Medicare Part A is hospitalization insurance — free for most people. It covers inpatient hospital stays, skilled nursing facility care, limited home health care, and hospice care for the terminally ill. It does not cover personal or custodial care such as help with eating, dressing, or moving around.
A benefit period begins the day you are admitted and ends when you've been out of the hospital or nursing facility for 60 consecutive days.
What is Medicare Part B?
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Medicare Part B is medical insurance covering doctor visits, outpatient care, surgical care, diagnostic tests, lab services, preventive services, physical and occupational therapy, and durable medical equipment. It does not cover prescription drugs, dental care, routine physicals, or services unrelated to treatment of illness or injury.
2026 Part B Costs:
Standard Monthly Premium: $202.90/month (automatically deducted from your Social Security check). Higher-income beneficiaries may pay more based on their income.
Annual Deductible: $283 per year
After deductible: Medicare pays 80% of approved charges — you pay the remaining 20%
Excess charges: Doctors who don't accept Medicare assignment can charge up to 15% above the Medicare-approved amount — you are responsible for that difference
A Medicare Supplement policy can help cover your 20% coinsurance and excess charges.
What is the difference between Medicare Advantage and Original Medicare?
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Original Medicare (Parts A & B) is provided directly by the federal government and lets you see any doctor that accepts Medicare nationwide. Medicare Advantage (Part C) is offered through private insurers approved by Medicare. It bundles your Medicare benefits and may include extra services like vision, hearing, and dental — but typically limits you to a network of providers and may include deductibles and copayments.
What is the difference between Medicare Advantage and a Medicare Supplement (Medigap) plan?
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Medicare Advantage (Part C) replaces Original Medicare. Offered through private insurers, it may include extra benefits like dental and vision, but restricts you to a provider network and may include copays.
Medicare Supplement (Medigap) works alongside Original Medicare to cover out-of-pocket costs like deductibles and coinsurance. You can see any Medicare-accepting doctor nationwide. It does not include prescription drug coverage — you'll need a separate Part D plan.
Important for Wisconsin residents: Medicare Advantage plans are NOT required to cover Wisconsin mandated benefits, and they are not guaranteed renewable for life — unlike Medicare Supplement policies.
What is Medicare Part D?
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Medicare Part D helps pay for outpatient prescription drug costs. It's optional but recommended — if you skip Part D when first eligible and go 63+ days without creditable drug coverage, you may face a permanent late enrollment penalty. For 2026, the late enrollment penalty equals 1% of the national base beneficiary premium ($38.99/month) for every month you waited to enroll.
What does Medicare NOT cover?
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Medicare was not designed to pay all your health care expenses. Common services NOT covered include:
Long-term/custodial care (help with eating, bathing, dressing)
Most dental care, eyeglasses, and hearing aids
Routine check-ups and cosmetic surgery
Private duty nursing
Prescription drugs (without Part D)
A Medicare Supplement or Advantage plan can help fill many of these gaps.
🛡️ Coverage & Plans
What are Wisconsin's mandated Medicare Supplement benefits?
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Wisconsin law requires Medicare Supplement and Medicare SELECT policies to include these extra benefits — even when Medicare doesn't cover them:
Skilled Nursing: 30 days in a licensed skilled nursing facility (no prior hospitalization required)
Home Health Care: 40 additional home care visits per year beyond Medicare
Kidney Disease: Up to $30,000/year for dialysis or transplantation
Diabetes Treatment: Insulin pumps and self-management services
Chiropractic Care: Usual and customary expenses
Breast Reconstruction & Colorectal Cancer Screening
Note: Medicare Advantage plans are NOT required to provide these Wisconsin mandated benefits.
What are the 2026 Medicare cost-sharing limits in Wisconsin?
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For 2026, key cost figures include:
Part A deductible: $1,736 per benefit period
Part B deductible: $283 per year
High-deductible supplement plan deductible: $2,950
25% cost-sharing out-of-pocket limit: $4,000
50% cost-sharing out-of-pocket limit: $8,000
Part D base beneficiary premium: $38.99/month
How do I choose the right Medicare plan?
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Choosing the right plan depends on your health needs, preferred doctors, current medications, and budget. Wisconsin offers unique Medicare Supplement policies different from other states due to a federal waiver. As an independent agent, Brad shops 21 top-rated carriers to find the best match for your specific situation — at no cost to you.
