Guide to Medicare Advantage Plans in Winnebago County, WI for 2025
There are 39 Medicare Advantage plans available in Winnebago County, WI for the 2025 plan year, including 25 plans with $0 premiums. Most plans include prescription drug coverage. These counts exclude Special Needs Plans.
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- Top 3 Plans by Enrollment:
1. Network Health Select (PPO) — 4,500 enrollees
2. Network Health Choice (PPO) — 2,831 enrollees
3. AARP Medicare Advantage from UHC WI-6 (PPO) — 2,672 enrollees - Average Monthly Premium: $31.04
- Average Maximum Out-of-Pocket Limit: $4,894
- Average Prescription Drug Deductible: $323.21
- Ratings (Plan Mix): 4+ Stars: 59% · 3 Stars: 41% · Below 3: 0%
- Plan Type Breakdown 24 PPO · 10 HMO-POS · 1 PFFS · 1 HMO · 2 REGIONAL PPO · 1 MSA
Winnebago County, Wisconsin Medicare Advantage Plans
| Plan Name | Type | Premium | MOOP | Rx Ded. | Rating |
|---|---|---|---|---|---|
| Network Health Armor* | PPO | $0 | $4,900 | N/A | |
| Network Health Choice* | PPO | $0 | $4,000 | $300 | |
| Network Health PlusRx* | PPO | $73 | $3,400 | $370 | |
| Network Health PremierRx* | PPO | $226 | $3,400 | $310 | |
| Network Health Select* | PPO | $0 | $3,900 | $340 | |
| Network Health Zero* | PPO | $0 | $3,860 | $145 | |
| Aetna Medicare Eagle* | PPO | $0 | $4,900 | N/A | |
| Aetna Medicare Smart Plus* | PPO | $57 | $5,000 | $590 | |
| Aetna Medicare Value* | PPO | $0 | $4,250 | $0 | |
| AARP Medicare Advantage CareFlex from UHC WI-18 | HMO-POS | $0 | $6,700 | $495 | |
| AARP Medicare Advantage from UHC WI-0011 | HMO-POS | $43 | $4,100 | $340 | |
| AARP Medicare Advantage from UHC WI-0014 | HMO-POS | $0 | $4,900 | $340 | |
| AARP Medicare Advantage Patriot No Rx WI-MA02 | HMO-POS | $0 | $6,700 | N/A | |
| Anthem Medicare Advantage | PPO | $0 | $4,700 | $195 | |
| Anthem Medicare Advantage 3 | PPO | $39 | $4,500 | $120 | |
| Anthem Veteran | PPO | $0 | $6,751 | N/A | |
| Security Health Plan of Wisconsin, Inc. Compass | HMO-POS | $0 | $3,400 | N/A | |
| Essence Rx | HMO-POS | $75 | $3,400 | $330 | |
| Esteem Rx | HMO-POS | $0 | $5,000 | $250 | |
| HealthPartners Birch | PPO | $0 | $4,500 | $200 | |
| HealthPartners Glory | PPO | $0 | $4,500 | N/A | |
| HealthPartners Maple | PPO | $62 | $4,500 | $200 | |
| Humana Gold Choice H8145-006 | PFFS | $38 | $7,000 | $590 | |
| Legacy Rx | HMO-POS | $247 | $2,000 | $0 | |
| Security Health Plan of Wisconsin, Inc. Spirit | HMO-POS | $70 | $1,500 | N/A | |
| Anthem Medicare Advantage | HMO-POS | $0 | $4,300 | $150 | |
| Humana Full Access H5216-410 | PPO | $0 | $5,000 | $350 | |
| Humana Gold Plus H6622-001 | HMO | $0 | $4,150 | $250 | |
| Humana USAA Honor Giveback | PPO | $0 | $5,500 | N/A | |
| Humana USAA Honor Giveback | PPO | $0 | $5,500 | N/A | |
| Humana USAA Honor Giveback | Regional PPO | $0 | $6,750 | N/A | |
| Humana USAA Honor Giveback with Rx | PPO | $0 | $5,500 | $250 | |
| Humana Value Plus H5216-173 | PPO | $39 | $9,350 | $590 | |
| HumanaChoice H5216-001 | PPO | $82 | $4,150 | $590 | |
| HumanaChoice H5216-253 | PPO | $0 | $4,200 | $250 | |
| HumanaChoice R5361-002 | Regional PPO | $104 | $7,200 | $590 | |
| AARP Medicare Advantage from UHC WI-0002 | PPO | $55 | $6,700 | $495 | |
| AARP Medicare Advantage from UHC WI-6 | PPO | $0 | $5,900 | $420 | |
| Network Health Prime | MSA | $0 | $Not Applicable | N/A | |
