2020 Waukesha County Wisconsin
Medicare Advantage Plans

There are 33 Medicare Advantage Plans available in Waukesha County WI from 8 different health insurance providers. 4 of these Medicare Advantage plans offer additional gap coverage. The plan with the lowest out of pocket expense is $1200 and the highest out of pocket is $6700. Waukesha County Wisconsin residents can also pick from 14 Medicare Special Needs Plans. The highest rated plan available in Waukesha County received a 5 overall star rating from CMS and the lowest rated plan is 3.5 stars

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Name ⇅ Premium Deductible MOOP Gap Plan
AARP Medicare Advantage (HMO-POS)
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$27.00 $250.00 $4,500 NoEnroll
AARP Medicare Advantage Value (HMO-POS)
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$0 $275.00 $4,900 NoEnroll
Aetna Medicare Premier (PPO)
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$26.00 $200.00 $4,200 YesEnroll
Aetna Medicare Value (PPO)
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$0 $200.00 $4,500 YesEnroll
Anthem MediBlue Access (PPO)
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$27.00 $95.00 $4,500 YesEnroll
Anthem MediBlue Plus (HMO)
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$0 $175.00 $4,900 YesEnroll
Assurance Rx (HMO-POS)
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$0 $330.00 $6,500 NoEnroll
Essence Rx (HMO-POS)
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$80.00 $330.00 $3,400 NoEnroll
Humana Gold Choice H8145-006 (PFFS)
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$98.00 $435.00 $- NoEnroll
Humana Gold Plus H6622-002 (HMO)
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$44.00 $200.00 $4,900 NoEnroll
Humana Gold Plus H6622-034 (HMO)
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$0 $300.00 $4,900 NoEnroll
Humana Gold Plus H6622-040 (HMO)
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$0 $315.00 $6,700 NoEnroll
Humana Value Plus H5216-173 (PPO)
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$26.70 $410.00 $6,700 NoEnroll
HumanaChoice H5216-001 (PPO)
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$86.00 $325.00 $6,700 NoEnroll
HumanaChoice R5361-002 (Regional PPO)
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$139.00 $420.00 $6,700 NoEnroll
Network Health Medicare Anywhere (PPO)
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$29.00 $250.00 $4,900 NoEnroll
Network Health Medicare Explore (HMO)
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$11.00 $260.00 $4,200 NoToo NewEnroll
Network Health Medicare Go (PPO)
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$0 $275.00 $5,900 NoEnroll
ProHealth Senior Preferred Elite (w/Rx) (HMO)
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$20.60 $100.00 $3,400 NoEnroll
ProHealth Senior Preferred Value (w/Rx) (HMO)
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$0 $100.00 $5,900 NoEnroll
Spirit Rx (HMO-POS)
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$222.00 $0 $1,200 NoEnroll
UnitedHealthcare Medicare Advantage Open (PPO)
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$47.00 $325.00 $5,900 NoEnroll

Return to 2020 Medicare Advantage Plans in Wisconsin

Medicare Advantage Health Plans Without Drug Coverage

Plan Name ⇅ Premium Type MOOP Overall
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AARP Medicare Advantage Essential (HMO-POS)
$0 Local HMO * $4,900 Enroll
Aetna Medicare Core Value (PPO)
$0 Local PPO * $6,000
Allwell Medicare Essentials (HMO)
$0 Local HMO * $4,900
Anthem MediBlue Access Core (PPO)
$0 Local PPO * $5,900
Essence (HMO-POS)
$16.00 Local HMO * $3,400
HumanaChoice H5216-178 (PPO)
$0 Local PPO * $6,700
HumanaChoice R5361-001 (Regional PPO)
$0 Regional PPO * $6,700 Enroll
NetworkPrime (MSA)
MSA * $- NA
ProHealth Senior Preferred Elite (no Rx) (HMO)
$0 Local HMO * $3,400
Secure Saver (MSA)
MSA * $- NA
Spirit (HMO-POS)
$157.00 Local HMO * $1,200

2020 Medicare Special Needs Plans in Waukesha county Wisconsin

Plan Name ⇅ Monthly
Part D
 Gap  Special Needs
Allwell Dual Medicare (HMO D-SNP)     $37.90 $225.0  Yes Dual-Eligible
Anthem MediBlue Dual Advantage (HMO D-SNP)     $33.40 $435.0  Yes Dual-Eligible
Aurora CompleteCare (HMO D-SNP)     $39.90 $435.0  No Dual-Eligible
Care Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)     $22.70 $435.0  No Dual-Eligible
Care Wisconsin Partnership Plan (HMO D-SNP)     $6.10 $435.0  No Dual-Eligible
Community Care's Partnership Program (HMO D-SNP)     $39.90 $435.0  No Dual-EligibleNA
iCare Medicare Plan (HMO D-SNP)     $39.90 $435.0  No Dual-Eligible
Molina Medicare Complete Care (HMO D-SNP)     $38.50 $435.0  No Dual-Eligible
UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)     $23.70 $200.0  No Institutional
UnitedHealthcare Dual Complete LP (HMO D-SNP)     $24.70 $435.0  No Dual-Eligible
UnitedHealthcare Dual Complete LP1 (HMO D-SNP)     $24.30 $435.0  No Dual-Eligible
UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)     $14.00 $300.0  No Chronic or Disabling Condition
UnitedHealthcare Nursing Home Plan 1 (HMO-POS I-SNP)     $39.90 $435.0  No Institutional
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)     $39.90 $435.0  No Institutional

Plan Type Is the type of organization offering the Medicare Plans.

  • HMO - Health Maintenance Organization
  • PPO - Preferred Provider Organization
  • PDP - Prescription Drug Plan
  • SNP - Special Needs Plan
  • POS - Point of Service
  • PFFS - Private Fee For Service

Monthly Consolidated Premium (Includes Part C + D) Your premium may be lower depending on your eligibility for medical assistance. Call your provider for details.

Part D Total Premium: The Part D Total Premium is the sum of the Basic and Supplemental Premiums. Note: the Part D Total Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums.

Benefit Type
  • (EA) Enhanced Alternative may offer additional gap coverage which is calculated as the percentage of generic formulary products with coverage above standard generic coverage gap cost-sharing benefit and/or the percentage of brand formulary products covered in addition to the coverage gap discount for applicable drugs.
  • (DS) Defined Standard Benefit
  • (BA) Basic Alternative
  • (AE) Actuarially Equivalent Standard


In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will pay 25% of the plans cost for covered brand-name prescription drugs and 25% on generic drugs unless your plan offers additional coverage.

Maximum Out-of-Pocket (MOOP) limit on enrollee spending that includes costs for all in-network Part A and Part B Services. NOT Part D - prescription drugs. N/A is defined as Not Applicable

Source: CMS. Data as of September 3, 2019.
Star Rating as of October 11, 2019.
For More Information on Ratings Please See the CMS Tech Notes.
Plans are subject to change as contracts are finalized.
Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2020, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.

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