Medicare in Wisconsin
This article was updated on: 09/16/2018
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About Medicare in Wisconsin
In Wisconsin, like the rest of the country, Medicare beneficiaries can choose to get their coverage through Original Medicare, Part A and/or Part B, the federal program that provides health coverage for seniors and certain disabled individuals. They may also choose to enroll in a Medicare Advantage plan (offered by private insurance companies), which covers at least the same level of coverage as Original Medicare (except for hospice care), but may also include additional benefits, such as routine vision and dental, or prescription drugs.
What makes Wisconsin unique is the availability of Medicare Supplement Insurance. It is one of just three states to offer its own version of it. Most states can offer up to 10 standardized plans, meaning that plan coverage details do not change no matter where they are purchased. Medicare beneficiaries in Wisconsin looking for supplemental coverage have a few options. These include the Wisconsin Basic Plan, which covers certain Part A and Part B coinsurance/copayment costs; the first three pints of blood used each year; and state-mandated benefits. The Basic Plan also provides additional mental health and home health care coverage beyond what Original Medicare pays for.
Wisconsin also has versions of Medicare Supplement Plans K and L, called the “50% and 25% Cost-Sharing Plans. A high-deductible plan is also available. Many insurance companies give beneficiaries the option to add on “riders” to their Medigap plans. These riders cover additional benefits such as foreign travel coverage, the Part B deductible, and more.
Types of Medicare coverage in Wisconsin
Original Medicare, Part A and Part B, is the health insurance program created and administered by the federal government. It is available to eligible beneficiaries in any state in the country. Medicare Part A covers inpatient hospital stays, home health care, and hospice services, and Part B covers doctor visits and some durable medical equipment.
Medicare Advantage plans, Part C, are available through private insurance companies and must cover at least the same level of coverage as Part A and Part B (with the exception of hospice care). Some plans may include other benefits, like routine vision, hearing, and prescription drug coverage. When you enroll in a Medicare Advantage plan, you must continue paying your Medicare Part B premium, regardless of whether your Medicare Advantage plan requires a premium.
Medicare Part D Prescription Drug Plans provide drug coverage (Medicare Part D) to Original Medicare beneficiaries. Not every Part D plan in Wisconsin may be available in each area. Another way to get Medicare prescription drug coverage is through a Medicare Advantage Prescription Drug plan.
Medicare Supplement insurance plans, known also as Medigap, are policies that cover some of the out-of-pocket costs surrounding Original Medicare. A Medicare Supplement policy may cover expenses such as deductibles, coinsurance, and copayments.
Local resources for Medicare in Wisconsin
Medicare Savings Programs in Wisconsin: Wisconsin’s Medicare Savings Programs may be able to help low-income Medicare beneficiaries pay for out-of-pocket Medicare costs like premiums and copayments. For more information, contact your state Medicaid department.
Wisconsin State Health Insurance Counseling and Assistance Program (SHIP): SHIP is a federal and state funded program that helps beneficiaries better understand their Medicare coverage. In Wisconsin, SHIP operates two toll-free assistance centers: the Wisconsin Medigap Part D and Prescription Drug Helpline for seniors and the Disability Drug Benefit Helpline for people who get Medicare because of a disability. Visit the Wisconsin state website for more information.
How to apply for Medicare in Wisconsin
You apply for Medicare in Wisconsin that same as you would in any state. You can visit your local Social Security Administration office or contact them either by phone or online to complete the enrollment process.
- Visit the Social Security website.
- Call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7AM to 7PM.
- Apply at a local Social Security office. Visit SSA.gov to find the closest location to you.
- If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM.
To apply for Medicare, you must be a United States citizen or legal permanent resident of at least five continuous years. You’re generally eligible when you are 65 or older, but you may qualify under 65 through disability or having certain conditions. You can manually enroll in Medicare during your Initial Enrollment Period, the seven-month period that starts three months before you turn 65, includes the month of your 65th birthday, and ends three months later.
Others may be enrolled automatically. This happens once you reach age 65 if you already receive retirement benefits through either Social Security or the Railroad Retirement Board.
You may also qualify for Medicare at any age through disability or by having end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals are automatically enrolled in Medicare after two years of receiving Social Security disability benefits (or certain Railroad Retirement Board benefits). Individuals with Lou Gehrig’s disease are automatically enrolled in the first month of disability benefits. When it comes to end-stage renal disease, eligibility and enrollment works differently and depends on your situation; contact Social Security for more information.
Once you’re enrolled in Original Medicare, Part A and Part B, you may be interested in your other coverage options as well. Do you want to know more about Medicare plans? I can help answer any questions you might have.
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