Medicare Advantage in Wisconsin

Looking for Wisconsin Medicare Advantage Plans? Enter your ZIP below to compare affordable or $0 premium plans in your area.

Wisconsin state

Information about Medicare Advantage Plans in Wisconsin

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41 percent of Medicare beneficiaries in Wisconsin were enrolled in a Medicare Advantage (Medicare Part C) plan in 2019.1

There are 79 different Wisconsin Medicare Advantage plans in 2019.1 Not every plan is available in each county, so it's important to find out which ones are offered where you live.

A licensed insurance agent can help you compare the availability, benefits and costs of Medicare Advantage plans in your area of Wisconsin. Read below to learn more about Medicare in your state.

You can also learn more about other types of Medicare plans:

Average costs of Medicare Advantage in Wisconsin

The average premium paid by a Wisconsin Medicare Advantage plan beneficiary in 2019 was $92 per month.

That average was affected by the 24 available plans that feature $0 monthly premiums.

  • Average monthly premium cost in 2019 (weighted): $92
  • Average in-network out-of-pocket spending limit: $4,310
  • Average deductible in 2019 (weighted): $156.331

Individual plan premiums, deductibles and out-of-pocket costs may vary greatly depending on where you live and the plan you have.

You can view the 2019 average Wisconsin Medicare Advantage plan monthly premiums by county listed below in this guide.

A licensed insurance agent can help you compare Medicare Advantage plan costs in your area.

Compare Wisconsin Medicare Advantage plan costs

Compare Plans

Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Medicare Eligibility & Enrollment

If you want to enroll in Medicare Advantage in Wisconsin, you must first be enrolled in Medicare Part A and Part B, often referred to as Original Medicare.

To be eligible for Original Medicare at age 65, you must meet the following requirements:

  • You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years.

  • You or your spouse must have worked long enough to be eligible for Social Security or Railroad Retirement benefits.

  • You or your spouse must be government employees or retirees who have not paid into Social Security but have paid Medicare payroll taxes.

You may also be eligible for Medicare benefits under 65 if:

  • You have been receiving Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.

  • You have ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease).

  • You have End-Stage Renal Disease (ESRD), and you or your spouse have paid Social Security taxes for a certain length of time.

It’s important to note that if you have ESRD, you may not qualify for most Medicare Advantage plans. If you have ESRD, you may be able to enroll in a Wisconsin Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

How to sign up for a Medicare Advantage Plan in Wisconsin

The first time you may be able to enroll in a Wisconsin Medicare Part C plan is during your Medicare Initial Enrollment Period (IEP).

Medicare Initial Enrollment Period graphic

Your Medicare IEP starts three months before your 65th birthday. It includes the month of your 65th birthday and then continues for another three months after your birthday.

Additional times at which you may sign up for a Medicare Advantage plan include:

Medicare Advantage Open Enrollment Period graphic

Medicare Advantage Open Enrollment Period: January 1 – March 31

If you're already enrolled in a Part C plan, from January 1 to March 31 every year, you may switch Medicare Advantage plans or drop your Medicare Advantage plan and return to Original Medicare.

If you return to Original Medicare during this period, you'll be able to join a Medicare standalone prescription drug plan (Medicare Part D).

Medicare AEP graphic

Medicare Annual Enrollment Period (AEP): October 15 – December 7

From October 15 to December 7 every year, you may enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

You may also drop your existing Medicare Advantage plan and return to Original Medicare.

During AEP, you may also join, switch or drop a Medicare Part D plan. 

Medicare Special Enrollment Periods (SEP)

You may potentially be granted a Medicare Special Enrollment Period (SEP) at any time throughout the year for qualifying circumstances.

A licensed insurance agent can help you find out if you qualify for a Medicare Special Enrollment Period.

Find a Wisconsin Medicare Advantage plan

Compare Plans

Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Top-rated Medicare Advantage Plans in Wisconsin 2019

Each year, the Centers for Medicare & Medicaid Services (CMS) issues Star Ratings for all Medicare Advantage plans using a system of one to five stars.2

In order for a Medicare Advantage plan to be considered a top-rated plan, it must have four or more stars out of five stars.

