Wisconsin-specific answers across all the insurance products Brad offers — updated for 2026. Click any category tab to browse, or use Ctrl+F to search for a specific question.
Medicare Part A is your hospital insurance. In 2026 it covers: inpatient hospital stays (semi-private room, meals, general nursing, drugs administered during your stay); skilled nursing facility (SNF) care following a qualifying 3-day hospital stay; home health care (part-time skilled nursing, physical therapy, speech-language therapy); and hospice care for terminal illness. Part A does not cover outpatient care, prescription drugs, dental, vision, or hearing — those require Part B, Part D, or a Medicare Supplement plan.
Most people pay $0 premium for Part A if they (or their spouse) worked at least 40 quarters (10 years) and paid Medicare taxes. If you worked 30–39 quarters, your 2026 premium is $285/month. If you worked fewer than 30 quarters, it is $518/month. In addition, there is a per-benefit-period deductible of $1,676 for hospital stays, plus daily coinsurance charges for extended stays. A Medicare Supplement plan can help cover these out-of-pocket costs.
A benefit period begins the day you are admitted as an inpatient to a hospital or SNF and ends when you have been out of inpatient care for 60 consecutive days. There is no limit to the number of benefit periods you can have, but you pay a new $1,676 deductible for each one. For days 1–60 in a hospital, Part A pays all covered costs after the deductible. Days 61–90 carry a $419/day coinsurance, and days 91+ use your 60 lifetime reserve days at $838/day. Understanding benefit periods is critical to planning your coverage — Brad can walk you through how a Medicare Supplement plan can eliminate most of these costs.
For most people, enrollment is automatic. If you are already receiving Social Security or Railroad Retirement benefits, you will be automatically enrolled in Part A (and Part B) the month you turn 65 — no action needed. If you are not yet receiving benefits, you must actively enroll during your Initial Enrollment Period (IEP) — a 7-month window starting 3 months before your 65th birthday month and ending 3 months after. Delaying enrollment past your IEP without qualifying coverage can result in a late enrollment penalty and a gap in coverage.
Yes, and since Part A is premium-free for most people, many choose to enroll in Part A even while continuing to work. However, if you contribute to a Health Savings Account (HSA) through your employer, enrolling in any part of Medicare — including Part A — makes you ineligible to continue making HSA contributions. If avoiding that restriction matters to you, you may want to delay Part A until you retire. Brad can help you weigh the pros and cons based on your specific situation.
Yes, but with conditions. Part A covers SNF care only if: (1) you had a qualifying inpatient hospital stay of at least 3 days, and (2) you need skilled care such as skilled nursing or physical therapy — not just custodial or personal care. Coverage in 2026: Days 1–20 are fully covered by Part A. Days 21–100 carry a $209.50/day coinsurance. After day 100, Part A pays nothing. A Medicare Supplement plan can cover the daily coinsurance, giving you significant financial protection for extended SNF stays.
You are eligible for Medicare Part A if you are: age 65 or older and a U.S. citizen or permanent resident who has lived in the U.S. for at least 5 consecutive years; under 65 with a qualifying disability after receiving Social Security Disability Insurance (SSDI) for 24 months; or any age with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's Disease). Not sure if you qualify? Call Brad at (920) 251-4969 for a free eligibility review.
If you are not automatically enrolled and you miss your Initial Enrollment Period without having other qualifying coverage, you may face a late enrollment penalty. Your Part A premium will increase by 10% for twice the number of years you went without coverage. For example, if you delayed enrollment for 2 years, you pay the penalty for 4 years. This is why it is important to enroll on time or make sure you have creditable coverage in place. Brad can help you avoid this penalty entirely.
Medicare Part B is your medical insurance. It covers two main categories of services: medically necessary services — doctor visits, outpatient care, lab tests, X-rays, ambulance services, durable medical equipment (DME), and mental health services; and preventive services — annual wellness visits, flu shots, cancer screenings, and other preventive care, often at no cost to you. Part B does not cover prescription drugs (that's Part D), routine dental, vision, hearing, or cosmetic procedures. A Medicare Supplement plan can help cover what Part B leaves behind.
In 2026, the standard monthly Part B premium is $202.90 — an increase of $17.90 from $185.00 in 2025. The annual deductible is $283 (up from $257 in 2025). After meeting the deductible, Medicare pays 80% of approved costs and you pay the remaining 20% coinsurance with no annual out-of-pocket cap under Original Medicare alone. High-income earners pay more through IRMAA surcharges. A Medicare Supplement plan can cover most or all of that 20%, protecting you from unexpected large bills.
