Updated: March 13, 2026
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Wisconsin residents can choose from 55 Medicare Advantage plans offered by eight insurers, with HMO, HMO-POS, PPO, PFFS and Regional PPO networks available. Four plans don't have monthly premiums entirely, while costs peak at $269 for comprehensive coverage.
Humana ranks first for both HMO and PPO categories in Wisconsin, while Security Health Plan of Wisconsin provides the best HMO-POS.
Look at whether your regular doctors accept the plan, find out which category your medications fall into and evaluate how monthly payments stack up against yearly cost limits.
Our analysis of Wisconsin's best Medicare Advantage plans based on CMS star ratings, premiums, maximum out-of-pocket costs and coverage features shows strong options across plans. Humana leads both HMO and PPO categories with a $0 monthly premium for HMO plans and a $4200 average MOOP, while Security Health Plan of Wisconsin tops HMO-POS options.
Security Health Plan has a 4.5-star rating and Humana gets a 3.5-star rating. Both have good prices.
| HMO | Humana | 3.50 | $0 | $4,200 | Humana Gold Plus H6622-001 (HMO) |
| HMO-POS | Security Health Plan of Wisconsin, Inc. | 4.50 | $269 | $2,200 | Legacy Rx (HMO-POS) |
| PPO | Humana | 3.50 | $21 | $9,250 | HumanaChoice H5216-253 (PPO) |
Medicare Advantage plans bundle hospital stays, doctor visits and prescription drugs into comprehensive packages that cover everything Original Medicare does. These Part C plans from private insurers add extra benefits like dental, vision and hearing coverage.
Best HMO
CMS Star Rating
Plan Types
Best HMO-POS
CMS Star Rating
Plan Types
Best PPO
CMS Star Rating
Plan Types
Wisconsin's three providers offer 11 HMO Medicare Advantage plans, with eight earning 4 stars or higher. Star ratings range from 3.5 to 4.0 stars. Four plans charge $0 monthly, though the median premium is $34. Out-of-pocket maximums run from $2,750 to $6,750, averaging $4,991 per year.
| Humana | 3.50 | $0 | $4,200 | 1 | 4.50 |
| Quartz Medicare Advantage (HMO) | 4.00 | $78 | $5,131 | 8 | 3.89 |
| Dean Advantage | 3.50 | $128 | $4,750 | 2 | 3.38 |
HMO plans work well for seniors who want coordinated care and don't mind working through a primary doctor for specialist referrals. You'll pay lower monthly premiums and out-of-pocket costs compared to other Medicare Advantage options.
Wisconsin's HMO-POS Medicare Advantage plans maintain high quality ratings, with nine of 16 earning 4 CMS stars and none rated at just 3 stars. Five providers offer these options, and half don't charge monthly premiums. Maximum out-of-pocket costs reach $4,983, though they vary considerably from $2,200 to $6,700.
| Security Health Plan of Wisconsin, Inc. | 4.50 | $269 | $2,200 | 3 | 5.00 |
| UnitedHealthcare | 4.00 | $15 | $5,694 | 9 | 4.07 |
| Anthem | 3.50 | $28 | $4,329 | 1 | 4.06 |
| Wellcare | 3.50 | $0 | $5,300 | 1 | 3.93 |
| Dean Advantage | 3.50 | $85 | $4,600 | 2 | 3.63 |
Looking for affordable coverage with some flexibility? HMO-POS plans cost less than PPO options while giving you the freedom to see out-of-network providers when needed, though you'll pay higher rates for those visits. They're ideal if you primarily stay in-network but want access to specialized care that might not be available through your regular doctors. You won't need referrals for out-of-network specialists, making it easier to get the care you need without the higher monthly premiums that come with PPO plans.
Wisconsin offers 28 PPO Medicare Advantage plans that skip the referral requirements of HMO coverage. Sixteen plans achieved 4 stars or better from CMS, with fifteen earning 4.5 stars, one reaching 4 stars, and twelve sitting at 3.5 stars.