There are 68 top-rated 2019 Medicare Advantage plans in Wisconsin that are rated four stars or higher.

Medicare Star Ratings
Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

Medicare Advantage plans are rated in the following five categories:

  • Preventive care and health maintenance (screenings, tests, vaccines, etc.)
  • Management of chronic conditions
  • Member experiences and ratings of the plan
  • Member complaints, problems receiving services and member retention
  • Customer service

The information for the star ratings is gathered from information that is submitted to Medicare, Medicare’s regular monitoring activities and member surveys.

List of Medicare Advantage Plans Available in Wisconsin in 2019

To view a list of plans offered in your area within Wisconsin, use our plan comparison tool.

Find a Wisconsin Medicare Advantage plan

Compare Plans

Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Private insurance companies offer Medicare Advantage plans in Wisconsin

Multiple insurance carriers may offer Medicare Advantage plans in Wisconsin, depending on where you live.

Private insurance companies offer Medicare Advantage plans that may be unique to the plan area they serve.

Call to speak with a licensed insurance agent who can help you compare the Medicare Advantage plans that are sold by insurance companies in your area.

When you’re shopping for Medicare Advantage plans in Wisconsin, you can compare plans from several different carriers by using some of the following information:

  • The Medicare Star Ratings can give you an idea of a plan’s overall quality.

  • Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide information about an insurance company’s credit rating and financial standing.

  • Websites such as the Better Business Bureau and Consumer Reports can teach you about a company’s reputation among its customers.

  • You can read through Medicare Advantage plan reviews and testimonials from customers.

Wisconsin Medicare Advantage plans by county

The chart below provides some more information about 2019 Wisconsin Medicare Advantage plans by county.1

2019 WI Medicare Advantage by County
County Total of County MA Enrollees % of Medicare Beneficiaries Enrolled in MA Average Monthly Premium Number of Plans Available Number of $0 Premium Plans Available % Enrolled in a $0 Premium Plan
Adams 2001 26% $41 9 3 10%
Ashland 1189 28% $125 1 0 1%
Barron 4521 36% $118 0 0 0%
Bayfield 1647 32% $118 0 0 1%
Brown 26053 54% $30 24 9 41%
Buffalo 506 14% $68 0 0 31%
Burnett 1820 32% $116 0 0 0%
Calumet 5448 61% $24 0 0 62%
Chippewa 4754 33% $110 0 0 0%
Clark 3113 44% $68 1 1 17%
Columbia 3925 29% $40 15 3 23%
Crawford 1509 33% $66 3 0 6%
Dane 24433 27% $40 0 0 15%
Dodge 7149 37% $40 0 0 20%
Door 3106 31% $38 0 0 15%
Douglas 4570 43% $114 0 0 0%
Dunn 2771 28% $109 0 0 0%
Eau Claire 6865 33% $111 0 0 0%
Florence 438 28% $44 0 0 7%
Fond du Lac 11585 51% $24 0 0 65%
Forest 971 35% $45 0 0 8%
Grant 4742 42% $49 3 1 7%
Green 1743 21% $42 0 0 15%
Green Lake 2702 51% $41 0 0 39%
Iowa 1727 31% $62 0 0 18%
Iron 850 39% $52 0 0 50%
Jackson 1611 33% $67 0 0 15%
Jefferson 5538 31% $41 0 0 14%
Juneau 1480 21% $64 0 0 9%
Kenosha 10190 33% $42 5 2 5%
Kewaunee 2394 50% $53 0 0 28%
La Crosse 9242 39% $72 0 0 12%
Lafayette 1274 35% $45 0 0 7%
Langlade 2576 43% $45 0 0 18%
Lincoln 3342 43% $75 3 1 13%
Manitowoc 9549 48% $32 0 0 41%
Marathon 13449 47% $72 0 0 16%
Marinette 5225 42% $40 0 0 9%
Marquette 1587 32% $46 0 0 5%
Menominee 248 26% $26 1 0 50%
Milwaukee 79233 49% $37 5 2 16%
Monroe 2667 28% $60 0 0 19%
Oconto 5371 55% $34 0 0 39%
Oneida 4237 33% $74 0 0 10%
Outagamie 20601 59% $27 0 0 47%
Ozaukee 8478 41% $28 0 0 38%
Pepin 305 14% $65 0 0 44%
Pierce 3129 39% $118 0 0 0%
Polk 4643 40% $115 0 0 0%
Portage 5928 41% $79 0 0 17%
Price 1609 35% $48 1 0 27%
Racine 18198 43% $39 0 0 11%
Richland 658 14% $61 0 0 8%
Rock 12602 36% $41 0 0 17%
Rusk 1565 37% $68 0 0 40%
Sauk 4756 32% $46 0 0 15%
Sawyer 1797 30% $120 0 0 1%
Shawano 5819 56% $39 0 0 36%
Sheboygan 11809 47% $20 0 0 60%
St. Croix 6161 39% $116 4 0 0%
Taylor 1905 43% $51 1 0 47%
Trempealeau 2192 33% $70 0 0 18%
Vernon 3302 44% $66 0 0 13%
Vilas 2624 29% $52 0 0 22%
Walworth 5916 26% $42 0 0 4%
Washburn 2019 35% $118 0 0 1%
Washington 12585 43% $29 0 0 35%
Waukesha 38678 43% $36 3 2 19%
Waupaca 7320 53% $43 0 0 32%
Waushara 3750 52% $27 0 0 51%
Winnebago 19523 57% $29 0 0 41%
Wood 9287 50% $87 0 0 6%

