Medicare Part D Plans in Wisconsin
President Lyndon Johnson signed Original Medicare into law in 1965, with the goal of helping seniors pay healthcare costs after they retired. Medicare did not include coverage for prescription medications until Congress passed the Medicare Modernization Act (MMA) in 2003. The passage of MMA increased beneficiaries' Medicare plan options and introduced Part C (Medicare Advantage) and Part D (prescription drug coverage). This page explains Medicare Part D in Wisconsin.
How Can You Get Medicare Part D in Wisconsin?
There are two ways to get Medicare Part D in Wisconsin:
- A standalone Medicare Part D plan
- A Medicare Advantage Prescription Drug plan (MA-PD)
Original Medicare's benefits include Part A, hospital insurance, and Part B, medical insurance. Medicare Advantage plans must offer the same cover you would have with Original Medicare. Most, though, provide additional benefits as well, including prescription drugs, routine vision and dental care, and fitness programs.
You can pair a standalone Part D plan with either Original Medicare or an Advantage plan if it does not include prescription drug coverage. (This accounts for around 10 percent of MA plans.)
If you're looking for an all-in-one plan, a Medicare Advantage Prescription Drug plan is your best bet. These plans bundle your Original Medicare and Part D benefits into a single policy.
You may not enroll in both a standalone Part D plan and an MA-PD plan.
Who Is Eligible for Medicare Part D in Wisconsin?
Once you sign up for Medicare Part A and/or Part B, you become eligible for Part D as well. You must also meet the plan's requirements, which usually just means living in the plan's service area.
If you are a U.S. citizen or permanent legal resident, you will become eligible for Medicare once you turn 65. Enrollment is only automatic if you began receiving Social Security benefits at least 4 months before your 65th birthday. Otherwise, you must apply for Medicare through Social Security.
You may qualify for Medicare before you turn 65 if you collect Social Security disability benefits for 24 months. In this case, enrollment in both Parts A and B occurs automatically during your 25th month of collecting disability benefits.
Medicare Part D enrollment is never automatic. You must always choose to join a prescription drug plan, even if you didn't have to sign up for Parts A and B.
When Can You Enroll in a Prescription Drug Plan in Wisconsin?
Medicare limits Part D enrollment in Wisconsin to specific times.
- Initial Enrollment Period: Your IEP lasts for 7 months and begins 3 months before the month you first become eligible for Medicare. For example, if your 65th birthday or 25th month of collecting disability benefits occurs in June, your IEP begins on March 1 and ends on September 30. After you enroll in Part A and/or Part B, you may then register for a Medicare Part D prescription drug plan
- General Enrollment Period: Between January 1 and March 31, if you missed your Initial Enrollment Period AND do not qualify for a Special Enrollment Period (SEP), you may sign up for Medicare Part A and/or Part B. You then have from April 1 through June 30 to join a prescription drug plan.
- Medicare Annual Enrollment Period: AEP lasts from October 15 through December 7 and allows current Medicare beneficiaries to make a variety of changes to their Medicare coverage, including joining an MA-PD or Part D plan.
- Medicare Advantage Open Enrollment Period: From January 1 through March 31, Medicare Advantage enrollees are able to either switch to a new Advantage plan or return to Original Medicare. You may also sign up for a standalone Part D plan if making that change causes you to lose your prescription drug coverage.
- Special Enrollment Periods: Certain life changes, such as moving to a new address or losing your current coverage through no fault of your own may qualify you for a Special Enrollment Period. Find the full list of qualifying special circumstances on Medicare.gov here.
Comparing Medicare Part D Plans in Wisconsin
As private insurance companies contract with Medicare to provide prescription drug plans, coverage and costs may vary widely from plan to plan. You need to compare your Wisconsin prescription drug plan options carefully to ensure you get the best plan for your unique needs and budget,.
Start by comparing a list of your prescription medications to the plan's drug formulary (the medications covered by the plan). If one or more of your medications is not included in the drug formulary, continue looking until you find a plan that does.
Review the Part D plan's drug tiers next. This helps you estimate what your copay or coinsurance would be for a particular medication. You will pay less for drugs on the lower tiers than you will for those on the top tiers.
Medicare Part D's out-of-pocket costs may include an annual deductible and monthly premium in addition to copays or coinsurance. Consider all three of these metrics when estimating your costs for a particular prescription plan.
Extra Help is available to Medicare beneficiaries who meet certain income and resource requirements. Either Medicare or Social Security should send you written notification if you qualify for Extra Help in Wisconsin. Contact your plan provider if you think you meet the requirements but did not receive this notification.
Please note that all communications from both Medicare and Social Security are via U.S. mail. Unless you requested a phone call, nobody from either program will ever call you. If you do receive a call from someone claiming to work for Medicare or Social Security, hang up the phone. Then, call the appropriate program (1-800-MEDICARE or 1-800-772-1213). Explain what happened and follow the representative's instructions.
Do You Have to Have Medicare Part D in Wisconsin?
No part of Medicare is mandatory in Wisconsin, including prescription drug coverage. But you may have to pay the Part D late enrollment penalty if delay signing up AND do not have creditable coverage elsewhere. To be considered creditable, the plan must be comparable to Medicare Part D in terms of both price and benefits. Going 63 days or more without creditable prescription drug coverage could land you with lifelong late penalties when you do finally join a Part D plan.