Find 2019 Medicare Plans in Wisconsin - WI Medicare Insurance Overview

Medicare Insurance in Wisconsin

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Wisconsin Medicare Insurance

Wisconsin Medical Insurance Stats

Medicare in Wisconsin

Medicare offers healthcare coverage to Wisconsin residents age 65 or older, or to those Wisconsin residents that suffer from certain medical disabilities. In 2016, 1,013,000 people are enrolled in Medicare in Wisconsin, accounting for 17.8% of the population in Wisconsin. In 2009 approximately $8,908 was spent per Medicare enrollee in Wisconsin, about 14.06% lower than the national average of $10,365. Between 2015 to 2030 the senior population in Wisconsin is expected to increase by an estimated 48.82% according to calculations based off of the 2000 Census. Therefore the number of eligible Medicare beneficiaries in the state is also predicted to grow.

Local Medicare Resources

Medicare beneficiaries, their families, and their caregivers in the state can receive free, one-on-one, and unbiased health insurance counseling through Wisconsin’s State Health Insurance Assistance Program (SHIP). Components of SHIP include a Prescription Drug Helpline as well as a Medigap Helpline which provides counseling on many more topics than just Medicare Supplemental Insurance (Medigap). Another program called Senior Medicare Patrol (SMP) aims to help educate and empower consumers on how to identify, avoid, and report possible cases of healthcare errors, fraud, waste, and/or abuse.

Types of Medicare Coverage

Individuals that qualify for Medicare can sign up for Medicare Part A (hospital services) and Part B (medical services) through the Federal government. Part A is generally paid for by paycheck deductions from their working years (or their spouse's) but most Medicare beneficiaries pay for Part B through monthly premiums unless they qualify for financial assistance. If you are eligible for Original Medicare (Parts A & B) or if you are already enrolled in it, you also have the option to enroll in a Medicare Advantage plan (Part C) instead of Original Medicare or add a standalone prescription drug plan (Part D) to your current Original Medicare coverage. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Many Medicare beneficiaries will elect to enroll in a Medicare Advantage plan that includes prescription drug coverage (MAPD) or purchase a standalone prescription drug plan to go with their Original Medicare coverage. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Additional benefits of Medicare Advantage plans such as dental, vision, or hearing coverage can help reduce out-of-pocket expenses for seniors with certain medical needs.

Wisconsin 2017 Medicare Advantage Plans at a glance

Using CMS data HealthPocket found that:

  • The average total monthly premium for a 2017 Medicare Advantage plan in Wisconsin is $82.78, 32.49% greater than the national average of $62.48. 22.52% of 2017 Medicare Part C insurance plans in Wisconsin have a $0 monthly premium.
  • The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $400, but in Wisconsin the average annual drug deductible for Medicare Part C insurance plans with drug components is $231.65. 24.21% of 2017 Medicare Part C insurance plans with a drug component in Wisconsin have a $0 annual drug deductible.
  • The average total monthly premium for a 2017 Medicare Advantage plan without a drug component in Wisconsin is $61.84. 41.11% of 2017 Medicare Part C insurance plans without a drug component in Wisconsin have a $0 monthly premium.
  • The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in Wisconsin is $4,618.42. 29.82% of 2017 Medicare Advantage plans in Wisconsin had a medical out-of-pocket limit of $3,400 or less.

To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).

  • The average overall CMS star rating assigned to Medicare Part C insurance plans in Wisconsin was 4.2 stars in 2017.
  • Among Wisconsin's 2017 Medicare Advantage plans with CMS star ratings:
    • 7.43% earned a score of 5 stars
    • 59.83% earned a score of 4 or 4.5 stars
    • 17.22% earned a score of 3 or 3.5 stars
    • 15.52% of plans are “Not enough data available” or “Too new to be measured”.

Sources:

Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation

There are 24 Medicare insurance providers that offer affordable and comprehensive Medicare insurance in Wisconsin. Of these, the companies that offer the largest variety of plans to choose from are Humana, Senior Preferred, and Network Health. In Wisconsin,Medica has the largest selection of Medicare Advantage plans while Humana offers the most Medicare Part D plans. The following are all medicare insurance providers in Wisconsin:

Humana

16 Plans

Senior Preferred

11 Plans

Dean Advantage, Prevea360 Medicare Advantage

9 Plans

Medica

6 Plans

Aetna

4 Plans

WellCare

3 Plans

BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY

3 Plans

Ucare

2 Plans

UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY

2 Plans

OMAHA HEALTH INSURANCE COMPANY

2 Plans

Assurance Rx (HMO-POS)
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UnitedHealthcare MedicareComplete Open Essential (PPO)
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UW Health Senior Preferred Value (no Rx) (HMO)
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ProHealth Senior Preferred Elite (no Rx) (HMO)
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HealthPartners Robin Birch (PPO)
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Surety Rx (HMO-POS)
TYPE:HMO-POSCOST:from $0
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ProHealth Senior Preferred Value (w/Rx) (HMO)
TYPE:HMOCOST:from $0
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Esteem Rx (HMO-POS)
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Dean Advantage Essential (HMO)
TYPE:HMOCOST:from $0
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Prevea360 Medicare Advantage Essential (HMO)
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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)