Medicare Advantage Plans in Wisconsin

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans offer added benefits like routine dental, vision, hearing, fitness programs, transportation, and meal support.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, but younger individuals may also qualify due to disability, ALS, or end-stage renal disease (ESRD).

You can enroll during specific timeframes:

• Initial Enrollment: 3 months before and after your 65th birthday month
• General Enrollment: Jan 1 – Mar 31 (for late Part B enrollees)
• Special Enrollment Periods: Triggered by qualifying life events like moving, losing coverage, or changes in health

What Types of Medicare Advantage Plans Are Available in Wisconsin?

Wisconsin offers a variety of Medicare Advantage plan options:

• Health Maintenance Organizations (HMOs): Require in-network care and referrals for specialists
• Preferred Provider Organizations (PPOs): Allow out-of-network care at a higher cost, typically no referrals needed
• Private Fee-for-Service (PFFS) Plans: Allow any provider who agrees to plan terms; some have networks
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions like diabetes, dementia, or autoimmune diseases
  • I-SNPs: For individuals in institutions or needing nursing-level care
  • Dual Eligible Special Needs Plans (D-SNPs): For people eligible for both Medicare and Medicaid, often with added benefits and low or no cost
• Medical Savings Accounts (MSAs): Combine a high-deductible MA plan with an insurer-funded savings account used for Medicare-covered costs

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, exceptions exist:

• MSAs and some PFFS plans do not include drug coverage
• If your plan doesn’t offer Part D coverage, you may:
  • Enroll in a separate Part D plan (allowed only for certain MA plans)
  • Face a late enrollment penalty if you delay without other creditable drug coverage

How Do You Choose a Medicare Advantage Plan?

Before choosing a plan, consider your Medicare Advantage costs:

• Premiums: Many Wisconsin plans have $0 premiums; others charge a monthly rate
• Deductibles, Coinsurance & Copays: Understand the amounts you pay before the plan covers expenses
• Out-of-Pocket Maximums: This annual limit protects you from excessive medical spending
• Extra Benefits: Look for plans offering dental, vision, hearing, telehealth, fitness, transportation, or meal delivery services

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment: 7-month window around your 65th birthday (or 25th month of disability)
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop a plan
• General Enrollment (Jan 1–Mar 31): Enroll in Part B and join an MA plan
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or revert to Original Medicare
• Special Enrollment Periods: Triggered by:
  • Moving out of your current plan’s area
  • Gaining or losing Medicaid
  • Moving into or out of a nursing facility
  • Employer/union coverage loss
  • Your MA plan leaving Medicare

What If You Want to Change Your Medicare Advantage Plan?

You can change plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

What Are Medicare Resources in Wisconsin?

Wisconsin provides several helpful Medicare support programs:

• Medigap Helpline: Offers free counseling on Medicare, MA, and Medigap plans. Call 800-242-1060
• Part D and Prescription Drug Helpline: Assists beneficiaries age 60+ with drug coverage. Call 855-677-2783
• Wisconsin Office of the Commissioner of Insurance: Handles insurance complaints
• Wisconsin Medicaid Program: Helps low-income residents. Apply online or call 800-362-3002

Learn about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans (Medigap) are standardized private policies designed to help with out-of-pocket costs from Original Medicare.

• You must be enrolled in Medicare Parts A and B to purchase
• The best time to enroll is during your six-month Medigap Open Enrollment Period
• Plans don’t include drug coverage—you must purchase a separate Part D plan
• There are 10 standardized plans; Medicare Supplement Plan G is the most popular
• Plan F is no longer available to new Medicare enrollees
• All Medigap plans offer predictable costs and nationwide provider access without referrals

Learn more about Medicare Supplement plans in Wisconsin.

Next Steps

If a Medicare Advantage plan in Wisconsin fits your needs, compare plans in your area. Evaluate premiums, provider networks, prescription coverage, and out-of-pocket costs. Be prepared to enroll during an eligible period to get the coverage that’s right for you.