Medicare Advantage Plans Wisconsin 2027

Nationwide, big insurers are removing plans from certain counties for 2027. If you live in Wisconsin, go through your Annual Notice of Change closely, and if a non-renewal letter arrived, pick a new plan before December 31, 2026.

Source: company announcements and CMS 2027 landscape data reported by Becker’s on October 1, 2026. For 2027, Wellmark, Blue Cross Blue Shield of North Dakota and Blue Cross Blue Shield of Mississippi are exiting Medicare Advantage as well.

Rather than Plans A through N, Wisconsin mandates a Basic plan covering the core gaps in Original Medicare and allows insurers to offer optional riders, such as coverage for the Part A deductible, extra home health care, the Part B deductible or Part B excess charges. Cost-sharing and high-deductible versions are also permitted in Wisconsin.

Wisconsin residents 65 and older can get help with prescription drugs through SeniorCare, the state’s program, with costs tied to income. Because it counts as creditable coverage, you can generally use SeniorCare in place of Part D and avoid a late enrollment penalty if you switch later. Weigh SeniorCare against Part D plans for your drugs.

Medicare Advantage, sometimes called Part C, lets you receive your Medicare benefits through a Medicare-approved private insurer. These plans cover everything Original Medicare Part A and Part B cover, with the exception of hospice care, which Original Medicare continues to pay for. Most also bundle Part D drug coverage, and many may tack on extras like routine dental, vision and hearing benefits.

The trade-off is that Medicare Advantage plans generally rely on doctor and hospital networks and may call for referrals or prior authorization for certain services. Each Medicare Advantage plan sets a yearly out-of-pocket maximum for covered medical care, something Original Medicare lacks. You still pay your Part B premium, along with the plan’s premium if there is one.

For those who prefer Original Medicare, a Wisconsin Medigap policy covers some or all of the costs Medicare does not pay and lets you use any provider in the U.S. that accepts Medicare. Because Wisconsin sets its own standardized plans, compare policies based on the Basic plan and which riders come with it.

If you keep Original Medicare in Wisconsin, add a standalone Part D plan. Compare plans with your exact drugs and pharmacies using the 2027 Part D plan finder.

In Wisconsin, federal guaranteed issue rights apply as well, generally within 63 days after other coverage ends:

Which method applies depends on the insurer and the state. Before buying, find out how a policy is priced, not only what it costs now.

Usually you won’t ever file a Medigap claim. Your doctor sends the bill to Medicare, Medicare pays its portion, and the claim passes automatically to your Medigap insurer, which then pays its portion. A Medicare Summary Notice and an explanation of benefits show you what each one paid.

Once you buy Medigap, its benefits never change, but its premiums can. Insurers submit rate increases to state regulators, frequently once a year. Since the same plan letter has the same benefits everywhere, moving to a cheaper insurer can cut costs while your coverage stays the same.

The drawback is underwriting. Outside your Medigap Open Enrollment Period or a guaranteed issue situation, most states allow the new insurer to ask health questions and turn you down. Do not cancel your current policy until the new one has been approved and is in force.

Riders are important because the Basic plan in Wisconsin leaves certain gaps. With the Part A deductible rider, you are shielded from a big bill in each hospital benefit period, and the excess charge rider counts if your doctors do not accept Medicare assignment. Get prices for the Basic plan both with and without each rider; at times a rider costs very little compared with the risk it takes away.

A non-renewal notice should have reached you in early October if your plan won’t be available in your county for 2027. Coverage doesn’t end immediately; it runs through December 31, 2026, which gives you time to decide.

Special Needs Plans (SNPs) are Medicare Advantage plans designed for particular groups. Their benefits, networks and drug lists are shaped around the members they serve, and many come with care coordinators. In 2027, SNPs are one of the few places large insurers are adding plans, even while cutting PPOs.

When you turn 65 in 2027, you get a seven-month Initial Enrollment Period: the three months before your birthday month, the birthday month itself and the three months that follow. If you sign up in the first three months, coverage begins on the first day of your birthday month.

When your income and savings are limited, two programs can greatly lower your Medicare costs:

If you qualify for both Medicare and full Medicaid, you may also be able to join a Dual Special Needs Plan. See help for low-income Part D beneficiaries.

Free, unbiased Medicare counseling is available from Wisconsin’s State Health Insurance Assistance Program, the Wisconsin State Health Insurance Assistance Program (SHIP). You can also call 1-800-MEDICARE at any time or compare plans with a licensed agent for free.

