For many Wisconsin residents, trying to sort out Medicare and Medicaid can feel overwhelming, especially when you are trying to figure out which programs apply to you or someone you care about. To make it easier for you, here’s a quick breakdown of what you can expect from both Medicare and Medicaid in Wisconsin.
Medicare in Wisconsin: What You Need to Know
Medicare is the federal health insurance program for adults 65 and older as well as people with certain disabilities. Wisconsin’s Office of the Commissioner of Insurance (OCI) and the Department of Health Services (DHS) provide detailed public guides that help residents make sense of their Medicare options.
Medicare Parts A B C and D
Medicare has four main parts and each one covers a different set of services.
· Medicare Part A pays for hospital care,skilled nursing facility stays and some home health services.
· Medicare Part B includes outpatient care,doctor visits, preventive care and medical equipment.
· Medicare Part C, also called MedicareAdvantage, lets you receive Medicare benefits through managed care plansoffered in certain parts of Wisconsin. These may include extra benefits likedental, vision or wellness services.
· Medicare Part D provides prescriptiondrug coverage. Wisconsin residents can choose from several plans or look into SeniorCare, the state program that helps with prescription costs for adults 65and older.
Supplemental Coverage: Medigap
Even with Medicare, some costs are still out of pocket.Medigap plans help cover these gaps. Wisconsin requires all Medigap policies toinclude basic benefits, and many offer more. Prices vary a lot, so it helps tocompare plans using the state’s consumer guides.
Free Help for Medicare Beneficiaries
Wisconsin offers statewide helplines to answer questions about coverage, billing or supplemental insurance. These hotlines are funded by the state and are not tied to insurance companies.
Medicaid in Wisconsin: Support for a Wide Range ofNeeds
Medicaid is different from Medicare. It is a jointfederal and state program that helps people with limited income get healthcare. In Wisconsin, Medicaid covers more than one million residents, includingchildren, older adults, people with disabilities, pregnant individuals andadults with low income.
BadgerCare Plus: The Core Program
BadgerCare Plus is the main Medicaid program forresidents under 65. It covers:
· Children and teens
· Pregnant people with incomes up to 300 percentof the federal poverty level
· Adults under 65 with incomes up to the povertylevel
Wisconsin did not fully expand Medicaid under theAffordable Care Act. Even so, it is the only non expansion state without acoverage gap because adults up to the poverty level are still insured.
Coverage for Older Adults and People with Disabilities
For adults 65 and older as well as people with disabilities, Medicaid has income and asset limits. It can cover a wide range of services like personal care, long term care, medical equipment and prescription drugs. These programs are all documented through publicly available DHS resources.
Long Term Care Programs
Wisconsin offers several Medicaid funded programs that help people stay independent or receive coordinated support.
· Family Care and Family Care Partnership provide long term care and care coordination for older adults and people with disabilities.
· IRIS (Include Respect I Self Direct) lets participants direct their own care based on their needs and preferences.
· Children’s Long Term Support helpsfamilies with children who have developmental physical or emotionaldisabilities.
These programs allow thousands of Wisconsinites to remainat home or in community settings instead of moving to institutional care.
What Medicaid Covers
Medicaid in Wisconsin includes a wide range of servicessuch as:
· Doctor visits and preventive care
· Hospital and emergency services
· Prenatal and maternity care
· Mental health and substance use treatment
· Pediatric care vaccines and screenings
· Prescription medications
Medicaid also supports long term care foster careservices and programs for people with chronic or complex medical needs.
How to Apply for Medicaid in Wisconsin
Residents can apply for Medicaid, BadgerCare Plus orother benefits through ACCESS Wisconsin, the state’s online portal. Thesite lets users apply, upload documents, track application status and managerenewals.
Medicare and Medicaid Together: Dual Eligibility
Some residents qualify for both programs. When that happens Wisconsin offers coordinated services that help cover Medicare premiums, copays and deductibles. DHS provides public information on how the two systems work together to make care more affordable and easier to navigate.
