Wisconsin Medicare beneficiaries have access to a range of coverage options, state-specific protections, and free counseling services. This comprehensive Wisconsin Medicare guide covers your SHIP office contacts, Medigap plan availability, birthday rule protections, Medicare Savings Program eligibility, Medicare Advantage options, and how to compare plans. Whether you are turning 65, helping a parent navigate Medicare, or re-evaluating your coverage, understanding Wisconsin Medicare rules is essential for making informed decisions.
All information in this guide has been verified against official state sources, CMS data, and NAIC reports as of April 2026.
In This Wisconsin Medicare Guide:
Wisconsin SHIP — Free Medicare Counseling
Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased Medicare counseling. Wisconsin’s SHIP program can help you understand your coverage options, compare plans, resolve billing issues, and navigate enrollment periods at no cost.
| SHIP Program | Wisconsin State Health Insurance Assistance Program (SHIP) — operated by the Board on Aging and Long-Term Care (Medigap Helpline) |
| Phone | 1-800-242-1060 |
| Website | https://www.dhs.wisconsin.gov/benefit-specialists/medicare-counseling.htm |
SHIP counselors are trained volunteers and staff who are not affiliated with any insurance company. They do not sell plans. Contact your Wisconsin SHIP office before making any major Medicare decisions.
Wisconsin Medigap (Medicare Supplement) Plans
Medigap plans in Wisconsin help cover out-of-pocket costs not paid by Original Medicare, including the Part A deductible, Part B coinsurance, and skilled nursing facility copays. Medigap plans are standardized by federal law, meaning Plan G from one carrier covers the same benefits as Plan G from another carrier. The difference is premium cost.
Plans available in Wisconsin: Wisconsin does NOT use the standard A-N lettered plans. It is one of three states (with Minnesota and Massachusetts) with its own system. Wisconsin requires insurers to offer: Basic Plan, 25% Cost Sharing Plan, 50% Cost Sharing Plan, and High Deductible Plan. Optional riders can be added to the Basic Plan including Part A Deductible, Part A 50% Deductible, Part B Deductible (pre-2020 eligibility only), Part B Excess Charges, Home Health Care (365 days), and Foreign Travel Emergency.
Most popular plan: Basic Plan with Part A Deductible rider and Part B Excess Charges rider (Wisconsin equivalent of Plan G coverage in standard states) is the most popular Medigap plan in Wisconsin. Plan G covers all gaps in Original Medicare except the annual Part B deductible ($240 in 2026). Plan N is the most popular lower-premium alternative, with small copays for some doctor visits and ER visits.
Pricing method: Wisconsin uses community-rated Medigap pricing. This is the most favorable method for consumers because premiums are the same regardless of age. Your premium will not increase simply because you get older.
The average monthly Plan G premium for a 65-year-old in Wisconsin is approximately 140 (Wisconsin does not sell standard Plan G — this is the approximate monthly cost of a Basic Plan with Part A Deductible and Part B Excess Charges riders, which provides equivalent coverage). Plan N averages approximately 111 (Wisconsin does not sell standard Plan N — this is the approximate monthly cost of a Basic Plan with 50% Cost Sharing, which provides roughly equivalent coverage) per month. Actual premiums vary by carrier, age, gender, tobacco use, and zip code. Always compare quotes from at least three carriers.
Wisconsin Medigap Switching Rights
Wisconsin does not have a Medigap birthday rule. Your primary opportunity to buy or switch Medigap plans without medical underwriting is during your initial Medigap Open Enrollment Period, which lasts 6 months starting when you first enroll in Medicare Part B at age 65 or older.
After your initial OEP closes, you may face medical underwriting if you apply for a new Medigap policy. However, federal law provides guaranteed issue rights in specific situations, such as losing employer coverage or leaving a Medicare Advantage plan during your first year.
Wisconsin guaranteed issue protections: Wisconsin provides the standard federal 6-month Medigap OEP plus additional state protections: (1) insurers must offer at least one Medigap plan to Medicare beneficiaries under age 65 with disabilities or ESRD; (2) beneficiaries who drop Medigap to join a Medicare Advantage, Medicare Cost, or Medicare Select plan for the first time may return to their original Medigap policy (or purchase any Medigap policy) with guaranteed issue if they leave within 12 months; (3) standard federal guaranteed issue rights apply when losing employer coverage, moving out of an MA service area, or when a plan leaves the market
Wisconsin Medicare Advantage (Part C)
Approximately 1130000 people in Wisconsin are enrolled in Medicare. About 42% of Wisconsin Medicare beneficiaries choose Medicare Advantage plans, with the remainder on Original Medicare with or without Medigap supplement coverage.