No, Part B is voluntary — but most people should enroll when first eligible. Here's what to know:
Not sure what applies to you? Call Brad at (920) 251-4969 for a free no-obligation review.
If you delay enrolling in Part B without qualifying coverage (such as active employer insurance), you will face a permanent late enrollment penalty. Your monthly premium increases by 10% for each full 12-month period you went without Part B. For example, if you delayed 2 years, your premium is permanently 20% higher for as long as you have Part B. This makes enrolling on time — or understanding exactly when you can delay — critically important. Brad can help you avoid this penalty entirely.
IRMAA stands for Income-Related Monthly Adjustment Amount. If your modified adjusted gross income (MAGI) exceeds certain thresholds, you pay a surcharge on top of the standard $202.90 Part B premium. In 2026, IRMAA applies to individuals earning over $106,000 (or couples over $212,000). Surcharges are based on your income tax return from two years prior — so your 2026 premium is based on 2024 income. If your income has dropped significantly since then (due to retirement, for example), you can appeal the IRMAA determination with Social Security.
Yes. Medicare Part B covers many preventive services at $0 cost to you — meaning no deductible or coinsurance — when provided by a Medicare-participating provider. These include: your annual wellness visit, cardiovascular screenings, colorectal cancer screenings, mammograms, flu and pneumonia shots, diabetes screenings, depression screenings, and more. It's one of the most overlooked benefits of Part B. Brad can help you understand which screenings you're entitled to and make sure your plan maximizes this coverage.
Doctors who accept Medicare assignment agree to charge only Medicare-approved rates, meaning you pay just 20% after your deductible. Doctors who do not accept assignment may charge up to 15% more than the Medicare-approved amount — a "limiting charge" — which you would pay out of pocket. To avoid surprise bills, always confirm your doctor accepts Medicare assignment before your visit. Most Wisconsin providers do accept assignment, and Brad can help you find plans and providers that keep your costs predictable.
Yes — and this is one of the most powerful reasons to consider a Medicare Supplement (Medigap) plan. Depending on the plan you choose, a Supplement can cover your Part B deductible ($283 in 2026), your 20% coinsurance, and even excess charges from doctors who don't accept assignment. Since Original Medicare has no annual out-of-pocket cap, a Supplement gives you financial predictability. Brad shops multiple top carriers to find you the best Supplement plan at the lowest premium. Learn more about Medicare Supplement plans →
Yes and no. Medicare Advantage (Part C) plans include all Part A and Part B benefits — but they are administered by a private insurance company rather than the federal government. You must remain enrolled in Part B and continue paying your Part B premium ($202.90/month in 2026) even with a Medicare Advantage plan. In return, the Advantage plan may offer additional benefits like dental, vision, hearing, and fitness coverage, and often has lower or $0 plan premiums. Brad can compare Advantage vs. Original Medicare + Supplement options side by side for your specific situation.
Medicare Advantage, also known as Part C, is an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare (Parts A and B) covers, but they do so through their own network of doctors and hospitals — often with additional benefits like dental, vision, hearing, and prescription drug coverage built in. The federal government pays the private insurer a fixed amount to manage your care. You still pay your Part B premium ($202.90/month in 2026), and the plan may charge its own additional premium on top of that — though many plans charge $0 extra.
In 2026, the average monthly Medicare Advantage premium is $14.00 — down from $16.40 in 2025. Two-thirds of all Medicare Advantage plans with drug coverage charge $0 in additional premium beyond the standard Part B premium. You will still pay your Part B premium of $202.90/month. Beyond premiums, Advantage plans use copays and coinsurance for services, and have an annual out-of-pocket maximum of $9,250 for in-network services in 2026 — once you hit that cap, the plan pays 100% for covered services for the rest of the year. Brad can compare plans side by side to find the best value for your needs.
There are several types of Medicare Advantage plans:
Brad can walk you through which plan type makes the most sense for your health needs and preferred providers.
Most do — in 2026, 89% of Medicare Advantage plans include Part D prescription drug coverage built in (called MA-PD plans). This means you typically do not need to purchase a separate Part D plan if you enroll in one of these. Each plan has its own formulary (drug list) and tier structure, so it's important to confirm your specific medications are covered before enrolling. Brad reviews your current prescriptions against available plans to make sure you get the best drug coverage at the lowest cost.
Medicare Advantage plans can offer benefits far beyond what Original Medicare covers. In 2026, nearly all plans offer: dental, vision, and hearing coverage; fitness memberships (93% of plans); and many offer over-the-counter item allowances (66% of plans). Some plans also offer meal delivery, transportation to medical appointments, home safety modifications, and caregiver support. Additionally, in 2026, all plans are required to match or improve upon Original Medicare's cost-sharing for mental health and substance use disorder services. Benefits vary by plan and location — Brad can help you find a plan with the extra benefits that matter most to you.
