Wisconsin residents who are over the age of 65 are likely already enrolled in the federal Medicare program. The basic program, which incorporates Part A and Part B of Original Medicare, helps senior citizens meet their health care needs during their golden years. Part B covers basic preventive and maintenance care, such as doctor visits. Part A, on the other hand, covers hospital visits and other hospital-related procedures.

Coverage and Benefits

For the most part, Medicare is relatively affordable. Part B requires some monthly premiums and an annual deductible, but they are fairly low and you can estimate your potential costs here. Part A, on the other hand, might cost you if you don’t have a long enough work history. Anything under 10 years (or 40 cumulative quarters), and you will be required to pay a fee for Part A benefits.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

There are four basic components to modern-day Medicare: Medicare Parts A, B, C, and D. Parts A & B are sometimes referred to as Original Medicare. When you enroll in Medicare, you automatically start accepting Part A benefits which help you pay for hospital stays and end-of-life care, among other things. You will have to pay a premium for your Part A benefits. You will also have to pay a premium for your Part B benefits, which relate to doctor visits and other outpatient care. Unlike Part A, however, you do not have to accept Part B or pay the premium for it if all you are planning to do is use Original Medicare.

If you need health coverage beyond that Original Medicare, Part B is usually no longer optional. With Medicare Part C, which is also known as the Medicare Advantage Plan, these insurance policies start with health benefits equal to those of Original Medicare. You will not have the option to reduce your benefits below this baseline. If you do not wish to purchase the Medicare Advantage Plan, but want to accept Original Medicare and prescription drug coverage from Medicare Part D, then you will have to accept both Medicare Parts A & B. And you will have to pay their associated premiums.

Alternate Medicare Plans in Wisconsin

Wisconsin has a significant population of 65+ seniors currently receiving Medicare benefits. Of the total pool, 35% have chosen to replace their Traditional Medicare with a Medicare Advantage policy. Another subset of seniors equal to one-quarter of all Medicare beneficiaries in the state (233,396 people) are supplementing with a Medigap policy. An additional minority of 40% (379,395 recipients) might not be supplementing the coverage gaps in their Medicare benefits at all – which could prove to be costly down the road.

Remember: you have to be enrolled in Medicare if you want to purchase any sort of Medicare-related supplemental coverage. If you have not enrolled in Medicare yet, go ahead and click that link to get started.

How Come So Many People Purchase Coverage Beyond Original Medicare?

Purchasing additional medical coverage beyond Traditional Medicare is the best way to protect yourself during your golden years from unexpected health care expenses. Medicare Part A and Medicare Part B cover most of what retired individuals need, medically speaking. Unfortunately, there are still holes in Medicare coverage that could leave you with some big bills if you aren’t protected. For examples, consult this helpful table:

Medicare Part A Costs in 2022 Medicare Part B Costs in 2022
  • Part A is premium-free for most
  • Part A deductible is $1,556 per benefit period
  • Inpatient hospital stay days 61-90 is $389
  • The standard Part B premium is $170.10
  • The annual deductible for Part B is $233
  • Medicare pays 80%, you pay 20% out-of-pocket

Obtaining supplemental health coverage could save you thousands in medical bills down the road. For a truly trustworthy and comprehensive plan, review the coverage options we’ve outlined below. The information can be invaluable for helping you make important decisions regarding your health care needs.

Most “cheeseheads” know that Wisconsin isn’t always the cheapest state when it comes to healthcare costs. Unfortunately, this situation isn’t going to reverse itself anytime soon. This is especially problematic for seniors because many of them live on fixed incomes yet require a disproportionately greater amount of healthcare. This can really stress your finances as you age.

Health programs like Medicare are very good at alleviating the financial burden for retired individuals 65 and older. But it’s not always enough. There are gaps in Original Medicare coverage which, even if you purchase Part D prescription coverage, can still leave you with some hefty medical bills. Thankfully, there are supplements out there designed to help you avoid these coverage gaps so that your healthcare will remain relatively affordable for many years to come.

There are different types of supplemental coverage you can purchase to protect yourself from Medicare coverage gaps. These coverage supplements can help make extended hospital stays much less expensive. They can help alleviate some of the financial burdens associated with Original Medicare premiums and coinsurance. And they can give you peace of mind that if an expensive medical emergency arises, you will be able to handle it. Unfortunately, finding the right supplement which fits your needs at an affordable price can be a little confusing.

You have two main choices when it comes to supplemental Medicare coverage: Medicare Advantage, also known as Medicare Part C, and Medicare Supplement insurance, also known as Medigap. But don’t let the fact that there are only two choices fool you. Choosing the right one can still be a very complicated process.

Option 1: A Medicare Supplement (Or “Medigap”) Plan

These are also known as “Medigap policies” for short. MEdigap policies are specifically tailored to cover the gaps in Traditional Medicare – hence the “gap” part of “Medigap”. The federal government has endorsed 10 different Medigap plans: A, B, C, D, F, G, K, L, M, and N. Plans E, H, and I are no longer available as of 2010. They were phased out due to the Medicare Modernization Act. Every single Medigap plan offers the exact same benefits across all 50 states. But, based on your area, they will differ by cost and by insurance company. Below is a comprehensive comparison list of all 10 plans:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
There are no plans to show

Additional Coverage Options: Medicare Advantage Plans

Medicare Advantage may also sometimes be referred to as Medicare Part C. Part C essentially replaces Original Medicare with a private health insurance plan. However, due to government mandates, that private plan must offer all of the same benefits as Part C. Some plans even offer additional benefits to entice potential customers. The important thing to understand is that the federal government will no longer be responsible for your health coverage if you go with a private insurer and purchase a Medicare Advantage plan.

