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Medicare in Wisconsin


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Are you a Medicare beneficiary in Wisconsin, or planning ahead? Learn more about Medicare coverage in Wisconsin.

1.1 million Wisconsin residents received Medicare coverage as of January 2018, according to the Centers for Medicare & Medicaid Services (CMS). As a Wisconsin resident and Medicare beneficiary, you may have several choices for your Medicare coverage, as described below.

Original Medicare in Wisconsin

Original Medicare is the government health insurance program for those who meet eligibility requirements. In Wisconsin, as in all states, Original Medicare includes Part A and Part B.

  • Part A may cover inpatient hospital, skilled nursing facility, and hospice care, as well as home health visits in limited situations (usually short-term).
  • Part B may cover many medical services such as physician visits, outpatient diagnostic tests, and preventive medical care, such as some cancer screens and annual check-ups with your doctor.

You typically pay deductibles and coinsurance for covered Medicare Part A and Part B services. Most people pay a Medicare Part B premium

Medigap (Medicare Supplement) insurance plans are also offered by private insurance companies and can help you pay some of your out-of-pocket costs for services covered under Original Medicare. Read more about Medicare Supplement insurance plans.

Medicare Part D Prescription Drug Plan (PDP) can help cover your prescription drug costs. Designed to work alongside Original Medicare coverage, stand-alone Medicare Part D Prescription Drug Plans are available from private insurance companies approved by Medicare and doing business in Wisconsin. According to the Centers for Medicare & Medicaid Services (CMS), 25 Prescription Drug Plans are available in Wisconsin in 2018. You can enroll in a Medicare Prescription Drug Plan if you have Medicare Part A or Part B and you live in the plan’s service area.

As an alternative to getting Original Medicare coverage directly from the government, you may want to consider Medicare Advantage (Medicare Part C). Medicare Advantage plans are offered by private insurance companies that contract with CMS to provide all Original Medicare Part A and Part B benefits except hospice care, which is covered by Medicare Part A. Many Medicare Advantage plans also include extra benefits for services such as routine dental and vision care.

Most Medicare Advantage plans also include prescription drug coverage; these are called Medicare Advantage Prescription Drug plans. They deliver all your Medicare medical and prescription drug benefits through a single plan. Medicare Advantage plans are required to limit your out-of-pocket spending for services covered under Medicare Part A and Part B to a certain maximum amount; after you spend up to that amount, the plan pays for the rest of your Medicare-covered services for the rest of that year.

To sign up for a Medicare Advantage plan, you must be enrolled in Medicare Part A and Part B, continue to pay your Part B premium and your Medicare Advantage premium (if any), and live in the Medicare Advantage plan’s service area. CMS reports that 100% of people in Wisconsin have access to at least one of the 86 Medicare Advantage plans available in the state in 2018.

Please note that if you have end-stage renal disease (ESRD, which is kidney failure requiring regular dialysis or a kidney transplant), you might not be eligible for a Medicare Advantage plan. Ask the plans you’re considering to see if you still qualify.

To review the various plans available to you, you’re welcome to visit the plan-finder tool on this page, and enter your home zip code.

Medicare resources in Wisconsin

Some agencies in Wisconsin offer information and counseling to seniors regarding Medicare coverage and other issues relevant to senior health and lifestyle.

  • Wisconsin’s Board on Aging and Long-term Care
  • Wisconsin Department of Health
  • Aging and Disability Resource Centers

Medicare statistical trends in Wisconsin

Listed below are some facts from the Center for Medicare & Medicaid Services (CMS) about Medicare coverage in Wisconsin in 2018 that may be of interest as you consider your Medicare coverage options.

  • The number of people living in Wisconsin who have Medicare coverage continues to grow. As of January 2018, 1,125,958 people were enrolled in Medicare, up from around 965,000 people in 2012.
  • As of January 2018, 468,792 people received their Medicare coverage from a Medicare Advantage or other Medicare plan. In other words, about 42% of Medicare beneficiaries were enrolled in Medicare Advantage and other Medicare plans while about 58% were enrolled in Original Medicare.
  • Medicare Part D prescription drug coverage gains membership annually. 815,573 individuals were enrolled in a stand-alone Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug plan as of January 2018 compared to the 584,469 in 2012.

CMS reports that for Wisconsin Medicare beneficiaries who have Medicare Part D prescription drug coverage in 2018

  • 23% of people with Medicare Part D are eligible to receive Extra Help (also called the low-income subsidy, or LIS) to help them with their prescription drug costs and premiums.
  • 70% of people with Medicare Part D coverage have access to a plan with a lower premium than what they paid in 2017. The lowest monthly premium for a Prescription Drug Plan is estimated to be $19.70

Statistical data from the Centers for Medicare & Medicaid Services, “2018 MA Part D Landscape State-by-State Fact Sheet,“ and “Medicare Enrollment Dashboard,“

Data in this article was checked when the article was written and might not be updated as newer data becomes available.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

The product and service descriptions, if any, provided on these eHealthInsurance.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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