Best Medicare Advantage Plans in Wisconsin (2026)

Key Takeaways

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.

Best Medicare Advantage Companies in Wisconsin

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 earns a 4.5-star rating compared to Humana's 3.5-star rating, though both providers offer competitive pricing and comprehensive benefits for Wisconsin residents.


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.

CMS Star Ratings: Plans earn 1 to 5 stars based on quality and performance measures. Higher-rated plans with 4 or 5 stars deliver better customer satisfaction and quality care.
Monthly premiums: You'll pay your Part B premium plus any plan-specific premium, though many charge $0 additional. Your total cost depends on coverage level and location.
Maximum out-of-pocket (MOOP) limits: These caps protect you from high medical expenses by limiting annual spending on covered services. Your plan pays 100% of covered costs after reaching this limit.
Drug coverage: Most plans include Part D prescription coverage as part of their package. Check the plan's formulary to confirm your medications are covered and understand any usage restrictions.

Humana

Best HMO

MoneyGeek Rating

5/ 5

5/5Affordability

5/5Quality

5/5Availability

CMS Star Rating
3.5
Plan Types
HMO, PPO, Regional PPO, PFFS

pros
- HMO plans earn 3.5-star CMS rating
- $0 monthly premium available on 6 plans
- Enhanced Part D drug coverage included with all plans
cons
- Does not offer HMO-POS plan options
- Out-of-pocket maximums up to $9,250
Humana's single HMO Medicare Advantage plan in Wisconsin earns a 3.5-star CMS rating with a $4,200 out-of-pocket maximum and $0 monthly premium.

With 11 PPO options earning a 3.5-star rating, Humana gives Wisconsin members significant flexibility in choosing providers, making it competitive among the state's plans. The standout HumanaChoice H5216-253 plan charges $0 monthly with a $4,200 MOOP and enhanced Part D coverage.

Security Health Plan of Wisconsin, Inc.

Best HMO-POS

MoneyGeek Rating

5/ 5

5/5Affordability

5/5Quality

5/5Availability

CMS Star Rating
4.5
Plan Types
HMO-POS

pros
- One plan available with $0 monthly premium
- Excellent 4.5 CMS rating across all plans
- Lowest MOOP option at $2,200 for budget protection
- Point of Service lets you see providers nationwide
cons
- Premium plans cost up to $269 monthly
- Only HMO-POS options, no PPO or HMO plans
Security Health Plan of Wisconsin, Inc. leads Wisconsin HMO-POS coverage with three plans earning 4.5-star CMS ratings and enhanced Part D prescription drug benefits.

The Legacy Rx plan caps annual costs at $2,200, ideal for members expecting high health care expenses, though it carries a $269 monthly premium.

Essence Rx has a $3,800 spending cap and $87 monthly cost, while Esteem Rx provides $0 premiums but caps costs at $5,000 annually. All three HMO-POS options provide valuable out-of-network access, offering flexibility for members needing specialized care while maintaining comprehensive coverage.

Humana

Best PPO

MoneyGeek Rating

5/ 5

5/5Affordability

5/5Quality

5/5Availability

CMS Star Rating
3.5
Plan Types
Regional PPO, PFFS, PPO, HMO

pros
- Zero monthly premium
- $4,200 MOOP below state average of $5,283
- See any Medicare provider without referral requirements
cons
- Rated 3.5 stars by CMS
- Higher costs for out-of-network care
The HumanaChoice H5216-253 plan leads Wisconsin's PPO Medicare Advantage landscape with a $0 monthly premium and $4,200 out-of-pocket maximum. Humana's enhanced Part D prescription coverage includes waived deductibles on select drug tiers, reducing upfront medication costs for Wisconsin seniors.

Humana provides 11 PPO options in Wisconsin, giving beneficiaries multiple plans to compare and find their best fit.

Best HMO Medicare Advantage Plans in Wisconsin

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's single plan charges no monthly premium and has a $4,200 maximum out-of-pocket limit, earning 3.5 stars.
Eight plans from Quartz Medicare Advantage average $78 monthly with $5,131 MOOP costs and 4.0-star ratings.
At $128 per month on average, Dean Advantage's two 3.5-star plans feature $4,750 out-of-pocket maximums.


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

WHY CHOOSE AN HMO PLAN?

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.