WI Medicare Advantage enrollees by plan type

The chart below illustrates the percentage of 2019 Wisconsin Medicare Advantage enrollees that are enrolled in each primary type of Medicare Advantage plan.1

Plan type Percentage of Wisconsin enrollees (2019)
Medicare Cost Plan 65.99%
Local PPO 27%
MSA 4.3%
HMO 1.5%
Other Plans <1%

The major types of Medicare Advantage plans include:

  • HMO
    Health Maintenance Organization (HMO) usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically requiring a referral from a primary care doctor in order to see a specialist.

  • PPO
    Medicare Advantage beneficiaries in a Preferred Provider Organization (PPO) are able to see providers outside of their plan’s network, often at a higher cost.

    Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network.

    PPO plans typically do not require patients to acquire a referral before visiting with a specialist.

  • PFFS
    A Private Fee-For-Service (PFFS) plan determines how much it will pay to health care providers and how much the patient will pay when care is received.

    With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.

  • SNP
    A Special Needs Plan (SNP) is a type of Medicare Advantage plan limited to people with certain chronic conditions and other specific characteristics.

    Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2019 Wisconsin Medicare Advantage plans that are available where you live.

Local health insurance resources in Wisconsin

  • The Medigap Helpline is not just for Medigap beneficiaries. This free and confidential counseling service will also assist Wisconsin residents with Medicare, Medicare Advantage and other insurance programs.

    The goal is to help people better understand and make use of their Medicare or other health insurance benefits.

    The program may be reached at 1-800-242-1060.    

  • You can also explore more information about the insurance industry in Wisconsin by visiting the state’s Commissioner of Insurance website.

  • Wisconsin Prescription Drug Assistance Programs
    The state of Wisconsin has a number of programs designed to help with the cost of prescription drugs. There are programs for both Medicare beneficiaries and non-Medicare beneficiaries alike that can cover the cost of premiums and cost-sharing or even lower the cost of the drugs themselves.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 MedicareAdvantage.com's internal analysis of CMS Medicare Advantage landscape source files, accessed May 2019. Data retrieved from www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn.

Includes 2019 approved contracts/plans. PACE, Special Needs Plans, Part B Only Plans, and Employer sponsored plans (800 series) are excluded. Plans under sanction are not shown.

2 Every year, Medicare evaluates plans based on a 5-star rating system.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC is a licensed and certified representative of A Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.

TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Medicare has neither reviewed nor endorsed this information.

Last Updated: 7/1/2019