With no deductible or monthly premiums, this plan has a lot to offer. Prescription drugs within tier one are less than $10, with reasonable pricing for higher tiers. Doctor visits are $25 for your PCP and $50 for a specialist. Wellness, mental health, vision, dental, and hearing services are covered.
Monthly Premium: $0
Out-of-Pocket Max: $5900
Although this plan comes with a higher monthly premium, it features very low co-payments and coinsurance. Visits to your PCP cost $5, and specialists cost $30. Inpatient hospital stays are $250 per stay. Lab fees and diagnostic tests are $2. Medicare Part B drug co-payments, including chemotherapy, are 10 percent.
Monthly Premium: $143
Out-of-Pocket Max: $3000
This health plan has great Medicare benefits, including a low $15 co-pay for doctor visits and $40 for specialists. Many of the hearing, vision, dental, and mental health services have a low or no co-pay.
Monthly Premium: $40
Out-of-Pocket Max: $3,450
All the tier one medications in this MA-PD are under $10. There’s no co-payment for vision or basic dental care. Doctor visits are $15, and specialists are $50.
Monthly Premium: $0
Out-of-Pocket Max: $5,600
The monthly premium is offset by low prices on the services you need most. Lab services are $5, as are visits to your primary care physician. Seeing a specialist costs $25. The prescription drug plan offers affordable prices on medication.
Monthly Premium: $100
Out-of-Pocket Max: $3,450
Medicare is an affordable way to continue your healthcare coverage as you enter retirement. It’s partially paid for by taxes that you’ve paid to the Medicare system during your working years.
Some parts of your plan are free, but others do come with a fee. Here’s a look at the expenses you may have with your Medicare Advantage plan:
Medicare Part A: This is Hospital Insurance and will cover hospital care. It is premium-free for people who meet the basic qualifications.
Medicare Part B: Also known as Medical insurance, this is not free. Be sure to enroll in Part B during your Initial Enrollment Period, so you don’t have to pay the penalty.
Medicare Part C: Medicare Advantage plans are Medicare Part C. Many are premium-free. If you opt for Part C, you also need to enroll in and pay for Parts A and B.
Monthly Premium: For Medicare Advantage plans that are not free, this is the amount you’ll pay each month.
Deductible: Many plans have a deductible, which is the amount of money you need to pay before the insurance starts covering costs. If your deductible is $500 and you have expenses of $800, you need to pay $500, and the insurance will pay the remaining $300.
Out-of-pocket Maximum: Some plans come with an out-of-pocket max, which puts a cap on your out-of- pocket costs. After you reach that amount, you don’t pay for future services in a given year.
Co-payment: Also called co-pay, this is the dollar amount you’ll pay for a doctor’s visit or procedure.
Coinsurance: Like a co-pay, coinsurance is the percentage of a bill you are responsible for paying. If you have 30 percent coinsurance on a $100 doctor fee, you will pay $30, and the insurance pays the other $70.
On a tight budget? You can contact your local Social Security office to see if you qualify for Extra Help, a program that helps with prescription drug costs.
Find the absolute best prices on the Medicare Advantage insurance plans for Wisconsin residents. Insurify’s comparison tool lets you compare monthly premiums, deductibles, and other costs in just minutes. Get cheaper healthcare now!
All Americans, regardless of income, can sign up for Medicare when they turn 65. You can sign up during your birth month and up to three months before and after your birth month.
Once you sign up for Medicare Part A and Medicare Part B, you can start looking for a Medicare Advantage plan.
Automatic enrollment occurs for some people, including those who:
Have end-stage renal disease ( ESRD )
Receive Social Security disability
Receive Railroad Board Benefits
For questions about your eligibility for Medicare health insurance, you can contact Medicare at 1 (800) MEDICARE, or 1 (800) 633-4227. TTY users can call 1 (877) 486-2048. Information is available online at Medicare.gov or t he Centers for Medicare & Medicaid Services website, CMS.gov.
As you look through the lists of top MA providers in Wisconsin, you’ll notice there are many plan options. Here’s a look at what the acronyms mean and how they differ from each other.
HMO: Health maintenance organizations keep costs low for members by requiring care to be done by doctors that are a part of the plan’s network. HMO plans require a primary care physician (PCP), and you need a referral to see a specialist.
PPO: Preferred provider organizations do not require you to have a primary care physician or get a specialist referral. There is a network for PPO plans, but you are given more flexibility and can see a PCP outside your network.
PFFS: With private fee-for-service plans, there are no provider networks. You can go to any provider who accepts the payment terms of your plan.
SNPs: Special needs plans cater to individuals with a specific health issue or those in a care facility. They are also available to people who qualify for both Medicaid and Medicare.
MSA: Medical savings accounts are just what they sound like: savings accounts that hold money to be used for medical expenses. These work with a high- deductible insurance plan and can be a great way to save on healthcare costs if you are generally healthy.
To be eligible for Medicare Advantage, you first need to meet the basic requirements of Medicare. These include being 65 years old, working for at least 10 years, and being an American citizen or permanent resident. Before signing up for a Medicare Advantage plan, you need to enroll in Medicare Part A and Medicare Part B.
Many Medicare Advantage plans cover prescription drugs. These plans will often be designated by the letters MA-PD (Medicare Advantage prescription drug). If the Medicare Advantage plan best for you does not offer coverage, you can join a prescription drug plan in addition to your Advantage plan.
Yes, you can switch from Original Medicare to a Medicare Advantage plan. Medicare beneficiaries can switch coverage options. This can be done during the Annual Enrollment Period, which is from October 15 to December 7 every year.
Yes, you can switch from one Medicare Advantage plan to another. This needs to be done during the Medicare Advantage Enrollment Period, which runs from January 1 to March 31 of each year.
While Wisconsin offers many great Medicare Advantage plans, not all of them will be a good fit for your needs. Choosing a Medicare Advantage plan is a very personal decision. What’s a great plan for your friend from the bowling league may not be suitable for you.
Here are the top factors to consider when comparing Wisconsin Medicare Advantage plans:
Type of plan
Prescription drug coverage
Dental, hearing, and vision coverage
Mental health services
Access to a skilled nursing facility
Once you know what you need most in your Medicare Advantage plan, you can search with confidence—no insurance agent necessary.
Compare plans now! Try out the Insurify comparison tool, which will generate a list of plans in your service area in less than two minutes. Spend time looking over their features, and then conveniently apply online.
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Charlotte Edwards is a freelance writer with a passion for educating others in the areas of personal finance, health, and education. An educator-turned-writer, she has written for publications worldwide over the past decade. In her spare time, she enjoys reading, watching classic movies, and spending time with her husband and two children. You can learn more about her work and life abroad at www.livinginchinawithkids.com.Learn More