| **Certain PFFS, MSA, and HMO-POS plans have a combined in and out-of-network maximum. Limits are detailed on the plan pages. | |||||
📊 At a Glance: Medicare Advantage in Winnebago County
- Average Monthly Premium
- $31.04
- Plans with $0 Premium
- 25
- Average MOOP Limit
- $4,894 ($9,350 max. in 2025)
- Average Rx Deductible
- $323.21
- Plans Without Drug Coverage
- 4 (standalone Wisconsin Part D plans)
- Plans with 5-Star Ratings
- There are 6 5-star plans.
- Stars Ratings (Plan Mix)
- 4+ Stars: 59% · 3 Stars: 41% · Below 3: 0%
- Plans Available
- 39 (excluding Winnebago County SNP plans)
- Plan Type Breakdown
- 24 PPO · 10 HMO-POS · 1 PFFS · 1 HMO · 2 REGIONAL PPO · 1 MSA
- Countywide Enrollments
- 21,856 (excluding SNP plans)
- Top 3 Plans by Enrollment
- 1. Network Health Select (PPO) — 4,500 enrollees
2. Network Health Choice (PPO) — 2,831 enrollees
3. AARP Medicare Advantage from UHC WI-6 (PPO) — 2,672 enrollees
Data Sources: CY2025 Landscape, PBP Benefits, Star Ratings Data, Monthly Enrollment by CPSC, and SimpleMaps U.S. Counties. Enrollment data last updated . County demographic data last updated .
Understanding Your Medicare Advantage Options
Medicare Advantage Plans, also known as Medicare Part C, are private health plans that provide all-in-one coverage, including Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). On top of the core benefits, many of the plans in Winnebago County throw in some nice extras - think prescription drug coverage, dental, vision, and wellness programs - making them a solid choice for those in Winnebago County looking for something more than Original Medicare.
🏥 Health Maintenance Organization (HMO) Plans
HMO plan members must use the plan's network of doctors and hospitals in Winnebago County, and typically need a referral to see a specialist. Some Medicare Advantage HMO Plans may have lower costs but offer less flexibility in choosing healthcare providers. There are 1,909 residents enrolled in HMO plans in this county. The most popular plan is Humana Gold Plus H6622-001 .
🔓 Preferred Provider Organization (PPO)
A PPO allows more flexibility in choosing healthcare providers, with the option to see specialists without referrals, though often at a higher cost. Medicare Advantage PPOs usually have higher premiums and out-of-pocket expenses. There are 15,395 Winnebago County residents enrolled in PPO plans. The most popular of these plans by enrollments is Network Health Select .
🪟 Private Fee-for-Service (PFFS)
Allows members to visit any Medicare-approved doctor or hospital in their area that accepts the plan's payment terms. Medicare PFFS plans offer more flexibility but may result in higher costs. There are 36 Winnebago County residents enrolled in PFFS plans. The most popular of these plans by enrollments is Humana Gold Choice H8145-006 .
🔀 Health Maintenance Organization Point of Sale (HMO-POS)
Medicare HMO-POS plans are a type of HMO that offers a little more flexibility. Like a regular HMO, you typically use the plan's network of doctors and hospitals for care, usually requiring a referral to see specialists. However, an HMO-POS plan lets you receive certain healthcare services outside of the network at a higher cost. There are 4,435 residents enrolled in HMO-POS plans in this Winnebago County. The most popular plan by enrollments is AARP Medicare Advantage from UHC WI-0011 .
