Medicare Advantage Part C in Wisconsin

Medicare Replacement plans – which are Medicare supplement plans designed to replace your federal health benefits with a private coverage option – are also known as Medicare Advantage (or Medicare Part C). Medicare supplement policies are designed to help with the gaps in Traditional Medicare (Medicare Parts A and B) coverage. Without a supplement, these coverage gaps have been known to cause some seniors to face huge out-of-pocket medical bills. However, for one affordable monthly premium, it is possible to protect yourself against expensive coverage gaps.

Federal Regulations for Medicare Advantage

Existing federal laws mandate that, no matter what Medicare Advantage policy you choose, it must provide at least the same amount of coverage as Traditional Medicare. However, most Advantage policies attract seniors by offering as much or more, so being sold an inferior policy is an unlikely occurrence. Below, we’ll get into some of the more popular coverage options you can add to a Medicare Advantage policy.

Medicare Advantage Enrollment In Wisconsin

Medicare Advantage seems to be a little less popular in Iowa than it is in other states. Only about 39% of residents are allowing private companies to manage their Medicare benefits through an Advantage plan. The other 61% likely are sticking with Original Medicare or have some leftover plan from their previous employer.

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Living in Wisconsin means that you most likely pay a different monthly rate than someone in Iowa or Nebraska. However, there is enough data out there to offer up a rough estimate. Below are some examples of going rates for Medicare Advantage policies near you.

Most Popular Medicare Advantage Plans in Wisconsin

Do you want to make your Medicare Advantage plan shopping quick and easy? Then we’ve got you covered. We’ve examined local Medicare Advantage plans in your area and we’ve ranked them accordingly. For plans and companies that are financially stable, manage healthcare competently, excel at customer service, and provide all of these services for an affordable premium, they can earn a maximum of five stars. The more stars, the better! It’ll help you figure out which companies and which Medicare Advantage plans will cater towards your medical needs the best.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

It’s best to do your homework and figure out what sort of Medicare Advantage network your preferred doctors are in (if you have them) before choosing your Medicare Advantage network. If you aren’t careful, you may end up having to switch doctors. It is also possible that your Advantage plan could change who they do and do not allow in your provider network unexpectedly.

Where you generally need to get your care and services from for:

  • HMO Plans – An HMO is a health management organization network. These networks are smaller and often consist of doctors, hospitals, and facilities that agree to charge your insurance company lower rates. This helps keep HMO plans more affordable for customers. You start with a primary care physician, you see them regularly for wellness visits and preventative care, and they refer you out to specialists who are in your network if they think you need their care. The only time you can go out-of -network without having to pay 100% out-of-pocket is in the event of an urgent medical emergency.
  • PPO Plans – PPO plans tend to be more expensive than an HMO, but this is because they offer more. You get to choose from a preferred provider list of doctors, hospitals, and outpatient facilities that your insurance company wants you to use; but if you decide to go outside of that network, they will still help you with your medical costs (just not as much). You’ll also be expected to pay a higher monthly premium. But some people believe having this freedom of choice is worth it, especially if you need more frequent or specialized care and you can afford to pay a premium for it.
  • PFFS Plans – Private Fee-For-Service plans give you unrestricted choice when it comes to your health care providers – but you may have to pay for this privilege by tolerating a little bit of aggravation. You can choose any care provider you wish as long as they agree to the payment terms established by your insurance company. But these terms change all the time, even between appointments with the same care provider. If either party changes their mind and doesn’t agree to the terms, you’ll have to get care somewhere else or you’ll have to be okay with paying much higher out-of-pocket costs.
  • Special Needs Plans – Do you have a chronic illness? Is that illness expensive to treat? Are you on a fixed income or otherwise limited in how much you can pay for your medical costs? Then you may qualify for a Special Needs Plan. These plans are for people who require a lot of specialized medical care for a specific chronic illness like End Stage Renal Disease. Your care has to be managed through a primary care physician and that doctor will give you referrals for specialized care within your medical network. There are exceptions for out-of-network emergency care though, and some plans allow you to negotiate for out-of-network care if you can prove to them that you need special treatment from a care provider which is not available within your current network.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan:

