Are you moving to or currently live in Wisconsin? Want to know about the Wisconsin Medicare Advantage coverage plans? Then read on to see how Medicare Advantage plans (Medicare Part C) work in Wisconsin. You may choose this plan as an alternative to Original Medicare (Part A and Part B).
The way Medicare Advantage coverage works in Wisconsin?
Original Medicare (Part A and Part B) used to be the only way to get health-care coverage when the Medicare program first started. This is solely a government-run Medicare program. Then, alternative plans like the Medicare Advantage plan allowed individuals to have another wart to get Part A and Part B coverage. Private insurance companies that Medicare approves offer these Medicare Advantage plans. In Wisconsin, the Medicare Advantage plan handles your coverage if you sign up for a Medicare Advantage plan. Unlike a government-run Medicare program.
Understand that all Medicare Advantage plans no matter the state have the same baseline level of coverage. Medicare Part C (or Medicare Advantage) plans must have the same level of coverage as Original Medicare (Part A and Part B). However, the exact benefits may be different from plan to plan.
One advantage in a Medicare Advantage plan is that there may be extra benefits than Original Medicare. Medicare Advantage plans can pay for benefits that Original Medicare doesn’t, including but not limited to:
- Dental
- Routine vision
- Hearing
- Wellness Programs
There are different types of Medicare Advantage plans. A few of the most popular Medicare Advantage plans include:
- Preferred Provider Organization (PPO) plans
- Health Maintenance Organization (HMO) plans
These plans may be similar in the fact the PPOs and HMOs may be through an employer-sponsored group plan.
What is a Medicare Advantage HMO plan? This is a plan that will cover for a network of hospitals and doctors for health-care services. If you do not use this network, the plan will generally not cover you unless it’s an emergency or urgent care. Usually, a primary care doctor will assist you with most of your care. If you need specialist care, you will generally need a referral from your primary care doctor.
What is a Medicare Advantage PPO plan? In contrast, this plan allows you to use providers outside the network if you want. However, you generally have to pay more for in-network providers than with an HMO plan. In this plan, you can see a specialist without a referral and you don’t need a primary care doctor.
What is a Private Fee-for-Service Plan? This plan is a great option if you like the provider versatility of Original Medicare. If you travel frequently, there are no provider networks in this type of Medicare Advantage plan. This means your providers are not limited to a single service area. If a provider accepts the responsibility to treat you on a case-by-case basis and accepts the PFFS plan’s terms and conditions, then you can use that provider. Every time you need a health-care service, make sure your providers contract with your plan.
What is a Special Needs Plan (SNP)? This is an alternative option if you have specific conditions. If you fit into these three conditions below then you can enroll in this type of Medicare Advantage plan:
- Currently live in an institution, like a nursing home.
- Have specific chronic illnesses that qualify for the plan.
- Have Medicare and Medicaid
If there is a Special Needs Plan in your services area and you qualify, then you can sign up for the plan. Every person has different health needs, and this plan designs their benefits to meet these needs. For instance, if you have diabetes, you may have doctors inside your provider network who specialize in treating diabetes. Or the plan could assist their members to stay healthy with wellness programs. These examples would be under the Chronic-Condition Special Needs Plan.
What is a Medicare Savings Account (MSA) plan? If you don’t care about paying higher out-of-pocket expenses before the plan begins to cover medical costs, this plan could be a good fit for you. These plans integrate a medical savings account with a high-deductible health insurance plan. A certain amount of money deposits into a savings account each year with your Medicare Savings Account plan. You can use this money to cover costs before you meet your annual deductible.
What are Medicare Advantage Prescription Drug plans in Wisconsin?
Medicare Prescription Drug plans are a combination of prescription drug coverage with health benefits. That is one advantage of Medicare Part C — you can receive prescription drug coverage as part of your Medicare Advantage plan.
This may be a good fit if you like all of your Medicare benefits organized under a single plan. If you don’t want this option, then you would normally have to enroll in a stand-alone prescription drug coverage. It’s a good choice to get your prescription drug benefits through a Medicare Advantage Prescription Drug plan if you have Medicare Part C rather than a separate Medicare Prescription Drug Plan.
How to Compare and Contrast Medicare Advantage plans in Wisconsin
Medicare Part C comes with many different choices of plans. Also Medicare Advantage plans may differ in costs such as coinsurance, deductibles, and copayments. Medicare Advantage plan premiums can be free, however in this case, you will still need to cover your Medicare Part B premium. As well as any cost sharing that the plan requires. You should note all out-of-pocket costs before signing up to a plan because you can pay higher amounts for copayments and deductibles if your Medicare Advantage plan has lower monthly premiums.
A big advantage of a Medicare Advantage plan is that they have an annual out-of-pocket spending limit. So, if the plan’s health-care costs (including deductible) hit the maximum limit, the Medicare Advantage plan will pay for the rest of the covered costs for the year. There is no maximum out-of-pocket limit with Original Medicare. This means there is no cap on how much you could pay within a year of health care.
If you have questions about how Medicare Advantage plans work in Wisconsin, then contact us to discuss your Medicare needs.