Medicare in Wisconsin: Plans and Coverage (2026)

Medicare in Wisconsin follows federal rules, but the state offers a free Medigap Helpline at 1-800-242-1060, staffed by certified counselors with no insurer ties.1 This guide covers 2026 costs, plan choices, and how Wisconsin residents can get help paying.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Wisconsin (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Wisconsin
• Help Paying for Medicare in Wisconsin
• Medicare Enrollment Periods
• Free Medicare Help: Wisconsin SHIP and Medigap Helpline
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1.2 Medicare costs change every year, and CMS publishes each year's figures on that fact sheet and at medicare.gov. To talk any of it through with a person, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), which answers 24 hours a day, 7 days a week except some federal holidays.6 In Wisconsin, the free Medigap Helpline at 1-800-242-1060 takes Medicare supplement and long-term care insurance questions.1

Original Medicare: Parts A and B

Original Medicare is the federal program run by CMS. Its mechanics and costs are the same in Wisconsin as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.2

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.2 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility. Get readmitted after that gap and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It does not cover routine dental, vision, or hearing.2,7

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)2
• Annual deductible: $2832
• After the deductible: 20% of the Medicare-approved amount for most services2

Delaying Part B beyond your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program triggers a permanent late-enrollment penalty: 10% added to your premium for every full 12-month period you could have had it, for as long as you keep Part B.8

Medicare Advantage in Wisconsin (Part C)

Medicare Advantage plans are sold by private insurers under contract with CMS. They bundle Part A and Part B coverage (except hospice, which Original Medicare keeps covering), and most include Part D drug coverage plus extras like dental, vision, and hearing.9

In Wisconsin, plan availability varies by geography. Milwaukee and Madison generally offer the widest selection, with multiple HMO and PPO options competing for enrollees. In rural areas of northern and central Wisconsin, the choice of plans narrows, and some counties may have only one or two carriers. Plan networks, premiums, and covered benefits change each year and differ by county, so compare what's actually available at your specific ZIP code before enrolling.9

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. CMS estimates the average Medicare Advantage premium for 2026 at about $14 a month; many plans charge $0 extra. Some plans go further and help pay all or part of your Part B premium.2,9
• Plans run on networks (HMO or PPO). Confirm your doctors and preferred hospitals are in-network before you enroll; emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network.9
• Plans typically require prior authorization for certain services, which Original Medicare generally does not.9
• Every plan caps your annual in-network out-of-pocket spending, federally limited to $9,250 in 2026; many plans set it lower. Original Medicare has no such cap on its own. CMS's sentence adds the condition: no yearly limit on what you pay out of pocket unless you have supplemental coverage, like Medigap, Medicaid, employer, retiree, or union coverage. What each covers varies by policy.9

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your current providers and prescriptions and it shows which plans cover them and what your estimated annual cost would be. A Wisconsin SHIP counselor will go through the results with you for free.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan alongside Original Medicare, or bundled into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap (the donut hole), so that higher-cost middle phase no longer exists.3 Part D now runs through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).10
2. Initial coverage: you pay copays or coinsurance while your plan and drug manufacturers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs for the rest of the year.3

The $2,100 cap is the most significant Part D change in recent years. The average standalone Part D premium in 2026 is about $34.50 a month, though actual plan premiums vary widely.2 Every Part D and Medicare Advantage drug plan must also offer the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs into capped monthly payments across the calendar year instead of paying in full at the pharmacy.3

People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Wisconsin

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.9

Wisconsin is one of three states (along with Massachusetts and Minnesota) that does NOT use the federally standardized A-through-N letter plans.4 Wisconsin's policies are regulated by the Wisconsin Office of the Commissioner of Insurance (OCI) under a state waiver, and use a different structure.4

The most common type is the Traditional (Basic) policy, which covers the main out-of-pocket costs in Original Medicare. Wisconsin also offers Cost-Sharing policies, sold as a 50% plan and a 25% plan, and the order matters. On these plans the policy pays only that named share of each listed basic benefit (half under the 50% plan, a quarter under the 25% plan) while you pay a portion of the cost of Medicare-covered services, and the plan takes over once you have met both the annual out-of-pocket limit and your calendar-year Part B deductible. For 2026 the out-of-pocket limit is $8,000 for the 50% plan and $4,000 for the 25% plan, and the Part B deductible is $283. That is the same shape as the federal Plans K and L sold elsewhere. Optional riders can expand coverage further. Because Wisconsin doesn't use plan letters, comparing Medigap plans here works differently than the lettered-plan comparisons in national guides; OCI publishes a list of the Medicare Supplement policies marketed in Wisconsin (document PI-010), updated annually.4

Your best opportunity to buy Medigap is the open enrollment period, and in Wisconsin it is not limited to people 65 and older: the state's Office of the Commissioner of Insurance requires Medicare Supplement and Medicare SELECT insurers to make coverage available "regardless of your age, for six months beginning with the date you enroll in Medicare Part B." During that window an insurer must sell you any Medigap plan at the standard rate regardless of your health.11 Wisconsin also gives a second window: if you came onto Medicare before 65 through disability or end-stage renal disease, "you are entitled to another six-month open enrollment period upon reaching age 65." A first window in which you were underwritten, surcharged, or turned down is not your only chance.4 Outside an open window, Wisconsin insurers may apply medical underwriting, meaning they can review your health history, charge more, or decline coverage.