Yes — this is one of the most valuable and overlooked features of some Medicare Advantage plans. In 2026, nearly one-third of individual Medicare Advantage plans offer a Part B premium reduction as a supplemental benefit. Among those plans, more than a third offer reductions of over $100/month. This means some enrollees effectively pay less than $202.90/month for their Part B coverage. Plan availability varies by ZIP code, so not every plan is available in every area. Brad can check which premium-reducing plans are available to you in Wisconsin.
Yes, most Medicare Advantage plans use provider networks. With an HMO, you must generally use in-network doctors and get referrals for specialists — going out of network typically means paying full cost. With a PPO, you can see out-of-network providers but pay more. All Medicare Advantage plans are required to cover emergency and urgent care nationwide regardless of network. Starting in 2026, the Medicare Plan Finder now shows provider network information directly, making it easier to confirm your doctors are covered before you enroll. Brad can verify your preferred providers are in-network before you sign up.
There is no one-size-fits-all answer — it depends on your health, budget, and priorities:
Brad specializes in comparing both options side by side for Wisconsin residents. Call (920) 251-4969 for a free no-obligation review.
There are several enrollment windows:
No — it is illegal to be enrolled in both simultaneously. Medicare Supplement (Medigap) plans are designed to work alongside Original Medicare only. If you enroll in a Medicare Advantage plan, your Medigap coverage cannot pay for any costs, making it useless and a waste of premium dollars. An agent is prohibited by law from knowingly enrolling you in both. If you want the flexibility of a Supplement, you must be on Original Medicare. Brad will always make sure your coverage is structured correctly and legally.
Medicare Part D is prescription drug coverage offered through private insurance companies approved by Medicare. It helps pay for generic and brand-name prescription drugs at pharmacies. Part D can be obtained two ways: as a standalone Prescription Drug Plan (PDP) added to Original Medicare, or bundled into a Medicare Advantage plan with drug coverage (MA-PD). Each plan has its own formulary (list of covered drugs), premiums, deductibles, and pharmacy network. Original Medicare (Parts A and B) does not cover most outpatient prescription drugs, making Part D essential for most beneficiaries.
Part D costs in 2026 include:
Brad compares plans across multiple carriers to find the lowest total cost for your specific medications.
In 2026, Part D has been simplified to three stages:
The old "donut hole" coverage gap has been eliminated. 2026 is significantly more protective than prior years.
No, Part D is not mandatory. However, if you go without creditable prescription drug coverage when first eligible and later decide to enroll, you will face a permanent late enrollment penalty. The penalty is calculated as 1% of the national base beneficiary premium ($38.99 in 2026) multiplied by the number of uncovered months — and it's added to your premium for as long as you have Part D. If you have other creditable drug coverage (such as through an employer, VA, or TRICARE), you may delay Part D without penalty. Not sure if your coverage qualifies? Brad can review it for free — call (920) 251-4969.
Yes, enrolling in at least a low-premium Part D plan is strongly recommended even if you currently take no medications. Here's why:
Brad can find you a low-cost plan that keeps you protected without breaking the bank.
Choosing the right Part D plan requires comparing several factors specific to your situation:
This is exactly what Brad does for free — he enters your medications, dosages, and preferred pharmacy into a plan comparison tool across all available Wisconsin carriers and finds you the best total value. Call (920) 251-4969 to get started.
Working with Brad makes enrolling in Part D simple and free:
Ready? Call (920) 251-4969 or request a free review online.
The Medicare Prescription Payment Plan (MPPP) is a newer benefit available in 2026 that allows Part D enrollees to spread their out-of-pocket drug costs into capped monthly payments throughout the year, rather than paying large amounts all at once at the pharmacy. All Medicare Part D plans are required to offer this option. Starting in 2026, if you were enrolled in the MPPP in 2025, you will be automatically re-enrolled each year unless you opt out — no action needed. Important note: the MPPP helps manage cash flow but does not lower your total drug costs or save you money. Ask Brad if this program makes sense for your situation.
Extra Help (also called the Low Income Subsidy or LIS) is a federal program that helps people with limited income and resources pay for Part D costs — including premiums, deductibles, and copays. If you qualify, you could pay little to nothing for your prescription drugs. Eligibility is based on income and assets. In 2026, individuals with incomes up to 150% of the federal poverty level may qualify. You apply through Social Security. Brad can help you determine if you or a family member may qualify — this is one of the most underutilized benefits in Medicare.
