Wisconsin Original Medicare Coverage

ORIGINAL MEDICARE HEALTH PLANS IN WISCONSIN

Thinking of applying for a Medicare Health Plan in Wisconsin?

Make a wise decision with O'Neal Insurance Group's help!

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Medicare Health Plans in Wisconsin ata Glance

According to the 2019 report from the Centers for Medicare and Medicaid Services, more than 1 million people have a Medicare Health Plan in Wisconsin.

Below are some important enrollment details regarding the state trend:

  • More than 1,180,000 Wisconsin residents have Medicare
  • Over 517,000 people are enrolled in Medicare Advantage Plans or other Medicare health plans
  • The total number of residents with Original Medicare Plan is more than 663,000
  • Over 867,000 people are enrolled in the Medicare Prescription Drug Plan

Different Options for a Medicare Health Plan In Wisconsin

The key to maximizing your health insurance coverage and securing your future is to explore and understand your options. The following are the options you get for a Medicare Health Plan in Wisconsin.

  • Original Medicare Plan (Part A)

    Part A or the hospital insurance part of the Medicare program offers coverage for hospitals, doctors, and healthcare facilities. This includes nurse care, medications, and hospital meals. Provided by the federal government, this fee-for-service plan requires you to pay a premium for each service.

  • Original Medicare Plan (Part B)

    Part B or the medical insurance part of the Medicare scheme covers the healthcare costs incurred outside the hospital. This includes the costs of doctor visits, ambulance services, medical lab tests, and any special medical supplies or equipment.

    It’s important to understand that the Original Medicare plan (Part A and B) doesn’t provide coverage for dental care, prescriptions, and custodial care. Beneficiaries typically take these plans together in order to receive both hospital and medical insurance.
  • Medicare Advantage Plan (Part C)

    Contrary to Part A and B, Medicare Advantage Plans are authorized by private insurance companies that are working in collaboration with Medicare. These plans not only provide the basic benefits of standard Original Medicare plans but also offer extra perks and privileges. With Part C, you can get access to dental care, eye check-ups, and health and wellness classes.

  • Medigap (Medicare Supplement)

    Medigap is a supplemental plan that covers any additional healthcare costs and unexpected expenses that aren’t covered by the standard plans. With this plan, you get coverage for copayments, coinsurance, and deductibles.

  • Medicare Prescription Drug Plan (Part D)

    Part D covers the costs of prolonged prescription treatment advised by a healthcare provider. Before enrolling in this plan, you must first check the list of drugs in your service area as it may vary from one area to another. You may either apply for a stand-alone Part D plan or use it as an extension of your Medicare Advantage Plan.

Do You Qualify For A Medicare Health Plan In Wisconsin

The eligibility requirements for a Medicare Health Plan in Wisconsin are simple and straightforward. All U.S. citizens aged 65 or above can apply. Moreover, those who have been living in the country as a permanent legal resident for five continuous years also qualify for Medicare.

Additional facts are stated below:

  • 65/+ year-olds with social security automatically qualify for the Original Medicare plan (Part A and B)
  • People who have been paying their Medicare taxes for ten years can get Part A for free
  • People have to pay a premium for Part B
  • People with a prolonged disability who have been receiving social security disability for ten years can also apply even before their 65th birthday
  • People who haven’t turned 65 can also apply if they have a Chronic Kidney Disease (stage 5)

Once you have enrolled in the Original Medicare Health Plan in Wisconsin, you can easily apply for Part C and D. Just make sure that your plan and its services are available in your zip code in order to avail all the benefits.  

Medicare Advantage Plans: A Closer Look

Maximize your medical coverage with the right advantage plan.

Medicare Advantage Plans offer the benefits of the standard Medicare plans along with extra perks in exchange for coinsurance, copayments, and deductibles. With these plans, you can enjoy a lower premium as compared to other Medicare plans.

The following are the two common types of Medicare Advantage Plans in Wisconsin:

elderly care

1. Health Maintenance Organization (HMO)

Health Maintenance Organization allows beneficiaries to avail healthcare services at reduced rates from healthcare providers in the network. In case you opt for a doctor who’s not a part of the HMO network, you’ll have to pay your bills yourself. With HMO, you can save yourself the time and hassle of scheduling appointments. Please note that you’ll have to get a referral from your primary healthcare provider in order to consult with a specialist.

2. Preferred Provider Organization (PPO)

This plan allows greater flexibility by allowing you to choose any healthcare provider of your choice. It’s optional to get a referral from your primary healthcare provider but if you do so, you can enjoy much lower rates. Just like HMO, PPO has a network of medical experts. If you opt for one outside the network, you’ll have to pay for the expenses out of your pocket.

Enrollment in a Medicare Health Plan in Wisconsin

You get three chances to enroll in the Medicare Health Plan.

People with social security automatically become eligible for a Medicare Health Plan in Wisconsin. Others can simply call Social Security or sign up through the website.

There are three enrollment periods for applying for a Medicare plan. Let’s discuss each below.

  • Initial Enrollment

    This period starts three months before you turn 65 and lasts for 7 months.

  • Special Enrollment

    People who fail to apply for a Medicare health plan during the initial period due to spousal or group coverage get access to a special period once their coverage ends. This period lasts for 8 months.

  • General Enrollment

    The general enrollment period comes every year from January to March. During this period, eligible candidates can apply for a Medicare plan and start receiving their coverage from July.

Looking for Professional Guidance for a Medicare Health Plan in Wisconsin?

The O'Neal Insurance Group is here to help you!

We are a team of insurance experts that’s equipped with the necessary information and resources to help you secure your future. Our aim is to maximize your insurance coverage and minimize stress and risks!

Are you ready to enroll in a Medicare Health Plan?

Book a free consultation to make the best decision.

Or call 1-888-966-8579 to schedule an appointment.

Insurance Carriers

  • Aetna
  • Allwell /Centene Ascension Complete
  • Anthem BCBS of Indiana
  • Bright Health
  • Blue Cross and Blue Shield of IL, (HCSC)
  • Blue Cross and Blue Shield of TX, (HCSC)
  • Cigna Medicare-Healthspring
  • Clearspring Health
  • Community Care Alliance of Illinois
  • GTL (Guarantee Trust Life Insurance Company)
  • Health Alliance
  • Humana
  • Mutual of Omaha
  • UnitedHealthcare
  • Wellcare
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  • Wisconsin