Medicare in Wisconsin
Key Takeaways
- Who’s eligible for Medicare in Wisconsin? All legal U.S. residents who are 65 or older.
- Original Medicare provides hospital and medically-necessary coverage. It’s made of Parts A and B. As an alternative, Medicare Advantage in Wisconsin often includes prescription drug coverage and other services.
- The prices of Medicare plans in Wisconsin start with standardized costs but depend on several other details, including income and work history.
If you’re approaching the age of 65, or already there, not knowing about Medicare in Wisconsin can leave you feeling snowed under when you need answers.
Who’s eligible for Medicare in Wisconsin? What are the available Medicare plans in Wisconsin? To help you dig out, here’s GoHealth’s guide to Medicare in Wisconsin.
How Much Does Medicare Cost in Wisconsin?
When figuring out your budget, there are a few standard costs for Medicare in Wisconsin you’ll want to start with. The final amount, though, will come down to your specific needs, personal details, and which plan you choose. Here’s a quick rundown of the standard charges you can expect from Medicare plans in Wisconsin as of 2025:
Medicare Part A
Premium:
- Typically no-cost if you or your spouse worked 10 or more years
- You or your spouse worked between 7.5 and 10 years: $285 a month
- You or your spouse worked fewer than 7.5 years: $518 a month
Deductible:
- $1,676 each plan period
Copayments & coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare Part B
Premium:
- $185 monthly and up (income-based)
Deductible:
- $257 for each plan period
Copayments & coinsurance:
- Most preventative services: $0; Medicare-approved services: 20% coinsurance
Medicare Part D
Premium:
- Income-based; varies by plan
Deductible:
- No more than $590 in 2025
Copayments & coinsurance:
- Plan- and drug-specific
Note: If you worked for a railroad, you may have to enroll in Medicare in WI through the Railroad Retirement Board (RRB). Call the RRB at 1-877-772-5772 for more information.
Find the Medicare Plan that works for you.
What Is the Cost of Medicare When You Turn 65?
Finding out how much Medicare in Wisconsin costs can be complicated. But there is a simpler solution when it comes down to figuring out how much it’ll cost if you enroll at 65. The answer? A lot less than if you enroll later.
Medicare has some steep enrollment penalties if you miss your enrollment. Even worse, each part punishes procrastination separately, meaning late enrollment can leave you with higher premiums for Part A, Part B, and Part D.
Can I Get Medicare When I Turn 65?
Who’s allowed to sign up for Medicare in Wisconsin? As with the rest of the nation, Medicare in Wisconsin is for all legal U.S. citizens and permanent residents of at least five years who are aged 65 and older.
You may also be eligible if you’re younger than 65 and:
- You’re received disability-based Social Security benefits for 24 months.
- You’ve received Railroad Retirement Benefits for 24 months.
- You’re living with End Stage Renal Disease (ESRD).
- You’re living with Lou Gehrig’s Disease, or Amyotrophic Lateral Sclerosis (ALS).
Let’s find your ideal Medicare Advantage plan.
Do You Automatically Get Part A Medicare?
Not unless you’ve been enrolled in Social Security or Railroad Retirement Benefits (RRB) for 24 months before you turn 65. Otherwise, you’ll need to enroll yourself into a Part A Medicare plan in Wisconsin when you’re first eligible.
Enroll at 65: Your Initial Enrollment Period
Don’t let this common Medicare myth cause you the headache of a missed Initial Enrollment Period (IEP). This is your first chance to enroll in a Medicare plan in Wisconsin the year your turn 65. Your Initial Enrollment Period begins three months before your birth month, and closes three months after. If you were born on the first of the month, your IEP includes the four months before your birth month.
For example, let’s say your birthday is in May. Your IEP will begin February 1 and close August 31.
What Is the Best Medicare Policy?
The answer depends on your needs and your budget. And based on some details, your plan options may be as different as Milwaukee and Minocqua.
If you’re new to Medicare in Wisconsin, here’s an overview of the differences between Original Medicare and Medicare Advantage.
Original Medicare
Health insurance partially funded by the federal government through the Social Security Administration (SSA). It’s made up of:
- Medicare Part A: Hospital coverage
- Medicare Part B: Medical coverage
Medicare Advantage
Your Medicare Parts A and B coverage is provided by private insurance companies. These policies usually include services Original Medicare doesn’t, like coverage for prescription drugs, vision, and dental. Also called Medicare Part C.
What Are the Dates for Changing Medicare Plans?
As we mentioned above, your first chance to enroll in Medicare plans in Wisconsin is known as your Initial Enrollment Period (IEP). This is the seven-month period around your 65th birthday during which you can enroll without a late enrollment penalty.
However, your IEP is just one of several Medicare enrollment periods held each year. Each enrollment period allows you to do different things with your plan. Here are the different enrollment periods and what they’re for:
Medicare Part C & D Open Enrollment Period
Each year, you can swap Original Medicare for Medicare Advantage (or vice versa) or join or switch your Medicare drug plan during the Annual Enrollment Period for Medicare Advantage and Medicare drug coverage. This enrollment period is held each year from October 15 to December 7.
