Medicare Plans in Wisconsin – Coverage and Benefits
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.
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)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
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||Medicare Part B Costs|
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.
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.
Top HMO Plans in the Area
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating||There are no plans to show|
Top PPO Plans in the Area
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating||There are no plans to show|
Comparing Medigap and Medicare Advantage Policies
Take a look at this informational chart for a more thorough explanation on the differences between Medigap and Medicare Advantage:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer 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.
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.