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Medicare in Wisconsin

October 6, 2016

Medicare beneficiaries in Wisconsin may want to familiarize themselves with every available Medicare plan option. Original Medicare includes both Medicare Part A and Part B, and is administered by the federal government.

As a Wisconsin resident, you might have other choices regarding your Medicare coverage. This article gives you a brief overview of Original Medicare and the Medicare plan options that may be available to you.

Original Medicare for Wisconsin beneficiaries

Medicare is available to U.S. citizens, as well as permanent legal residents of at least five continuous years, aged 65 and older. It is also available to those under age 65 with qualifying disabilities. Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance).

Medicare beneficiaries in Wisconsin, as in the other states, are enrolled automatically at the age of 65 if they’re already receiving retirement benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB) when they turn 65. Disabled persons under the age of 65 who receive SSA disability benefits, or certain RRB disability benefits, for 24 consecutive months may also be enrolled automatically. However, if you have end-stage renal disease (ESRD), you might be eligible for Medicare before age 65, but you have to sign up manually as described below.

Your Medicare card is generally mailed to you about three months before your coverage begins. This card lists your Medicare number and whatever parts of the Medicare program you are enrolled in.

Residents in Wisconsin who need to register manually can apply for Medicare by visiting their local SSA office in person or by registering online. They can also do so over the phone:

  • Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. SSA representatives are available Monday through Friday, from 7AM to 7PM.
  • If you worked for a railroad, call the RRB at 1-877-772-5772. TTY users can call 1-312-751-4701. RRB representatives are available Monday through Friday, from 9AM to 3:30PM.

Medicare plan options in Wisconsin

As a Medicare beneficiary in Wisconsin, you may wish to familiarize yourself with all the Medicare coverage options available to you. Depending on where you live in Wisconsin, there can be a number of Medicare plan options to choose from – but not every option or plan may be available in every part of Wisconsin.

The Medicare Part C program, also called Medicare Advantage, gives you an opportunity to receive your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company instead of directly through the government. The exception is hospice care, which Part A still covers directly even if you have a Medicare Advantage plan.

Many Medicare Advantage plans offer additional benefits, such as wellness or fitness programs. Not every Medicare Advantage plan includes prescription drug coverage, but many do and are known as Medicare Advantage Prescription Drug plans, and they provide all of your coverage through a single Medicare Advantage plan. Even if you enroll in a Medicare Advantage plan, you will remain enrolled in the Medicare program, and must continue paying your Part B premium.

You might want to learn about Medigap (Medicare Supplement) plans if you decide to stay with Original Medicare. Click here to read about Medigap in Wisconsin.

Stand-alone Medicare Part D Prescription Drug Plans work alongside your Original Medicare coverage. Every plan has a formulary, which is a list of covered drugs. The formulary may vary by company, so you may want to shop around to find one that best suits your medical needs. The formulary may change at any time. You will receive notice from your plan when necessary.

Wisconsin resources for Medicare beneficiaries

Medicare.gov offers a list of educational resources for health organizations in Wisconsin, although you can also refer to the list of local and informational Medicare resources below.

  • State Health Insurance Assistance Program (SHIP): Toll-free number 1-800-242-1060; TTY 800-947-6644. Call Monday through Friday between 8AM and 4:30PM. Website.
  • National Institute on Aging Information Center: Toll-free number 1-800-222-2225 (TTY: 1-800-222-4225). Representatives are available Monday through Friday, 8:30AM to 5:00PM ET. Website.

Learn more about how Medicare plans work in Wisconsin including:

The product and service descriptions, if any, provided on these PlanPrescriber Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.