  • HMO Plans – Do you want your Medicare Advantage plan to be as affordable as possible? Then you might want to look at a Medicare Advantage HMO plan first. It’ll work the same way as a regular HMO plan, but you’ll have all the same benefits you would normally get with Medicare, and your health insurance provider will help you manage your care the same way they would with a private HMO policy.
  • PPO Plans – For many seniors, a PPO health care plan is financially out of reach; but once they turn 65, Medicare Advantage makes a PPO network more affordable. Something like a Medicare Advantage HMO might cost less than a Medicare Advantage PPO, but you’ll have a wider selection of doctors to choose from and you’ll have more options when it comes to meeting your healthcare needs. Even if it does cost a little bit extra, it might be worth it to some people.
  • PFFS Plans – Medicare Advantage PFFS plans tend to make your healthcare more affordable and also make it easier to get care. Medicare is much more widely accepted than most private health insurance plans, so it’s usually easier for insurance companies and medical facilities to agree on payment terms.
  • Special Needs Plans – Having special healthcare needs can make getting your health care at an affordable price more difficult than it is for most. But if you have ESRD or any other condition which qualifies you for a Medicare Advantage SNP, then you’ll be a lot better off. You’ll have federal help to pay for your plan, and you’ll likely have a better network of doctors and facilities to choose from thanks to how widely accepted Medicare is.

For your convenience, Medicare.gov has an easy and efficient database you can search to see if your preferred doctor(s) and facilities are included in your plan.

Drug, Vision and Dental Coverage

Most supplements do not provide the option to add ancillary coverage options (such as dental or vision) to their policies. Likewise, few supplements allow you to incorporate prescription drug coverage into the same plan (for Medicare Advantage, they are called MAPD plans). But you can get all of these benefits and bundle them under the same Advantage policy. There is no need to hassle with dealing with multiple forms of insurance.

  • Are you worried about your eye health? Do you require regular care to keep your vision optimal? Then you should know that Medicare Advantage plans offer seniors the option to purchase vision insurance. this is an addition to the medical benefits you get on a typical Medicare Advantage policy. You may be limited to their specific network of eye care specialists, but you’ll get the convenience of managing everything under the same policy for a modest increase in your monthly premiums.
  • Medicare Advantage plans also offer this option with dental insurance. Again, your network of dentists and orthodontists on your Medicare Advantage plan may be limited and might not include the dental care providers you’re seeing right now; it’s important to check with your Medicare Advantage provider and see whether or not your preferred care providers are in their network. Additionally, not all Medicare Advantage plans in all areas will offer the option to add dental (or vision) coverage to your policy.

Enrollment Options & Best Time To Enroll

The earlier you decide to enroll in a Medicare Advantage plan, the better. Within your first six months of receiving Medicare (your Initial Enrollment Period), you will face the fewest number of obstacles with regard to getting hassle-free coverage. However, waiting to enroll can make the process more complicated. You may also face difficulty finding coverage if you are dealing with a chronic health condition like ESRD. For more information on your enrollment options, contact your local insurance agent. You can also take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

Choosing the right health insurance plan when it’s time to enroll in Medicare can be very complicated. You have to choose the right plan, you have to choose a plan that is affordable, and you have to do your research to make sure you’re purchasing a plan from a reputable company. It’s a lot of information to take in at once! Most seniors that try to do it on their own don’t succeed on their first try.

Part of the reason they don’t succeed is because they don’t have the right help. But if you’re here, then that means you have us. We have decades of experience helping people like you choose the right Medicare plan when they come of age. All we need is a little bit of basic information from you, and we can help you start comparing quotes from the best Medicare supplement providers near you in minutes. Don’t delay – your enrollment period will be over before you know it!

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