State of Wisconsin Medicare Advantage Information

As of 2010, more than 40 million people in the United States were enrolled in Medicare, the government's health insurance plan designed for senior citizens. Medicare comes in four basic categories, labeled A, B, C and D. Parts A and B cover hospital, home health and hospice care, while Part D benefits are for prescription medications. Part C, Medicare Advantage, is different than the other parts of Medicare. It combines all the benefits of Part A and Part B but is sold only through private insurance companies. In Wisconsin, Medicare Advantage plans are overseen by the state Commissioner of Insurance.

Service Area

• Not all Medicare Advantage plans are sold in every area of Wisconsin. Companies that provide Medicare Advantage plans do so according to service area. It is possible to buy an MA plan and then move out of its service area if you go to another city or county. In these cases, you will have change companies or purchase a different plan from the same company. Your company may also elect to drop its plan or not renew its contract in certain service areas. If you involuntarily dis-enrolled because of this, you will automatically be covered under original Medicare.

HMO and POS Plans

• Medicare Advantage in Wisconsin can be sold as a number of different kinds of plans. Amongst the most popular are HMO (health maintenance organization) and POS (point of service) policies. Both of these supply a network of preferred medical providers. With an HMO plan, you must generally receive all services from within the network. With a POS, you may be allowed to go outside the network if you agree to pay higher costs. POS plans may also ask that users obtain referrals from their primary care physicians before the insurance company will pay anything for out-of-network services. HMOs and POS plans in Wisconsin cover only certain geographical areas.

Special Needs Plans

• Special needs plans are Medicare Advantage plans customized for people with certain conditions or who are in specific financial situations. Some SNPs are for those living in nursing homes or other kinds of institutions, while others are only for dual-eligibility residents who qualify for both Medicaid and Medicare. SNPs usually enroll only a small number of people and are offered in limited areas.

Medicare Medical Savings Account Plans

• Wisconsin residents can purchase Medicare Advantage plans, which will work with medical savings accounts. These are high-deductible policies that offer the same benefits as original Medicare Parts A and B. These kinds of Medicare Advantage plans will deposit money straight into your savings account to help you pay for services and to meet deductibles.

Mandated Benefits

• Most Wisconsin insurance is regulated by a mandated benefit law, which requires companies to cover specific services, such as skilled nursing care and diabetic supplies. MA plans are required to include Part A and B benefits by federal law, but they do not have to comply with Wisconsin's mandated benefits law.