Why Medicare Advantage Plans Are Different in Wisconsin

While there are Medicare advantage plans in 47 states, that are standardized and obliged by law to offer the same benefits, in three states Medicare advantage plans are different and not standardized similarly. The Medicare advantage plans as known elsewhere, divided into the letters: A, B, C, D, F, G, K, L, M, N are different in Wisconsin, Massachusetts and Minnesota.

Medicare advantage plans in Wisconsin

In Wisconsin, all Medicare advantage plans are obliged to offer the so-called basic benefits. The expenses that are covered by the advantage plans are:

  • Expenses for Medicare part A coinsurance due to hospital care
  • Expenses for Medicare part A hospice copayment and coinsurance
  • Expenses for Medicare part B coinsurance due to medical services
  • Expenses for the first three pints of blood

One example of how a Medicare advantage plan would look like in wisconsin, is the well-known basic plan. In addition to the basic benefits, that each advantage plan covers, the basic plan also additionally offers the following benefits:

  • Expenses for Medicare part A coinsurance due to skilled nursing facility
  • Expenses for up to 175 days of inpatient mental health care (per lifetime)
  • Expenses for up to 40 home health care services
  • Expenses for preventive services, which are mandated by the state

In Wisconsin, the Medicare advantage plans found at https://www.medicareadvantageplans2019.org can be advantageed as well, by adding the so-called “riders”. If, for example, on a Medicare basic advantage plan, you can add the riders you feel to be necessary, to be insured even more. They help cover for expenses such as the deductibles for part A, deductibles for part B, excess charges of part B or travel insurance.

Another example of a Medicare advantage plan in Wisconsin, is one that covers on a cost-sharing level and your out-of-pocket limit can be either 20% of the expense or 50%. Such plans are found in other states too and are called he advantage plan L and advantage plan K. Similar to these states, there is no Medicare advantage plan to cover for prescription medication, but there are Medicare Prescription Drug Plans that can be added to Medicare original part A or B.

A similarity that Wisconsin also shares with the 47 states is that to be able to enroll to a Medicare advantage plan, you would need to be enrolled to a Medicare part A or B first. Also, for most plans the eligibility is when you turn 65 or over, however law obliges health insurance companies to provide those younger than 65 with at least one Medicare advantage plan they can enroll to.

When deciding on enrolling to a Medicare advantage plan, a general rule is to compare the price of the premium rates in different companies. Health insurance companies can set the price based on their own criteria, which is why it is more than possible that the price can be different from company to company. Also, it might depend on the area in Wisconsin where you live in.