Medicare General Enrollment Period
Did you miss your Initial Enrollment Period? You can sign up for Medicare in Wisconsin during the General Enrollment Period (GEP). The GEP is open each year from January to March 31. The bad news? You’ll have to pay an enrollment penalty unless you qualify for a Special Enrollment Period.
Medicare Advantage Open Enrollment Period
Not happy with your choice of Medicare Advantage in Wisconsin? Held annually from January 1 to March 31, this is the time to enroll in a different Medicare Advantage plan or switch back to Original Medicare.
Find the Medicare Plan that works for you.
What Do the Different Parts of Medicare Cover?
As we explained above, Medicare in Wisconsin is broken down into Original Medicare and Medicare Advantage. But that’s far from all you need to know. Here are the different parts of Medicare and what they cover:
Original Medicare
- Part A: This can include inpatient hospital stays, hospice, skilled nursing and nursing home facilities, and some home health care.
- Part B: This covers the medically necessary and preventive services you receive from a doctor or other provider.
Medicare Advantage (Part C)
Medicare Advantage (Part C) is a private insurance alternative to Original Medicare that substitutes for Parts A and B. These plans often include Part D along with hearing, vision, and dental.
Additional Coverage for Medicare in Wisconsin
If you’re enrolled in an Original Medicare plan in Wisconsin, Prescription Drug Plan (Part D) and Medicare Supplement Insurance (Medigap) can provide drug coverage and help with out-of-pocket costs, respectively.
Medicare Part D (Prescription Drug Plan)
Part D: Medicare Prescription Drug Plan (Part D) provides prescription drug coverage as a stand-alone plan. Many Medicare Advantage plans in Wisconsin include Part D, but Original Medicare enrollees will need to sign up separately.
Medicare Supplement (Medigap)
Medicare Supplement Insurance, also called Medigap, policies provide standardized benefits alongside Original Medicare.
If you choose to add a Medigap plan, it may pay for some or all costs not covered by Part A and Part B, including deductibles, coinsurance, and copayments. If you have a Medicare Advantage Plan, you cannot add Medigap.
In WI, Medigap plans provide a different set of standard benefits. Medigap in Wisconsin offers plans known as “50% and 25% Cost-sharing Plans.” These plans are similar to standardized Plans K (50%) and L (25%). A high-deductible plan is also available.
Private insurance Medigap plans in Wisconsin are also allowed to offer:
- Part A deductible
- Additional home health care (365 visits including those paid by Medicare)
- Part B deductible
- Part B excess charges
- Foreign travel emergency
- 50% Part A deductible
- Part B copayment or coinsurance (note: if you join Medicare on or after January 1, 2020, you are not eligible for the Part B deductible)
What Is the Best Medicare Advantage Plan?
To assess the different Medicare Advantage plans in Wisconsin, you’ll need to know how they operate, especially when it comes to your preferred doctors. Here are the four different kinds of Medicare Advantage:
- Health Maintenance Organization (HMO) plans use provider networks to treat an insurance company’s customers. HMOs typically also require primary care physicians (PCP).
- Preferred Provider Organization (PPO) plans use PCPs but give you the freedom to see any doctor in your network without a referral.
- Private Fee-for-Service (FFS) plans pay your providers each time you receive a service.
- Special Needs Plans (SNP) are for patients with specific conditions or diseases.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,160,274 people are enrolled in Medicare Part A and B in Wisconsin. The total number of beneficiaries enrolled in Medicare Advantage increased from 534,088 to 580,872 year over year. Medicare Advantage participation in Wisconsin went from 47.26% to 50.06% year over year. If you’d like to dive deeper into how Medicare in Wisconsin breaks down across the state, we provide a glance at who is using Medicare and how.
1,160,274 Beneficiaries with Part A & Part B
580,872 Medicare Advantage Beneficiaries
50.06% Medicare Advantage Participation Rate
53.90% Female
46.10% Male
89.65% Non-Hispanic White
3.16% African American
1.85% Hispanic
5.35% Other/Unknown
19.11% Eligible for Medicaid
0.95 Average HCC Score
$9,070.91 Actual Per Capita Costs
16.76% Hospital Readmission Rate
27.98% % of Beneficiaries with an Emergency Department Visit
534,088 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
47.26% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Wisconsin Office of the Commissioner of Insurance
https://oci.wi.gov/Pages/ConsumersHome.aspx
What should I know about the Wisconsin Office of the Commissioner of Insurance?
Check here to research insurance companies or file a complaint.
Wisconsin Department of Health Services
https://www.dhs.wisconsin.gov/guide/medicare.htm
What should I know about the Wisconsin Department of Health Services?
State department that oversees Medicaid and programs centered on healthy living in WI.
Wisconsin Department of Veterans Affairs
https://dva.wi.gov/Pages/Home.aspx
What should I know about the Wisconsin Department of Veterans Affairs?
Apply for benefits and receive health, educational, and economic assistance.
Tribal Affairs Office
https://www.dhs.wisconsin.gov/tribal-affairs/index.htm
What should I know about the Tribal Affairs Office?
Find out how the Wisconsin Department of Health Services works with Wisconsin’s 11 tribes to encourage healthy habits.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in Wisconsin about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Medigap in Wisconsin. Medicare.gov.
- Special Needs Plans (SNP). Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.