What Are Medicare Advantage Plans in Wisconsin?

While you may be familiar with Medicare Parts A and B, you may not know as much about Medicare Part C. Part C is also known as Medicare Advantage (MA). Medicare Part A covers hospital insurance and Medicare Part B covers doctor’s office insurance, while Medicare Advantage plans combine these benefits. Medicare Advantage plans are approved by Medicare, are sold by private insurance companies, offer at least the same coverage as Medicare Parts A and B and often include additional benefits.

Am I Eligible for a Medicare Advantage Plan in Wisconsin?

You can determine your eligibility for a Medicare Advantage plan in Wisconsin by answering two questions. 1) Are you currently approved for Medicare Parts A and B? and 2) Do you reside in a county or zip code in Wisconsin where Medicare Advantage plans are sold? If the answer to both questions is yes, you’re approved. Copayments, coinsurance and deductibles vary depending on the Medicare Advantage plan in which you enroll.

Wisconsin residents cannot be enrolled in a Medicare Advantage Plan and a Medicare Supplement Insurance plan at the same time. A Medicare Supplement Insurance plan helps cover some of the gaps in coverage like copayments, coinsurance and deductibles that aren’t covered by Medicare Parts A and B.

Will a Medicare Advantage Plan in Wisconsin Cover Prescription Drugs?

Wisconsin residents looking for prescription drug coverage should consider a Medicare Part C plan, as some Medicare Advantage plans may include a Medicare Prescription Drug plan. A Medicare Advantage plan with prescription drug coverage is called a MAPD plan and can help cover some of the costs of prescription drugs.

When is the Wisconsin Medicare Advantage Plan Enrollment Period?

Enrollment in a Medicare Advantage plan occurs during specified enrollment periods. Medicare enrollment in Wisconsin opens for residents prior to turning age 65 or earlier in special disability cases. The Initial Enrollment Period (IEP) runs for seven months.

IEP begins three months before turning age 65, including the birthday month, and ends three months after the birthday month. It is also the time allotted for enrollment in Medicare Parts A, B, C and D. For example, if you’re a Wisconsin resident with a May birthday, your IEP runs from February through August.

You may also enroll in a Medicare Advantage plan during the Medicare Annual Enrollment Period, which occurs annually each fall. Medicare’s AEP runs from October 15 through December 7 each year. The key dates for AEP are as follows:

Oct. 15 – Annual Enrollment Period Begins

Dec. 7 – Annual Enrollment Period Ends

Jan. 1 – First Date Coverage can start

During the Annual Enrollment every year, Wisconsin residents can:

• Switch from Medicare Parts A and B (Original Medicare) to a Medicare Advantage (Part C) plan

• Change from one Medicare Advantage Plan to another

• Switch from one Prescription Drug (Part D) plan to another

• Add a Prescription Drug (Part D) plan if you didn’t enroll when first eligible for Medicare
  
  

In addition to AEP, Wisconsin residents who are enrolled in a Medicare Advantage plan can make a one-time plan change during the Open Enrollment (OEP) period, which occurs each year from January 1 through March 31. There are also Medicare Special Enrollment Periods (SEP) you may be able to enroll in Medicare or make changes to your existing Medicare Advantage coverage because of certain events and life changes, such as moving or losing employer coverage.