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.
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:
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.
Wisconsin offers four Medicare Advantage plans, including a Medicare Advantage PPO plan:
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.
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:
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.
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.
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:
By comparing their offerings and understanding the differences in coverage, you can make an informed decision that best suits your healthcare needs and budget.
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:
The coverage options available through Quartz Medicare Advantage plans, also known as Network Health Medicare Advantage plans, include:
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.
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.
To fully benefit from your chosen Medicare Advantage plan, it’s important to familiarize yourself with the additional benefits and coverage options available. These may include:
By exploring these extra benefits and utilizing them effectively, you can enhance your overall healthcare experience and maximize the value of your Medicare Advantage plan.
Many Medicare Advantage plans in Wisconsin offer coverage options for dental, vision, and hearing aids. This may include routine dental exams, routine vision exams with glasses coverage, and hearing exams with hearing aid coverage. It is crucial to compare different plans to determine which one is most suitable for your needs and offers the necessary coverage for your dental, vision, and hearing requirements.
However, it’s essential to be aware of any limitations and exclusions on dental, vision, and hearing aids coverage in Wisconsin Medicare Advantage plans. These can include restrictions on the annual dollar limit of coverage, frequency of covered services, and specific exclusions for certain services.
By reviewing the details of each plan, you can gain a better understanding of the limitations and exclusions for dental, vision, and hearing aids coverage, ensuring you select the most appropriate plan for your needs.
Certain Medicare Advantage plans in Wisconsin may include additional benefits that many beneficiaries may not be aware of, such as routine vision exams with allowance for glasses, routine dental exams, and hearing exams. These extra perks can significantly enhance your overall healthcare experience and provide added support for maintaining your well-being.
In addition to these benefits, some Wisconsin Medicare Advantage plans also offer fitness memberships and transportation services for medical appointments. These extra perks can make a significant difference in your overall healthcare experience, so be sure to explore all available benefits when selecting a Medicare Advantage plan in Wisconsin.
When selecting a Medicare Advantage plan in Wisconsin, it’s important to consider the financial aspects, which include the average costs of the plans, the cost calculation method, and factors that can influence the costs.
By understanding these financial considerations, you can make a well-informed decision that best fits your budget and healthcare requirements.
The cost of Medicare Advantage plans in Wisconsin is determined by a variety of factors, including the insurer, the level of coverage, and the geographic location. According to estimates, the average monthly premium for Medicare Advantage plans in 2024 is approximately $18.50.
However, this cost may vary depending on the specific plan and insurer. Some plans may have a $0 premium, while others may have higher premiums, depending on the level of coverage provided.
There are several factors that can affect the cost of Medicare Advantage plans, including:
By evaluating these factors and estimating your costs with Medicare Advantage, you can make an informed decision that aligns with your financial constraints and healthcare needs.
Some of the Medicare Advantage plans available at a low cost in Wisconsin are:
To compare the costs of various Medicare Advantage plans in Wisconsin, it is recommended to visit websites like NerdWallet, MedicarePlans.com, and eHealthInsurance.com. These websites provide comprehensive information on different Medicare Advantage companies in Wisconsin and enable users to compare plan options and costs.
Healthcare usage can also have an impact on the cost of Medicare Advantage plans in Wisconsin. When beneficiaries make more frequent use of healthcare services, it can increase the overall cost of providing coverage, resulting in higher premiums or out-of-pocket costs for Medicare Advantage plans.
Conversely, if healthcare usage is lower, it may lead to lower costs and potentially lower premiums for these plans in Wisconsin. By exploring low-cost plan options and considering your healthcare needs, you can find the best plan for your budget.
Having access to resources and support can be invaluable for Medicare beneficiaries in Wisconsin. By leveraging local and online Medicare resources, you can gain a comprehensive understanding of your options and make well-informed decisions regarding your healthcare coverage.
Local resources, such as the Certified Senior Advisor (CSA)® program, can provide invaluable support for Medicare beneficiaries in Wisconsin. CSAs are trained to help seniors understand their Medicare options, including Medicare Advantage plans, and offer advice to enable them to make informed decisions based on their individual needs and preferences.
They can offer guidance on plan selection, enrollment, and ongoing support to ensure that seniors receive the most appropriate coverage for their healthcare needs.
In addition to the CSA program, the State Health Insurance Assistance Program (SHIP) in Wisconsin offers support for Medicare beneficiaries. They provide free and unbiased assistance with Medicare, helping you navigate the complexities of the system and make informed decisions about your healthcare coverage.
For more information, please visit the Wisconsin Department of Health Services website.
There are several online tools and services available to help you find and compare Medicare Advantage plans in Wisconsin. Websites such as Medicare.gov’s Plan Comparison Tool, NerdWallet, and eHealthInsurance.com allow you to evaluate different plans based on factors like cost, benefits, prescription coverage, and doctors.
By using these online tools, you can gather essential information to make a well-informed decision about your healthcare coverage.
Additionally, Wisconsin-based online tools, such as Insurify’s Comparison Tool, enable you to compare Medicare Advantage plans within the state. By leveraging these online resources, you can gain a comprehensive understanding of your options and make an informed decision about the best Medicare Advantage plan for your needs and budget.
The features and accessibility of Wisconsin’s Medicare Advantage plans significantly influence your overall healthcare experience. By understanding the nuances of telehealth services and provider network flexibility, you can ensure that your chosen plan offers the necessary support for your healthcare journey.
Telehealth and digital health services are increasingly important in modern healthcare, allowing patients to access medical services remotely via video and audio communication. These services are covered under Medicare Advantage plans in Wisconsin and can be utilized for:
During the COVID-19 pandemic, temporary changes and flexibilities were implemented to encourage the use of telehealth services among Medicare beneficiaries in Wisconsin. These changes included waiving member cost-sharing for telehealth visits and covering medically necessary telehealth services the same as in-person visits.
As a result, Wisconsin Medicare Advantage members can access telehealth services at no extra cost, ensuring they receive essential healthcare services in a safe and convenient manner.
Provider network flexibility is a key factor in the accessibility of Medicare Advantage plans in Wisconsin. HMO plans typically have more limited networks and require referrals for specialists, while PPO plans provide greater flexibility in selecting providers, enabling you to visit any doctor or specialist without a referral, both in-network and out-of-network.
Plans with more expansive networks of providers may have higher costs than plans with more limited networks. This is due to the fact that plans with broader networks can provide access to a greater variety of doctors, specialists, and hospitals.
On the other hand, plans with more restricted networks may be able to negotiate lower rates with their contracted providers, resulting in lower costs.
Therefore, it is essential to consider the pros and cons of network flexibility and cost when selecting a Medicare Advantage Plan in Wisconsin.
Finding the best Medicare Advantage plan in Wisconsin requires thorough research and a solid understanding of your healthcare needs and financial constraints. By exploring coverage options, assessing health plan providers, maximizing benefits, considering financial aspects, and leveraging available resources, you can make an informed decision that ensures you receive the most suitable coverage for your unique healthcare journey.
The average cost of a Medicare Advantage plan in Wisconsin is $26.15 per month in 2024, with 129 plans available.
Medicare Advantage plans can be expensive, often lack comprehensive coverage, and provide limited provider networks, making them unsuitable for all individuals.
When selecting a Medicare Advantage plan in Wisconsin, it is important to consider costs, network coverage, prescription drug coverage, dental coverage, and additional benefits.
To find the top-rated Medicare Advantage plans in Wisconsin, use our plan finder tool on this website by entering your zip code above. Or you can call us today at 1-833-641-4938.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.