Key takeaways

  • Over 1.3 million Wisconsin residents are enrolled in Medicare with access to Original Medicare (parts A and B), Medicare Advantage (Part C), stand-alone prescription drug plans (Part D), and Medigap, each offering different coverage and benefits.
  • Medigap plans in Wisconsin differ from the standardized plans available in most other states.
  • You can enroll in Medicare during specific periods, such as the initial enrollment period, the general enrollment period, and special enrollment periods triggered by certain life events.

Medicare is a health insurance program for individuals ages 65 and older, as well as younger people with certain health conditions and disabilities.

It consists of four components:

  • Part A (hospital insurance) and Part B (medical insurance) are known as Original Medicare.
  • Part C, known as Medicare Advantage, offers an alternative to Original Medicare.
  • Part D covers prescription medications.

If you have Original Medicare, you can also enroll in a supplemental insurance plan (Medigap) to help with additional out-of-pocket expenses.

Medicare snapshot in Wisconsin


The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in Wisconsin for the 2026 plan year:

  • 18.73% of people with a stand-alone Part D plan get Extra Help.
  • A total of 1,337,740 residents of Wisconsin were enrolled in Medicare.
  • The average monthly Medicare Advantage plan premium changed from $22.86 in 2025
  • to $23.44 in 2026.
  • There are 113 Medicare Advantage plans available in Wisconsin for 2026, compared with 118 plans in 2025.
  • All Wisconsin residents with Medicare have access to buy a Medicare Advantage plan with a $0 premium.
  • In 2026, 10 stand-alone Medicare Part D plans and four Medigap plans are available in Wisconsin.

Medicare is more than just one plan. Different plans and components cover different parts of your healthcare.

  • Original Medicare: This is managed by the federal government and includes two main parts: Part A (hospital insurance) and Part B (medical insurance). Neither part covers prescription drugs.
  • Medicare Advantage (Part C): These plans are private plans that cover the same benefits as Original Medicare, and may also cover benefits like vision, dental, or prescription drugs. Some plans have limited provider networks, so confirm your doctors and facilities are in-network before enrolling.
  • Medicare Part D: This is another private, stand-alone plan option for prescription drug coverage. You’d enroll in Part D with Original Medicare or with a Part C plan without lumped-in drug coverage.

For all private Medicare options, availability varies by county, so check Medicare.gov for what’s available in your area.

Medigap

Medicare supplement (Medigap) plans help cover the gaps in Original Medicare coverage, which might include copays and coinsurance. You cannot use Medigap with Medicare Advantage.

Medigap plans are standardized in most states, where you can choose among 10 plans to supplement Original Medicare. However, Wisconsin is one of three states where Medigap plans differ.

Wisconsin offers residents one basic plan that covers:

  • Part A coinsurance or copayments for inpatient hospital stays, skilled nursing facility care, and hospice care
  • Up to 175 days of inpatient mental health treatment in a lifetime, beyond Medicare’s coverage
  • Up to 40 additional home healthcare visits beyond what Medicare covers
  • Part B coinsurance (typically 20% of the Medicare-approved amount) for medical services
  • The cost of the first 3 pints of blood each year
  • Additional state-mandated benefits are required in Wisconsin

In addition, you can choose the following adjustments to this plan:

  • high deductible option
  • 25% cost-sharing
  • 50% cost-sharing

If you select the high-deductible plan, you should get the same benefits as the basic plan, but only after you meet your Medigap plan’s deductible. You also generally have a lower premium than the standard plan.

The 25% and 50% cost-sharing plans are similar in terms of coverage to the standardized plans K (50%) and L (25%) in that the plan covers a percentage of your out-of-pocket costs, and you’re responsible for the rest.

Each insurer establishes its own cost and coverage options. You can check the costs of a specific plan by entering your zipcode on Medicare.gov.

If you live in Wisconsin, you can qualify for Medicare at age 65 if you’re a U.S. citizen or legal resident for at least 5 years. If you’re under 65 years, you may also qualify through disability or by living with end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

When choosing a plan, consider provider networks, costs, and quality ratings. You may be able to join a plan or modify your coverage during one or more of the following enrollment periods:

  • Initial enrollment: Enroll 3 months before to 3 months after the month of your 65th birthday.
  • Open enrollment: Join or change plans from October 15 to December 7.
  • Medicare Advantage open enrollment: Switch Medicare Advantage plans or return to Original Medicare from January 1 to March 31.
  • Special enrollment period: Enroll after a life change, such as losing job-based coverage.

If you’re eligible for Medicare due to a disability, you’ll be automatically enrolled. If you’re eligible based on age, you’ll need to enroll yourself.

To help you narrow down your options, consider the following:

  • Provider network: If you enroll in a Medicare Advantage plan, you may need to use in-network providers. Confirm that your healthcare team is included in the network.
  • Prescription drugs: Compare your current medication list with the coverage offered by stand-alone prescription drug and Medicare Advantage plans in your area. Ensure your medications are covered and reasonably priced.
  • Travel coverage: Some Medicare Advantage plans offer coverage outside the plan’s main service area. If you travel a lot, it may be beneficial to choose a plan that offers this coverage.
  • Plan performance: The CMS publishes annual ratings ranging from one to five stars, with five being the best rating.

Medicare has a helpline with staff available 24 hours a day, 7 days a week (excluding some federal holidays) to answer your questions. You can call Medicare at 1-800-633-4227 (TTY: 1-877-486-2048).

For personalized health insurance counseling, contact Wisconsin’sState Health Insurance Assistance Program (SHIP)at 1-800-242-1060 (TTY: 711).

More than 1.3 million Wisconsin residents are enrolled in Medicare.

Dozens of private insurance companies offer Medicare Advantage and stand-alone prescription drug coverage throughout the state.

Overall, monthly premium costs have decreased for Medicare Advantage plans in Wisconsin. In addition, Wisconsin’s Medigap plans differ from the standard plans offered in most other states.