Yes — 2026 marks a major milestone in Medicare drug pricing. For the first time, Medicare has negotiated lower prices on 10 high-cost prescription drugs, including medications for arthritis, blood clots, cancer, and diabetes. These negotiated prices took effect January 1, 2026 and must be honored by all Medicare Advantage and standalone Part D plans. The savings are estimated to reduce out-of-pocket spending by $1.5 billion across all beneficiaries in 2026. Additionally, GLP-1 weight-loss medications from Eli Lilly and Novo Nordisk are expected to become available at lower prices through Medicare starting in July 2026. Brad stays current on all drug pricing changes so he can find you the best plan for your medications every year.
Medicare Supplement insurance — also called Medigap — is a secondary insurance policy sold by private companies that helps pay for the out-of-pocket costs that Original Medicare (Parts A and B) leaves behind, such as copays, coinsurance, and deductibles. Medigap always pays after Original Medicare pays its share first. It has no provider networks, no referrals required, and works with any doctor or hospital in the U.S. that accepts Medicare. You must be enrolled in both Medicare Part A and Part B to purchase a Medigap policy. Note: Medigap does not include prescription drug coverage — you'll need a separate Part D plan for that.
Wisconsin is one of only three states in the country — along with Massachusetts and Minnesota — that have a federal waiver to run their own Medigap standardization system. In most states, you choose from 10 standardized lettered plans (Plan A through Plan N). In Wisconsin, there is one Basic Plan with a core set of mandated benefits, and you customize it by adding optional riders to build the coverage you need. This "build your own" approach gives Wisconsin residents more flexibility but can also make comparison shopping more complex. Brad specializes in Wisconsin Medicare Supplement plans and can walk you through exactly which riders make sense for your situation.
The Wisconsin Basic Plan includes these core benefits as standard:
Additional coverage is available by adding riders for the Part A deductible, Part B deductible (if eligible), foreign travel emergencies, and more.
Wisconsin Medicare Supplement enrollees can choose from four plan structures:
Brad can compare all four structures and help you select the right riders to match your health needs and budget.
The best time — and the most important window — is your Medigap Open Enrollment Period. This 6-month window starts the first month you are both enrolled in Medicare Part B and age 65 or older. During this period:
This is a one-time window — it does not repeat. After it closes, insurers can use medical underwriting to deny your application or charge higher premiums. Enrolling on time is one of the most impactful Medicare decisions you can make. Brad can make sure you don't miss it.
Outside of your Open Enrollment Period, yes — insurance companies can use medical underwriting to review your health history and either deny your application or charge higher premiums based on pre-existing conditions. This is one of the most critical reasons to enroll during your Open Enrollment Period when guaranteed issue rights protect you. There are limited Special Enrollment Periods that trigger guaranteed issue rights — such as losing other coverage, moving out of a Medicare Advantage plan's service area, or if your plan goes bankrupt. Brad can help you determine if you qualify for guaranteed issue rights outside of the standard enrollment window.
Premiums can increase over time — but only on a class-wide basis. An insurance company cannot single you out and raise your rate based on your personal health or claims history. Rate increases apply to everyone in the same state with the same carrier and plan. As for cancellation — Medigap policies are guaranteed renewable, meaning your insurer cannot cancel your coverage as long as you pay your premiums and did not commit fraud on your application. This gives Wisconsin Medigap holders strong long-term protection.
Yes — if a doctor or provider accepts Original Medicare, they must also accept your Medicare Supplement plan. This is one of the biggest advantages of Medigap over Medicare Advantage: there are no network restrictions, no referrals required, and no need to check if your doctor is "in-network." You can see any Medicare-participating provider anywhere in the United States. This makes Medigap especially valuable if you travel frequently, have specialists outside your local area, or want the freedom to choose any doctor without restriction.
Yes, but switching outside your Open Enrollment Period generally requires passing medical underwriting. If you are in good health, you may be able to switch to a plan with lower premiums or different coverage — but if your health has changed, you could be denied or charged more. There is one notable Wisconsin advantage: if you left an employer plan to join a Medicare Advantage plan, you can drop the Advantage plan within 12 months and apply for a Medigap plan with guaranteed issue rights — no health questions. Brad can evaluate whether switching makes financial sense for your specific situation.
Even with a robust Wisconsin Medigap plan, there are services not covered:
Brad can help you pair your Wisconsin Medigap plan with the right Part D plan and point you toward supplemental dental/vision options to round out your coverage.
Call Brad today for a free, no-obligation insurance review.