Medicare Plans in Wisconsin 2025: Coverage Options and Costs Starting at $0

Residents of Wisconsin can choose from 129 Medicare Advantage plans, 16 prescription drug plans, and 4 Medigap policies, with available options varying by location.

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

The program is divided into four main parts:

• Part A (hospital insurance) and Part B (medical insurance), collectively called Original Medicare.
• Part C, or Medicare Advantage, which offers an alternative to Original Medicare by combining coverage and adding extra benefits.
• Part D, which provides prescription drug coverage.

Those enrolled in Original Medicare can also opt for supplemental coverage through Medigap plans to reduce out-of-pocket costs.

Medicare Landscape in Wisconsin for 2025

The Centers for Medicare & Medicaid Services (CMS) reports that 1,304,783 Wisconsinites are currently enrolled in Medicare.

Key 2025 Medicare trends in Wisconsin include:

• The average monthly premium for Medicare Advantage plans decreased by $1.80, dropping from $26.01 in 2024 to $24.21 in 2025.
• The number of Medicare Advantage plans available increased by 11, from 118 to 129.
• All beneficiaries may enroll in Medicare Advantage plans, including options with $0 monthly premiums.
• Original Medicare enrollees can purchase stand-alone prescription drug plans.
• There are 16 stand-alone Part D plans, with the lowest premium available at $0.
• Many beneficiaries with stand-alone drug plans can switch to lower-cost options compared to their 2024 premiums.
• Approximately 20% of individuals with prescription drug plans qualify for Extra Help assistance.

Understanding Medicare Choices in Wisconsin

Each Medicare part offers unique benefits, so it’s important to understand what each covers.

Original Medicare (Parts A and B)

Original Medicare is a federal program offering hospital and medical insurance. Most Wisconsinites qualify for premium-free Part A. In 2025, the standard Part B premium is estimated at $185 per month, though it may be higher based on income.

Medicare Advantage (Part C)

Offered by private insurers partnering with Medicare, these plans combine Parts A and B and often include additional benefits such as prescription drugs, vision, dental, and hearing coverage.

Notable Medicare Advantage providers in Wisconsin include:

• Aetna Medicare
• Anthem Blue Cross and Blue Shield
• Humana
• Network Health Medicare Advantage
• Quartz Medicare Advantage
• UnitedHealthcare

Coverage areas and plan costs vary by provider.

Stand-Alone Prescription Drug Plans (Part D)

These plans cover prescription medications and require enrollment in Part A or B. Wisconsin residents can select from 16 plans offered by providers such as Aetna, Anthem, Cigna, Humana, UnitedHealthcare, and Wellcare.

Plan availability and costs differ by region.

Medigap (Supplemental Insurance)

Medigap policies help cover out-of-pocket expenses not included in Original Medicare, like deductibles and copayments. Wisconsin offers several options including Medigap 25% and 50% Cost Sharing Plans, Basic, and High Deductible plans.

Leading insurers offering Medigap coverage in Wisconsin include Ace, Aetna, AFLAC, Allstate, Anthem, Cigna, Humana, Mutual of Omaha, State Farm, UnitedHealthcare, and others.

Coverage and pricing vary by insurer and plan.

Medicare Enrollment Guidelines in Wisconsin

Eligibility criteria:

• Age 65 or older
• U.S. citizenship or lawful residence for at least 5 years

Under 65, eligibility includes:

• Receiving Social Security Disability Insurance or Railroad Retirement Board benefits for 24+ months
• Having End-Stage Renal Disease (ESRD) or a kidney transplant
• Living with Amyotrophic Lateral Sclerosis (ALS)

Enrollment Periods

Medicare enrollment and plan changes are limited to specific timeframes:

• Initial Enrollment Period (IEP): Seven months surrounding your 65th birthday (three months before, the month of, and three months after).
• Open Enrollment Period (OEP): October 15 to December 7 each year, allowing enrollment, plan switching, or dropping coverage.
• Medicare Advantage OEP: January 1 to March 31 for those already enrolled in Medicare Advantage plans.
• Medigap OEP: Six months after turning 65 to enroll in Medigap without medical underwriting.

Special Enrollment Periods may apply due to qualifying life events.

Tips for Choosing the Right Medicare Plan in Wisconsin

• Provider Networks: Confirm your preferred doctors and hospitals are included, especially with Medicare Advantage plans.
• Medication Coverage: Review drug formularies to ensure your prescriptions are covered affordably.
• Travel Considerations: Select plans offering coverage beyond your local area if you travel frequently.
• Plan Ratings: Use CMS star ratings (1-5 stars) to evaluate plan quality.

Resources for Wisconsin Medicare Beneficiaries

Medicare assistance is available anytime by calling 1-800-633-4227 (TTY: 1-877-486-2048).

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

Summary

With over 1.3 million enrollees, Wisconsin offers a robust selection of Medicare plans, including numerous Medicare Advantage, Medigap, and stand-alone drug options. Premiums for Medicare Advantage plans have decreased in 2025, creating more affordable choices for beneficiaries statewide.

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