Premiums span $0 to $226, settling around $16 for most enrollees. Annual spending caps vary widely from $3,400 to $9,250, around $5,283. You'll sacrifice HMO's lower costs for unrestricted provider access.
| Humana | 3.50 | $21 | $9,250 | 11 | 5.00 |
| Aetna | 4.50 | $12 | $5,450 | 5 | 4.54 |
| Network Health Medicare Advantage Plans | 4.50 | $60 | $3,920 | 7 | 4.28 |
| Anthem | 4.00 | $68 | $4,500 | 1 | 3.91 |
| Aspirus Health Plan | 3.50 | $0 | $5,500 | 1 | 3.89 |
| UnitedHealthcare | 3.50 | $80 | $6,700 | 3 | 3.50 |
PPO plans are helpful if you frequently travel or want unrestricted access to specialists without primary care approval. You'll pay higher premiums than other Medicare Advantage options, but you can see any provider without referrals and visit out-of-network doctors when needed. While staying in-network saves money, you're never limited by referral requirements or network restrictions.
Wisconsin Medicare Advantage plans vary in price, coverage and provider access. Match plans to how you actually use health care.
Call each of your doctors and ask if they accept the specific Medicare Advantage plan you're considering by name. Insurers maintain multiple networks across different products.
Monthly premium amounts don't reflect true costs. Add up copays across all your expected medical interactions for the year. Include specialist appointments, prescription refills and routine visits. Premium-free plans charging $50 copays cost more annually than plans with $30 premiums and $15 copays when you use health care regularly.
Each Wisconsin Medicare Advantage plan maintains a formulary organizing drugs into cost tiers. Lower-tier placement means lower costs at pickup. Prior authorization requirements delay certain prescriptions until the plan approves medical necessity, sometimes taking days or weeks to process.
Referral requirements and network rules separate Wisconsin health insurance plan structures into distinct categories. HMO plans coordinate care through your primary doctor and require referrals before specialist visits while keeping costs low. HMO-POS plans maintain referral rules but add out-of-network options for extra fees, but PPO plans don't require referrals entirely and charge higher premiums for unrestricted access.
Medicare assigns 1 to 5 stars measuring plan performance on service, claims and health outcomes. Wisconsin plans earning 4 or 5 stars consistently outperform lower-rated options on member satisfaction surveys and quality benchmarks. Check ratings first. Star ratings appear on Medicare.gov alongside premium and benefit information when comparing plans.
Benefit additions differ across Wisconsin Medicare Advantage plans. Some plans offer comprehensive dental covering fillings and crowns beyond cleanings while others prioritize vision benefits including frames and lenses. Fitness programs, hearing aid coverage and monthly over-the-counter allowances appear in various combinations.
Once you reach your out-of-pocket maximum, Wisconsin Medicare Advantage plans pay remaining covered expenses through year end. Lower maximums mean better protection against catastrophic costs but result in higher monthly premiums throughout the year.
Your plan type choice affects Medicare Advantage costs in Wisconsin. HMO plans charge $79 monthly on average. Despite those higher premiums, they protect your wallet better with $4,991 average out-of-pocket maximums. For just $36 monthly on average, PPO plans offer the lowest upfront costs. Those savings disappear when you need care, though, because PPO out-of-pocket maximums average $5,283. That's nearly double what HMO members pay.
| HMO | $34 | $79 | $4,991 |
| HMO-POS | $14 | $44 | $4,983 |
| PFFS | $37 | $37 | $6,800 |
| PPO | $16 | $36 | $5,283 |
| Regional PPO | $103 | $103 | $7,200 |
Get answers about how to enroll in Medicare Advantage, what's covered and enrollment timing for Wisconsin residents.
Sign up when its the Annual Enrollment Period (Oct. 15 to Dec. 7). Compare plans on Medicare.gov. Your coverage begins Jan. 1 if you enrolled in the Fall or during other qualifying periods.
Medicare Advantage plans cover everything Original Medicare does. Most also include prescription drug coverage and extra benefits like dental, vision and fitness memberships.
Medicare Advantage replaces Original Medicare with bundled private insurance coverage. Medicare Supplement (Medigap) is used with Original Medicare to cover deductibles and copays.
Wisconsin offers multiple times to enroll for Medicare Advantage plans. The Annual Enrollment is Oct. 15 through Dec. 7, plus Jan. 1 to March 31 for current enrollees.
Our analysis of Medicare Advantage plans uses a scoring methodology and three key factors:
This scoring system helps you compare plans objectively while accounting for what matters most: what you'll pay and the quality of care you'll receive.
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. He has analyzed the insurance market for over five years, conducting original research for insurance shoppers. His insights have been featured in CNBC, NBC News and Mashable.
Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!
He writes about economics and insurance, breaking down complex topics so people know what they're buying.