For objective help comparing Medigap plans and premiums in Wisconsin, call the Medigap Helpline at 1-800-242-1060. The counselors are certified SHIP counselors with no insurer ties.1

For a side-by-side look at the Medigap vs. Medicare Advantage trade-off, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Wisconsin

Two programs can significantly cut Medicare costs for Wisconsin residents with limited income and resources.

Medicare Savings Programs (ForwardHealth)

Wisconsin administers the Medicare Savings Programs through ForwardHealth, the state's Medicaid program operated by the Department of Health Services. Wisconsin publishes the federal figures unraised, and it tests your countable monthly income after certain credits are applied, not your gross pay. DHS's own 2026 table prints the bare poverty-level amounts, about $20 below the federal limits shown below: $1,330.00 for one person at the QMB tier, $1,596.00 at the SLMB tier. DHS does not say which credits it applies, so if your income lands between the two figures, apply and let the agency do the counting.5

QMB is the most valuable tier. It pays your Part A and Part B premiums and covers all Medicare deductibles, coinsurance, and copays. Federal law bars providers from billing a QMB enrollee for any of that cost-sharing.5 For all three programs, the 2026 limit on countable assets is $9,950 for one person and $14,910 for a couple, which is not a ceiling on everything you own. Wisconsin calls the QI tier SLMB+, and that tier additionally requires that you not be enrolled in full-benefit Medicaid, Family Planning Only Services, or Tuberculosis-Related Only Services. If you receive SSI, DHS enrolls you in QMB automatically and you do not need to apply.5

Income limits are tied to the Federal Poverty Level, and both the income and asset limits follow federal guidelines that can change each year. These are the federal standards, not a hard cutoff to screen yourself against: states can effectively raise both the income and the resource limits by disregarding certain income and resources, so a Wisconsinite above these figures should apply rather than rule themselves out. QI is also the one tier you must reapply for every year; qualifying once does not carry you into the next year.5 Apply online at access.wi.gov, or by phone, by mail, or in person with your county or tribal agency; a local SHIP counselor or the Medigap Helpline can walk you through the application.5 Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D; QDWI, the fourth savings program, does not.5

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources. The premium help runs up to your service area's regional benchmark premium, so a plan priced above the benchmark leaves you owing the difference. Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now receives the full benefit.12

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC (Alaska and Hawaii run higher)12
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell SSA you expect to use some of your resources for burial expenses12
• Full Extra Help enrollees pay no more than $5.10 per generic and $12.65 per brand-name covered drug, and $0 once out-of-pocket costs reach the $2,100 annual cap, a total that counts certain payments made on your behalf through Extra Help and not just your own copays; $5.10 and $12.65 are the ceiling, and full-benefit dual eligibles at or below 100% of the poverty level pay $1.60 and $4.90, or $0 if they are institutionalized or receiving home and community-based services12,3
• Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help; QDWI, the fourth savings program, does not5

Apply through Social Security at ssa.gov or call 1-800-772-1213.12

Medicare Enrollment Periods

Miss a deadline and you risk coverage gaps or permanent late penalties. These dates are federal and apply the same way in Wisconsin as everywhere else.13

Changes made during Annual Open Enrollment take effect January 1 of the following year. If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically; otherwise, you sign up through the Social Security Administration.13 If you're still working past 65 with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first; miss it and you wait for the General Enrollment Period (January 1 to March 31) and may owe a late penalty. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it qualifies before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).14

For the full picture on timing rules and late penalties, see our guide to Medicare enrollment periods.

Free Medicare Help: Wisconsin SHIP and Medigap Helpline

Wisconsin's free Medicare counseling all comes from one program, the State Health Insurance Assistance Program (SHIP), run by the Wisconsin Bureau of Aging and Disability Resources on federal grant funding from the Administration for Community Living, with its consumer page on the Wisconsin Department of Health Services site. You can reach SHIP in person through a local benefit specialist or by phone through the Medigap Helpline. Either way, counselors sell nothing and are paid by no insurance company or plan.1

Wisconsin SHIP provides free, confidential, one-on-one counseling through screened, trained, and certified counselors across the state. A SHIP counselor can help you:

• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Understand what each part of Medicare covers and what it costs
• Apply for the Medicare Savings Programs through ForwardHealth and for Extra Help
• Work through claims, denials, and appeals

Wisconsin Medigap Helpline (1-800-242-1060) is SHIP's statewide telephone service, a toll-free line run by the Wisconsin Board on Aging and Long-Term Care. Its counseling covers Medicare supplement insurance, Medicare Advantage plans, long-term care insurance, and employer-based health insurance, so it's the number to call if you're weighing Medigap options, comparing premiums, or checking whether a plan covers what you need. A separate Wisconsin Part D and Prescription Drug Helpline, 1-855-677-2783, answers questions about Part D and other prescription drug coverage.1

Reach the Medigap Helpline at 1-800-242-1060, or contact Wisconsin SHIP through the Wisconsin DHS benefit-specialists page to find a local benefit specialist.1

Key Wisconsin Medicare Contacts

Learn More

Find personalized help with Medicare in Wisconsin at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.