Is a Medicare Supplement policy guaranteed renewable?
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Yes — all Medicare Supplement and Medicare SELECT policies sold in Wisconsin are guaranteed renewable for life, meaning you can keep your policy as long as you pay the premium. The insurance company cannot cancel your coverage due to health changes, though premiums may increase. Medicare Advantage plans are NOT guaranteed renewable.
What is the 30-day free look period?
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All Medicare Supplement and Medicare SELECT policies sold in Wisconsin include a 30-day free-look period. If you're not satisfied with your policy, you can return it within 30 days for a full refund — as long as no claims have been made. Use this time to review your coverage carefully.
📋 How to Get Started
When can I enroll in Medicare?
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Your Initial Enrollment Period (IEP) is a 7-month window — it begins 3 months before the month you turn 65 and ends 3 months after. Missing this window without a qualifying Special Enrollment Period can result in permanent late enrollment penalties. If you're under 65 and eligible due to disability, you get another 6-month open enrollment period when you turn 65.
When is Medicare Open Enrollment?
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Medicare Annual Open Enrollment runs October 15 – December 7 each year. During this period you can join, switch, or drop a Medicare Advantage or Part D plan — coverage begins January 1. Those already on Medicare Advantage have an additional opportunity to switch plans from January 1 – March 31. Brad reviews your coverage every year during Open Enrollment to make sure you have the best plan.
What is a Special Enrollment Period (SEP)?
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If you didn't enroll in Medicare Part B when first eligible because you or your spouse had employer group coverage, you may qualify for a Special Enrollment Period (SEP). You have an 8-month SEP starting from the month employment or group coverage ends — whichever comes first. COBRA and retiree plans do not count as current employment coverage.
What is Medicare Supplement Open Enrollment?
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Medicare Supplement open enrollment is a one-time, 6-month window starting the day you enroll in Medicare Part B at age 65 or older. During this period, insurance companies cannot deny you coverage, charge more due to health history, or impose waiting periods based on preexisting conditions. This is the best time to enroll in a Medigap policy.
Can I get Extra Help paying for Medicare Part D?
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Yes! The federal Extra Help (Low Income Subsidy) program assists with Part D prescription drug costs. For 2026, you may qualify if your resources are less than $17,600 (individual) or $35,130 (married couples). Apply through the Social Security Administration at ssa.gov or call 1-800-772-1213. Wisconsin's SeniorCare program (1-800-657-2038) also provides prescription assistance for residents 65+.
❤️ Health & Life Insurance
Do I still need additional coverage if I have Medicare?
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Medicare was never intended to pay 100% of your medical bills. Even covered services aren't fully covered — you'll face deductibles, copays, and coinsurance. Common gaps include dental, vision, hearing aids, and long-term care. A Medicare Supplement (Medigap) or Medicare Advantage plan can help cover these out-of-pocket costs. Brad can help evaluate what makes sense for your specific situation.
What if I cannot afford a Medicare Supplement policy?
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If you can't afford a Medicare Supplement premium, Wisconsin offers help:
Medicaid: Pays nearly all health care costs for those who qualify
QMB Program: Pays Medicare premiums, deductibles, and coinsurance for low-income beneficiaries
SLMB Program: Pays your Medicare Part B premium if income doesn't exceed poverty level by more than 20%
SHIP/Medigap Helpline: Free counseling at 1-800-242-1060
Brad can help connect you with the right resources.
What life insurance options are available?
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Brad offers a variety of life insurance options including term life, whole life, final expense insurance, and mortgage protection. These plans help protect your family's financial future and can be tailored to fit your budget and needs.
📞 Contact & Support
Do you offer free consultations?
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Yes! All consultations are completely free and come with no obligation. Brad is here to educate and guide you — never to pressure you into a plan that isn't right for you. You do not have to pay an enrollment fee or pay for assistance to enroll in Medicare plans.
Brad serves clients throughout the Fox Cities area and all of Wisconsin. Whether you're local to Kimberly or anywhere across the state, Brad can help you find the right Medicare and insurance coverage.
Where can I get free Medicare counseling in Wisconsin?
Hi! I'm Brad's virtual assistant. I can help answer questions about Medicare, health, auto, home, life, and business insurance in Wisconsin. What can I help you with today?
AI assistant — for personalized advice call (920) 251-4969