Best Medicare Advantage Plans Wisconsin 2025

Navigating the world of Medicare Advantage plans can be overwhelming, especially when searching for the best option to fit your unique needs.

If you reside in Wisconsin, this comprehensive guide will help you understand Medicare Advantage plans for 2025 in the state, compare top insurers, and make an informed decision based on your healthcare requirements and budget.

In this article, we will focus on Medicare Advantage plans, ensuring you have all the information you need to make the best choice for your healthcare needs in Wisconsin, specifically discussing  Medicare Advantage plans in Wisconsin.

Key Takeaways

• Navigate Medicare Advantage Plans in Wisconsin to find the best coverage and benefits for your needs and budget.

• Compare top providers, such as Network Health, Anthem, Humana & UnitedHealthcare to evaluate plan options.

• Leverage local resources like CSA® program & SHIP for guidance on enrollment & selection of plans with telehealth/digital health services covered at no extra cost.

Navigating Medicare Advantage Plans in Wisconsin

Choosing the appropriate Medicare Advantage plan in Wisconsin requires a comprehensive understanding of your coverage options, enrollment periods, and eligibility requirements. Carefully evaluating these factors will help you choose the plan that best fits your healthcare needs and budget.

So, what exactly are Medicare Advantage plans? They are comprehensive plans that encompass the benefits of Parts A and B, as well as additional features, such as:

• Prescription drug coverage

• Dental care

• Vision care

• Hearing care

• Fitness programs

• Wellness programs

These additional features can provide you with more comprehensive coverage and potentially save you money on out-of-pocket expenses.

There are many top-rated Medicare Advantage plans available in Wisconsin, including Network Health Medicare Advantage, which earned a 5-star rating from the Centers for Medicare & Medicaid Services. However, selecting the best Medicare Advantage plans for you requires a comparison of the costs, physician network, prescription drug coverage, dental coverage, and additional benefits each plan offers.

Understanding Your Coverage Options

Wisconsin offers four Medicare Advantage plans, including a Medicare Advantage PPO plan:

• Health Maintenance Organization (HMO)

• Preferred Provider Organization (PPO)

• Private Fee-for-Service (PFFS)

• Special Needs Plans (SNP)

These Medicare plans provide a variety of coverage options for seniors in the state. They offer a combination of Original Medicare coverage (Parts A and B) and additional benefits such as prescription drug coverage (Part D), dental, vision, and hearing benefits.

Most plans feature a $0 monthly premium and a maximum out-of-pocket cost, along with allowances for utilities, groceries, and over-the-counter health items.

The key distinctions between HMO, PPO, PFFS, and SNP Medicare Advantage plans in Wisconsin lie in their network restrictions and referral requirements. HMO plans require members to select a primary care physician and obtain referrals to consult specialists, while PPO plans allow members to visit any doctor or specialist without a referral, but at a lower cost if they utilize providers within the plan’s network.

PFFS plans allow members to visit any doctor or specialist who accepts the plan’s payment terms and conditions, while SNP plans are designed for individuals with specific health conditions or who are eligible for both Medicare and Medicaid.

Enrollment Periods and Eligibility

Eligibility for Medicare Advantage plans in Wisconsin is open to individuals aged 65 or older, as well as those with a qualifying disability. The Initial Enrollment Period for Medicare Advantage plans begins three months before your 65th birthday and concludes three months after it.

There are three distinct enrollment periods for Medicare Advantage Plans in Wisconsin, allowing ample opportunity for individuals to enroll, change, or discontinue their coverage.

Costs associated with Medicare Advantage plans in Wisconsin include:

• Premiums

• Deductibles

• Co-pays

• Coinsurance

It’s worth noting that all individuals eligible for Medicare in Wisconsin can obtain a Medicare Advantage plan with no premium.

Individuals can contact Medicare.gov, 1-800-MEDICARE, or their local State Health Insurance Program (SHIP) to obtain information on all available Medicare Advantage plan options. SHIP provides objective information and free counseling to those with Medicare-related questions.

Prescription Drug Coverage Insights

Most Medicare Advantage plans in Wisconsin typically include prescription drug coverage (Part D). Part D coverage is a common benefit included with most insurance plans. It usually includes copays as low as $0 for prescriptions, no copay or deductible for most vaccines, and additional advantages.

The types of prescription drugs covered under Medicare Advantage Plans in Wisconsin typically include health maintenance organization (HMO) plans and preferred provider organization (PPO) plans.

Certain plans may provide routine coverage for dental, vision, and hearing needs. This additional coverage can be essential for maintaining overall health and well-being. By exploring the available prescription drug coverage options and considering your specific healthcare requirements, you can ensure that your chosen Medicare Advantage plan provides the necessary support for your health journey.

Assessing Health Plan Providers in Wisconsin

To aid in your selection of the most suitable Medicare Advantage plan, it’s important to evaluate Wisconsin’s leading health plan providers. Some of the top providers in the state include:

• Blue Cross Blue Shield

• Humana

• Aetna

• UnitedHealthcare

• Cigna

• Anthem

By comparing their offerings and understanding the differences in coverage, you can make an informed decision that best suits your healthcare needs and budget.

Spotlight on Network Health Medicare Advantage

Network Health Medicare Advantage Plans are a top choice for many Wisconsin residents, thanks to their 5-star rating from the Centers for Medicare & Medicaid Services. These plans offer:

• Comprehensive coverage

• Access to a wide network of doctors and hospitals

• Prescription drug coverage

• Additional benefits such as dental, vision, and fitness programs.

The coverage options available through Quartz Medicare Advantage plans, also known as Network Health Medicare Advantage plans, include:

• Fitness programs

• Dental and vision coverage

• Over-the-counter items

• Acupuncture

• Massage

Additionally, they provide medical and pharmacy coverage with a $0 monthly premium and low copayments. Some plans also offer a monthly Part B premium giveback and an annual maximum out-of-pocket limit.

Comparing Plan Options from Top Insurers

In addition to Network Health, other top insurers in Wisconsin include Anthem, HealthPartners, and UnitedHealthcare.

Anthem offers a variety of Medicare Advantage plans in the state, with different coverage levels and premiums to suit various budgets and healthcare needs.

HealthPartners Robin, another leading insurer, offers three Medicare Advantage plans in Wisconsin: Birch, Maple, and Glory. Bellin Health, ThedaCare, Holy Family Memorial, Aurora Health Care, Froedtert & the Medical College of Wisconsin, and UW Health are some of their provider network inclusions.

Many more care locations are also part of their network.

UnitedHealthcare also provides four distinct Medicare Advantage plans in Wisconsin, tailored to meet different healthcare requirements and financial constraints.

By comparing plan options from these top insurers, you can determine which plan best aligns with your needs, preferences, and budget.