Medicare

Medicare in Wisconsin

In Wisconsin, Medicare is compromised of four parts: A, B, C, and D, and you have two plan options:

  • Part A & Part B (With a supplement plan) & Part D
  • Part C/Part D Bundle

Option One: Part A & Part B (With a supplement plan) & Part D

Part A & B – Traditional Medicare

Seniors qualify for traditional Medicare starting at age 65 (you may qualify earlier if you qualify for disability), and covers the following:

Part A

  • Hospital stays
  • Home health care
  • Skilled nursing facilities
  • Hospice

Part B

  • Visits to the doctor’s office
  • Lab work/diagnostic/radiation
  • Outpatient procedures
  • Durable medical equipment

Benefits include:

  • Freedom to chose your own hospitals and doctors
  • No referrals required to see a specialist
  • Coverage in all 50 states
  • No claims paperwork

You are able to enroll in Medicare Part A and Part B during your Initial Enrollment period (which extends from three months before your 65th birthday until three months after your 65th birthday for a total of seven months). However, if you continue to work past this timeframe and have group insurance, you don’t qualify for Medicare. Upon retiring or working only full-time can you then enroll in a Medicare plan.

Supplements for Part A & Part B (Medigap)

Also referred to as Medigap, these plans help pay for your share of co-pays and deductibles in Traditional Medicare. Why the need for supplements? While Part A is free, there is a deductible every 60 days. And Part B only covers 80%, so a supplement plan would help you cover the existing 20% of your medical bills.

Note: You must have Part A and Part B prior to enrolling in a Medigap policy, and are offered through private insurance providers.
Contact Mang for information about specific plans.

Part D – Prescription Drug Coverage

Each Part D plan, like supplements, are available through independent insurance companies. With that being said, each plan has its own list of drugs that it will cover so you will want to ensure you are on the plan that best fits your medical needs upon enrolling in a Part D plan.

Your first opportunity to enroll in Part D in Wisconsin is during your Initial Enrollment period (three months before your 65th birthday, the month of your 65th birthday, and the three months following your 65th birthday). The next opportunity to enroll or change plans is during the Annual Election Period (AEP), which runs every year from October 15 to December 7.

Not on any prescription drugs?

While enrollment in Medicare Part D is voluntary, you may be assessed a late enrollment penalty if you do not have creditable prescription drug plan. In order to bypass that penalty, you can enroll in WI SeniorCare or a Part D plan.

Option Two: Part C/Part D Bundle

Part C – Medicare Advantage Plan

Medicare Advantage offers all of the same treatment as Traditional Medicare, but there may be additional benefits you could take advantage of by enrolling in a Medicare Advantage Plan.

Benefits & Coverage Include:

  • Health & wellness programs
  • Vision
  • Hearing
  • Dental
  • Transportation to medical appointments
  • Low monthly premiums
  • Prescription drug coverage*

*Most Medicare Advantage Plans include drug coverage, but varies according to insurance company. Contact Mang for specific information.

Medicare Plan Options in Wisconsin

Wondering if you should go with Medicare Advantage or Medicare Supplement? Here is a comparison chart:

Medicare AdvantageMedicare Supplement
Monthly premiumsAs low as $0Usually has a monthly premium
Can make changesTwo open enrollment periods per yearOne period per lifetime (unless there are special circumstances)
Part B premiumMust payMust pay
Part B deductibleMay not have a deductibleMay pay unless you got Plan C before 1/1/2020
Prescription drugsGenerally coversDoes not cover
Network restrictionYesNo
Dental, vision, hearingMay coverDoes not cover
Copays and coinsuranceUsually have to payMay cover all
Standardized benefitsNoYes

We are not affiliated with or endorsed by the U.S Government or the Federal Medicare Program. This is an advertisement for insurance. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact  Medicare.gov or 1-800-MEDICARE to get information on all your options.

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