Medicare in Wisconsin: 2026 Plans, Costs, and Enrollment Guide

Wisconsin Medicare Snapshot

Wisconsin has one of the most distinctive Medicare markets in the country — 113 Medicare health plans from 18 carriers covering all 72 Wisconsin counties for 2026 (CMS 2026 MA & Part D Landscape Fact Sheet), including 14 Medicare Cost plans (§1876 contracts, NOT Medicare Advantage / Part C); the remaining 99 are Medicare Advantage. Wisconsin is also one of three states (with Massachusetts and Minnesota) that did not adopt the federal Medigap plan-letter standardization. Wisconsin Medigap is built around a state-standardized Wisconsin Basic Plan with optional rider benefits and state-defined 25% / 50% Medicare cost-sharing options (principally Wis. Stat. § 632.81 and Wis. Admin. Code Ins 3.39, administered by the Wisconsin Office of the Commissioner of Insurance).

The average consolidated premium across all 113 Wisconsin Medicare health plans is $23.44/month (CMS 2026 Medicare MA & Part D Landscape State-by-State Fact Sheet). The standard Medicare Part B premium is $202.90/month in 2026. The Wisconsin MA market is led by UnitedHealthcare (23 plans), Humana (19), and Quartz Medicare Advantage (HMO) (14) — a Wisconsin-based regional carrier with strong integrated-delivery presence.

Plan Types Available in Wisconsin

Medicare Advantage and Medicare Cost Plans

Wisconsin offers 113 Medicare health plans for 2026 from 18 carriers (CMS 2026 MA & Part D Landscape Fact Sheet) — including 14 Medicare Cost plans (§1876 contracts, NOT Medicare Advantage); the remaining 99 are Medicare Advantage (Part C). The largest categories are PPO (40), HMO-POS (22), HMO (16), Cost (14), and HMO D-SNP (10); additional MA plans fall outside these top categories.

Top carriers by plan count: UnitedHealthcare (23 plans), Humana (19 plans), and Quartz Medicare Advantage (HMO) (14 plans). Quartz is a Wisconsin-based regional carrier. Average MA star rating is 3.89 (CMS Star Ratings apply to MA and PDP contracts; Medicare Cost plans are generally not part of the MA Star Ratings program).

About Medicare Cost plans: Cost plans operate in counties that CMS has NOT determined to have significant Medicare Advantage competition (under 42 CFR Part 417 and related CMS guidance). They are structurally distinct from HMO/PPO MA plans: Original Medicare pays for out-of-network services (you can use any Medicare provider), and the plan covers in-network services.

Medigap (Wisconsin Basic Plan + Riders)

Wisconsin does not use federal Medigap plan letters. Under Wis. Stat. ch. 600 and Wisconsin Office of the Commissioner of Insurance (OCI) regulations, Wisconsin Medigap insurers sell a state-standardized structure:

• Wisconsin Basic Plan: The mandatory base policy covering core federal Medigap benefits (Part A and Part B coinsurance, hospital extension days, the first three pints of blood, and other statutorily required benefits).
• Optional Medicare riders: Carriers may sell rider benefits in addition to the Basic Plan, such as Part A deductible coverage, Part B deductible coverage (available only to those who became Medicare-eligible before January 1, 2020, mirroring federal MACRA 2015), Part B excess charges, foreign-travel emergency, additional home-health-care visits, and preventive coverage.
• 25% and 50% Medicare cost-sharing options: State-defined high-cost- sharing variants (similar in concept to federal Plans K and L) that combine the Wisconsin Basic Plan with a defined percentage of Medicare cost-sharing.
• High-deductible Wisconsin Medigap:High-deductible variants of the Wisconsin standardization (conceptually similar to federal HDG) are offered by some carriers; per Wisconsin OCI rules, the high-deductible amount tracks the federal HDG/HDF deductible ($2,950 in 2026, per CMS's 2026 Medigap High-Deductible Options notice). Wisconsin does not sell federal-letter Medigap plans, so the federal HDF designation does not apply in Wisconsin.