Best HMO-POS Medicare Advantage Plans in Wisconsin

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.

At $2,200, Security Health Plan of Wisconsin, Inc. has the state's lowest out-of-pocket maximum. The trade-off: monthly premiums hit $269 across three plans, though they score 5.0 with MoneyGeek and rate 4.5 stars from CMS.
UnitedHealthcare provides coverage to the most members with nine plans rated 4.0 stars, charging $15 monthly with $5,694 maximum out-of-pocket costs and scoring 4.07.
Two budget-focused options compete for affordability. Anthem's single plan costs $28 per month with a $4,329 MOOP and 4.06 score. Wellcare eliminates monthly premiums entirely but raises the cap to $5,300 with 4-star quality.


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

WHY CHOOSE AN HMO-POS PLAN?

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.

Best PPO Medicare Advantage Plans in Wisconsin

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.

A perfect 5.0 MoneyGeek score positions Humana at the top through 11 plans charging $21 monthly. The trade-off: a 3.5 CMS star rating and Wisconsin's highest $9,250 out-of-pocket maximum.
Five plans through Aetna cost just $12 per month, the lowest among leading insurers. Annual expenses cap at $5,450, backed by a 4.5 MoneyGeek score and 4.5 CMS stars.
Network Health Medicare Advantage Plans operates seven plans at $60 monthly, the steepest premium among top-rated options. But you get the state's lowest $3,920 spending limit alongside 4.5 CMS stars and a 4.28 MoneyGeek score.


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

WHY CHOOSE A PPO PLAN?

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.

How to Choose the Best Wisconsin Medicare Advantage Plan

Wisconsin Medicare Advantage plans vary in price, coverage and provider access. Match plans to how you actually use health care.

1
Confirm Your Doctors and Hospitals Are In-Network
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.
2
Compare Total Costs, Not Just Premiums
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.
3
Check Prescription Drug Coverage
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.
4
Compare Different Plan Types
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.
5
Review Star Ratings and Quality Metrics
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.
6
Compare Extra Benefits
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.
7
Check Out-of-Pocket Maximums
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.

How Much Does Medicare Advantage Cost in Wisconsin?

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

Best Wisconsin Medicare Advantage: FAQ

Get answers about how to enroll in Medicare Advantage, what's covered and enrollment timing for Wisconsin residents.

How do you get a Medicare Advantage plan in Wisconsin?

Enroll during the Annual Enrollment Period (Oct. 15-Dec. 7) or when first eligible for Medicare. Compare plans on Medicare.gov, contact insurers directly, or work with licensed agents. Coverage begins Jan. 1 for fall enrollments or during other qualifying periods.

What does Medicare Advantage cover?

Medicare Advantage plans cover everything Original Medicare does, plus most include prescription drugs and additional benefits like dental, vision, and fitness memberships.

What's the difference between Medicare Advantage and Medicare Supplement?

Medicare Advantage replaces Original Medicare with bundled private insurance coverage, while Medicare Supplement (Medigap) works alongside Original Medicare to cover deductibles and copays.

When is open enrollment for Medicare Advantage in Wisconsin?

Wisconsin offers multiple enrollment periods for Medicare Advantage plans. The Annual Enrollment Period runs Oct. 15 through Dec. 7, plus Jan. 1 to March 31 for current enrollees.

Our Methodology: How We Ranked Wisconsin's Best Medicare Advantage Plans

Our analysis of Medicare Advantage plans uses a scoring methodology and three key factors:

Affordability (50%): Cost accounts for half of our overall score because it affects your budget. We evaluated monthly premiums for Part C and Part D coverage combined (30% weight) and in-network maximum out-of-pocket limits (20% weight). Plans with lower premiums and MOOP amounts score higher since they reduce your total annual health care spending.
Star Ratings (40%): CMS star ratings measure plan quality across categories such as care effectiveness, customer service, and member satisfaction. The Overall Star Rating combines both Part C (medical coverage) and Part D (prescription drug) ratings on a scale from 1 to 5 stars. Plans with higher ratings earn better scores in our analysis.
Availability (10%): We score providers based on how many states they operate in, including Washington, D.C. Providers with broader geographic availability score higher because they're more likely to maintain coverage if you move and often have more resources for customer support and plan improvements.

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.

Read Full Bio »