Gather your Medicare card, a list of your drugs and doses, your doctors and your preferred pharmacies before you call. That way a long conversation becomes a quick one.

The Annual Notice of Change must reach members by September 30. It is the most useful single document you receive each fall, since it spells out exactly how your plan will change on January 1.

Outside of the fall and early-year windows, changing plans generally requires a Special Enrollment Period. Typical reasons include:

Every Special Enrollment Period has a separate time limit, so move as soon as the event occurs.

Prior authorization is required by most Medicare Advantage plans for certain services, including some surgeries, advanced imaging, skilled nursing stays and some drugs. While your doctor usually submits the request, ask whether a scheduled service needs approval so you are not caught off guard by a denial.

You or your doctor can appeal a denied request. Medicare rules give plans deadlines for decisions, and those deadlines are shorter when a wait could seriously harm your health.

Emergency and urgent care are covered by every Medicare Advantage plan anywhere in the U.S., whether in or out of network, and an emergency does not require prior approval. Routine care while traveling is different: HMOs generally do not cover it, and PPOs cover out-of-network care at a higher cost.

If you’re away from home for months each year, ask every plan how it covers care where you stay. This is among the most frequent reasons people change plans partway through the year.

You have the right to appeal if your plan denies a service, a drug or payment for care. The denial notice from the plan explains the process. Appeals have several levels, beginning with the plan and moving on to independent reviewers.

If your issue isn’t about coverage, such as wait times or customer service, you can file a grievance with your plan. For help, you can also reach out to 1-800-MEDICARE or your State Health Insurance Assistance Program.

Of the major figures, only the Part B premium is not published alongside the plans. CMS typically announces it in November. Projections in the 2026 Medicare Trustees Report put the 2027 standard premium at about $209.50 a month and the deductible at about $292, up from $202.90 and $283 in 2026. You continue paying it even with Medicare Advantage.

Miss the Annual Enrollment deadline and your current plan automatically renews for 2027, including the changes listed in your Annual Notice of Change. Medicare Advantage members get one more opportunity, from January 1 to March 31, 2027, to change Medicare Advantage plans or go back to Original Medicare and join a Part D plan.

Many Medicare Advantage plans may cover telehealth for some services, at times with a lower copay than an in-person office visit. It is handy for follow-ups and minor problems, but you still need to confirm that your regular doctors are in network.

Each fall, Medicare gives every Medicare Advantage and Part D plan a rating of 1 to 5 stars, based on factors such as preventive care, how well chronic conditions are managed, member complaints, customer service and accuracy of drug pricing. You can see the ratings in Medicare Plan Finder.

A drug you take may not be on a plan’s 2027 formulary, or it may come with a rule such as prior authorization. Even then, you have options:

See steps to appeal a Medicare Part D denial.

You get a six-month Medigap Open Enrollment Period beginning in the first month you are both 65 or older and enrolled in Part B. It occurs only once and can’t be restarted. During this period, insurers have to sell you any Medigap plan they offer in your state at the same price healthy people pay.

If you work past 65, keep employer coverage and postpone Part B, your Medigap Open Enrollment Period does not begin until you sign up for Part B. Signing up for Part B early when you do not need it starts the clock and can waste this protection.

With coverage through a current employer, you may not need Medigap yet, and postponing Part B can save your Medigap Open Enrollment Period for later. Retiree coverage works differently: it can act like a supplement, so weigh it against Medigap before you give it up, since you may not be able to regain retiree coverage.

You generally have a guaranteed issue right to buy certain Medigap plans when employer or union coverage that pays after Medicare comes to an end.

When you purchase Medigap during your open enrollment period or under a guaranteed issue right, you generally cannot be turned down or charged extra because of health conditions. Even so, if you lacked creditable coverage beforehand, the insurer may apply a waiting period of up to six months before it pays for a pre-existing condition. Having had creditable coverage shortens or eliminates that wait.

When you swap one Medigap policy for another, you generally have 30 days to decide if you want to keep the new one. During that period, pay both premiums, and hold off on canceling the old policy until you’re confident in the new one.

When a quote has an introductory discount, find out what the premium will be once it expires.

Aspirus Health Plan is leaving Medicare Advantage in its 21 Wisconsin counties for 2027. Members can choose another plan, such as Network Health, UnitedHealthcare or Humana where offered, or move to Original Medicare with a Wisconsin Medigap Basic plan and riders.