Wisconsin Medigap rates use attained-age pricing — premiums increase as you age. Premium comparisons should be made between Wisconsin Medigap policies, not against federal plan letters from out-of-state. If you are moving to or from Wisconsin →

Standalone Part D (Prescription Drug Plans)

Wisconsin is a single-state PDP region (CMS PDP Region 16). For 2026, there are 10 standalone PDP plans from 5 carriers in Wisconsin. The CMS LIS benchmark for Region 16 is $21.12/month.

Costs in Wisconsin

Medicare Advantage Premiums

The average consolidated premium across all 113 Wisconsin Medicare health plans (MA + Cost combined) is $23.44/month (CMS 2026 Medicare MA & Part D Landscape State-by-State Fact Sheet). The standard Medicare Part B premium is $202.90/month in 2026.

Wisconsin Medigap Premiums

Wisconsin Medigap rates use attained-age pricing — premiums are based on your current age and increase as you age. Because Wisconsin uses its own Basic Plan + riders + 25% / 50% cost-sharing structure rather than federal plan letters, premium comparisons should be made between Wisconsin policies. For 2026 quotes, use our Medigap comparison tool.

Part D Costs and the LIS Benchmark

For 2026, Wisconsin (PDP Region 16 — single-state) has 10 standalone PDP plans from 5 carriers (CMS CY2026 Landscape). The CMS Low Income Subsidy (LIS / Extra Help) benchmark premium for Region 16 is $21.12/month (CMS CY2026 Regional Rates and Benchmarks).

Wisconsin-Specific Medicare Rules

Wisconsin Custom Medigap Standardization

Wisconsin's Medigap law (Wis. Stat. ch. 600, OCI regulations) predates the federal Medigap standardization adopted by most states under OBRA 1990, and Wisconsin elected to retain its own structure. The result is a hybrid: a state-standardized Wisconsin Basic Plan that all WI Medigap carriers must offer, plus a menu of OCI-approved riders and state-defined 25% / 50% cost-sharing variants. Federal MACRA 2015 still applies — the Part B deductible rider is available only to those who first became Medicare-eligible before January 1, 2020.

Medicare Savings Programs (MSPs)

Wisconsin offers Medicare Savings Programs (MSPs) through the Wisconsin Department of Health Services (Medicaid / BadgerCare):

• QMB (Qualified Medicare Beneficiary): Covers Part A and Part B premiums, deductibles, and cost-sharing.
• SLMB (Specified Low-Income Medicare Beneficiary): Covers Part B premiums only.
• QI (Qualifying Individual): Also covers Part B premiums; subject to annual appropriations.

Apply through the Wisconsin Department of Health Services or contact the Medigap Helpline (1-800-242-1060) for free enrollment assistance. MSP enrollment also automatically qualifies you for Extra Help / LIS on Part D. Learn more about MSPs →

Wisconsin Medigap Helpline (SHIP)

The Wisconsin Medigap Helpline is Wisconsin's federally designated State Health Insurance Assistance Program (SHIP). The Helpline provides free, unbiased Medicare counseling statewide.

Phone: 1-800-242-1060
Website: dhs.wisconsin.gov/ship

For Wisconsin Medigap rate filings and insurance regulatory questions, contact the Wisconsin Office of the Commissioner of Insurance (OCI): oci.wi.gov.

Enrolling in Medicare in Wisconsin

Standard Enrollment Periods

• Initial Enrollment Period (IEP): 7-month window centered on your 65th birthday month. Enroll at ssa.gov or call 1-800-772-1213.
• Annual Election Period (AEP): October 15 – December 7 each year.
• Medicare Advantage Open Enrollment Period (OEP): January 1 – March 31.
• Federal 6-month Medigap OEP: Starts when you are 65+ and enrolled in Part B; first-time Medigap guaranteed-issue for Wisconsin Basic Plan + riders.
• Special Enrollment Periods (SEPs): Learn more →

Wisconsin Medigap Helpline Counseling

Contact the Medigap Helpline at 1-800-242-1060 for free one-on-one Medicare guidance statewide.

Frequently Asked Questions