Medicare Advantage plans in Wisconsin are offered by private insurers as an alternative to Original Medicare. Most MA plans include prescription drug coverage (Part D) and often add dental, vision, and hearing benefits. However, MA plans use provider networks, which can limit your choice of doctors and hospitals.
Key Medicare Advantage considerations in Wisconsin:
- Networks matter: HMO plans require you to use in-network providers except in emergencies. PPO plans allow out-of-network care at higher cost.
- $0 premium plans: Many Wisconsin MA plans have $0 monthly premiums (you still pay your Part B premium).
- Maximum Out-of-Pocket (MOOP): MA plans cap your annual spending, unlike Original Medicare which has no cap.
- Star ratings: CMS rates MA plans 1-5 stars. Higher-rated plans often have lower costs and better coverage.
Top Medicare Advantage carriers in Wisconsin by enrollment:
- UnitedHealthcare
- Humana
- Network Health
- Anthem Blue Cross Blue Shield
- Security Health Plan
Wisconsin Medicare Financial Help Programs
Wisconsin offers Medicare Savings Programs (MSPs) that help low-income Medicare beneficiaries pay for premiums, deductibles, and copays. The four programs are:
- QMB (Qualified Medicare Beneficiary): Pays Part A and Part B premiums, deductibles, coinsurance, and copays.
- SLMB (Specified Low-Income Medicare Beneficiary): Pays Part B premiums only.
- QI (Qualifying Individual): Pays Part B premiums (limited funding, first-come first-served).
- QDWI (Qualified Disabled Working Individual): Pays Part A premiums for disabled workers.
Wisconsin MSP eligibility: QMB (100% FPL): 1330/month single, 1803.33/month couple; SLMB (120% FPL): 1596/month single, 2164/month couple; SLMB+ (135% FPL): 1795.50/month single, 2434.50/month couple; Asset limits: 9950 single, 14910 couple (QMB/SLMB/SLMB+); QDWI asset limits: 4000 single, 6000 couple
Apply through your local SHIP office or your state Medicaid agency for free help determining eligibility.
Top Medicare Insurance Companies in Wisconsin
Top Medigap carriers in Wisconsin:
- Blue Cross Blue Shield
- AARP/UnitedHealthcare
- Mutual of Omaha
- Aflac
- State Farm
When comparing carriers, focus on premium cost (for identical standardized Medigap plans, benefits are the same — only price differs), financial strength ratings from AM Best (A or higher), customer satisfaction ratings, and claims processing speed.
Wisconsin Medicare Enrollment Periods
Understanding Medicare enrollment deadlines prevents costly late enrollment penalties:
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday (3 months before, birthday month, 3 months after). Enroll in Parts A and B during this period.
- Medigap Open Enrollment: 6 months beginning on the date an individual starts Medicare Part B (standard federal OEP) — during this window insurers may not deny coverage or apply health underwriting based on health status, claims experience, or medical condition. During this period, insurance companies cannot deny you Medigap coverage or charge higher premiums based on health conditions.
- Annual Enrollment Period (AEP): October 15 through December 7 each year. Switch between Original Medicare and Medicare Advantage, change MA plans, or add/change Part D drug plans.
- Medicare Advantage Open Enrollment Period (OEP): January 1 through March 31. Switch MA plans or return to Original Medicare (and add a Medigap plan, subject to underwriting).
- Special Enrollment Periods (SEP): Available when you lose employer coverage, move, or qualify for other life events.
Additional Wisconsin Medicare protections: Wisconsin is one of three states with a non-standard Medigap system (Basic Plan + optional riders instead of Plans A-N); state law requires insurers to offer at least one Medigap plan to beneficiaries under age 65 with disabilities or ESRD; the OCI publishes an annual Medicare Supplement Insurance Policies List (PI-010) comparing all carrier premiums side by side; the Board on Aging and Long-Term Care operates a dedicated Medigap Helpline and Part D Helpline (1-855-677-2783) funded by OCI; insurers must offer all four plan types (Basic, 25% Cost Sharing, 50% Cost Sharing, High Deductible); 2026 high-deductible plan amount is 2870
Compare Wisconsin Medicare Plans
Ready to compare Medicare options in Wisconsin? Use the official Medicare Plan Finder or contact your local SHIP counselor for free, unbiased help.
Official Sources & Resources
- Medicare.gov: medicare.gov
- Office of the Commissioner of Insurance (OCI): https://oci.wi.gov
- Wisconsin State Health Insurance Assistance Program (SHIP) — operated by the Board on Aging and Long-Term Care (Medigap Helpline): https://www.dhs.wisconsin.gov/benefit-specialists/medicare-counseling.htm
- CMS.gov: cms.gov
- NAIC: naic.org
This Wisconsin Medicare guide was last verified against official sources in April 2026. If you notice outdated information, please contact us.