Some of the extra benefits in Medicare Part C might include dental or prescription drugs (or even more options than that). However, many of the networks in which Medicare Advantage operates are highly restricted. Just keep in mind that, with Medicare Advantage, you run the risk of losing your current doctors if you happen to sign up for one of these restrictive networks.

Medicare Advantage plans prefer that their members stay within their HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) network in order to receive medical care.

Comparing Medigap and Medicare Advantage Policies

Medigap insurance policies are simpler and easier to understand then most Medicare Advantage programs. Medigap policies specifically target the gaps in Original Medicare coverage so that you do not get slammed with sudden and unexpected medical expenses. All you have to do is pay one low monthly premium and you are basically guaranteed for life – as long as you pay your premiums on time every month and the company stays financially solvent, of course.

There are 10 Medicare Supplement insurance plans in total. Each plan is designated by letter. furthermore, each plan offers a different level of coverage based on the price you can afford to pay and your specific healthcare needs. Policies like Medigap plan A cover fewer benefits, such as extended hospital stays and extra blood transfusions which Medicare Part A usually won’t pay for. As you go down the list alphabetically, you’ll see plans which offer many more benefits beyond that. Best of all, these plans are standardized across all 50 states so the whether you’re in Alabama or New York City, you know what you’re getting.

Medicare Advantage, on the other hand, is a much larger and more confusing plan – but it is also more comprehensive. Many seniors don’t know that Medicare Advantage is actually a private health insurance policy sold to you by a private health insurance company. The federal government has very little to do with your medical care if you purchase Medicare Part C. The government will help pay most if not all of your monthly premium for your healthcare plan, but there’s very little involvement beyond that.

Some seniors appreciate the fact that you can pick and choose exactly what coverage you need with Medicare Advantage. This includes optional coverages such as dental, vision, and coverages which protect you from Medicare coverage gaps. And it’s easier to manage since it’s all under the same policy. But there are some downsides to Medicare Advantage as well. They try to keep costs low by operating within very restrictive HMO networks, which means you may not always have access to the doctors or facilities you want. You’ll also have to pass a qualifying exam in order to be offered coverage. There aren’t as many guarantees with Medicare Advantage because it is being handled by a private company instead of the government.

So far, the differences between Medigap and Medicare Advantage that we’ve discussed are only a snapshot of how different these two programs are. But we are experts in the subject, and we want to help seniors like you make the best possible choice. If you’re still interest, take a look at our FAQ below. And if you have any questions, don’t hesitate to call us. We will gladly clear up any misinformation and we may even be able to find you a policy with an affordable rate.

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? The federal government will pay for some if not all of your monthly premium. Any other expenses will be your responsibility. You will be responsible for paying the monthly premium for your plan.
Will I still have to pay for Part B? Yes Yes
What will it cost me? Medicare Advantage will cost you whatever portion of your monthly premium that Uncle Sam does not cover, as well as any other incidentals (co-pays, coinsurance, and deductibles) which your insurance company decides to charge you. That largely depends on how comprehensive your plan is. There is of course your monthly premium; you may also need to pay certain coinsurance or co-pay costs if you purchase a less comprehensive plan.
What will the plan cover? That’s up to you. Medicare Advantage plans start with the exact same benefits as Original Medicare. Beyond that, your insurance provider may allow you to add a wide variety of riders such as gap coverage, dental, vision, and even prescription drug coverage. Medigap policies are designed to only cover the gaps in Original Medicare coverage. You’ll have to purchase your own private policy for coverage like dental or vision. You can still enroll in Medicare Part D prescription drug coverage with a Medigap plan.
Is it easy to budget my health care expenses? The less frequently you use your insurance plan, the easier it will be to budget and predict your healthcare costs. But if your health isn’t predictable or requires a lot of care, you may struggle with budgeting your expenses. It is easier to budget with a Medigap plan, especially if it is a highly comprehensive one like Plan F or Plan G
Is my plan guaranteed? Or can it be cancelled? Private insurance companies have greater discretion when it comes to cancelling your insurance policy. There are fewer guarantees, so you will be less likely to keep being renewed for coverage if your healthcare needs start becoming prohibitively expensive. Your Medigap insurance has the same guarantees on it that Original Medicare does. The only way you can lose your coverage is if your insurance provider goes belly-up or if you stop paying your premiums.
Do I have to clear a pre-approval or pre-certification process? Like many private plans, you will almost always have to go through some sort of pre-certification approval process. And there’s no guarantee you will pass. If you are approved for Medicare, you will be automatically approved for a Medigap supplement. It’s that easy.
Am I limited to specific doctors or hospitals? Yes. You will be limited to a highly restrictive HMO network. This keeps costs low, although it doesn’t always give you access to the doctors and hospitals you need. All doctors and hospitals which accept Original Medicare will also accept Medicare Supplement insurance. So, you won’t have anything to worry about.
What type of plan is best for me? If you want all of your healthcare coverage to be under one plan, if you live in a large metropolitan area where your healthcare options are abundant, and if you are on the younger side of the spectrum with relatively good health, there are many benefits to Medicare Advantage. If you are older, if you are not in great health, if your healthcare options are limited in your area, if you need a policy which makes it easier to budget your medical expenses, or if you don’t need all of the extra coverage you can get with Medicare Advantage, there are many advantages to purchasing a Medicare Supplement plan.

Helpful Medicare Resources

If you still have questions, we’ve included a phone number directory below. It has some invaluable contact information for resources on Medicare and Medicare supplemental policies. To resolve unanswered questions, you can contact your State Health Insurance & Assistance Program, your local Social Security Office, and more.

Useful Contacts

Choose at least one topic area you are interested in: Select All

Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area

Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.
by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.