Advantages of Enrolling in Medicare Advantage
Many Medicare Advantage Plans offer extra benefits that go beyond Original Medicare, making them an attractive option for some people. These plans provide comprehensive coverage, often including additional services like prescription drug coverage, dental, vision, and wellness programs, all bundled into one plan. By choosing a Medicare Advantage Plan, you can simplify your healthcare and potentially save on costs.
Take a look at the main benefits provided by Medicare Advantage Plans in Winnebago County:
🧑⚕️Coordinated Care
Plans often include care coordination services, which help you manage your healthcare across different providers and services.
💸 Cost Savings
Many plans have low or $0 premiums and offer capped out-of-pocket costs, providing financial protection against high medical expenses.
🧾 Comprehensive Coverage
Includes Medicare Part A, Part B, and often Part D (prescription drug coverage), along with additional benefits like dental, vision, and hearing.
🧘 Wellness Programs
Many Yavapai County plans offer free gym memberships, wellness programs, and preventive care services. You need to stay healthy, right?
Tips for Selecting a Medicare Advantage Plan
Choosing the right Medicare Advantage Plan out of the 39 plans available in Winnebago County requires careful consideration of several key factors:
🏥1. Provider Network
Verify that your current doctors and preferred hospitals are included in the plan's network. Access to your healthcare providers can significantly impact your care experience.
💊 2. Prescription Drug Coverage
Make sure the plan covers your medications, particularly if you have specific prescriptions you rely on regularly.
💰 3. Costs
Examine the plan's premiums, copayments, and out-of-pocket limits. Compare these costs against your budget to avoid unexpected expenses.
🎁 4. Additional Benefits
Consider what extra services, such as dental, vision, or wellness programs, are important to you, and check if the plan offers them.
⭐ 5. Plan Ratings
Look into the plan's star ratings, which provide insight into the plan's overall quality and member satisfaction.
Learn more about the basics of comparing Medicare Advantage Plans.
Medicare Advantage Enrollment Periods
Making sense of Medicare Advantage enrollment periods can seem overwhelming, but it's worth the effort for better health coverage. Missing these key dates could delay your coverage or limit your plan choices for 2025 in Winnebago County.
📅 Initial Enrollment Period (IEP)
This initial enrollment window starts three months before and ends three months after your 65th birthday, offering a total of seven months to enroll in a Medicare Advantage Plan.
🗓️ Annual Enrollment Period (AEP)
Every year from October 15 to December 7, you have the option to change, enroll, or disenroll from a Medicare Advantage Plan.
🔁 Open Enrollment Period (OEP)
Running from January 1 to March 31, this period allows changes to your Medicare Advantage Plan if you’re already enrolled or lets you switch back to Original Medicare.
For comprehensive details on how to enroll, visit our detailed guide on Medicare Enrollment.
Frequently Asked Questions
What are the most popular Medicare Advantage plan types in Winnebago County?
Based on the 2025 plan data, PPO plans are the most common in Winnebago County. The full breakdown of plan types is: 24 PPO · 10 HMO-POS · 1 PFFS · 1 HMO · 2 REGIONAL PPO · 1 MSA.
How much can I expect to pay out of pocket for Medicare Advantage plans?
The average maximum out-of-pocket limit (MOOP) in Winnebago County is $4,894 for 2025.
Do any Medicare Advantage plans in Winnebago County have 5-star ratings?
There are 6 5-star rated Medicare Advantage plans in Winnebago County, and 59% of all plans have a rating of 4 stars or higher.
What is the average monthly premium for Medicare Advantage plans in Winnebago County?
The average monthly premium for Medicare Advantage plans in Winnebago County is $31.04. A total of 25 offer $0 premiums, though costs vary by plan type and benefits.
More About These Plans
Carrier Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Master Plan Pages by Plan ID
The plan pages listed in the table above have been modified for localization to help consumers identify plans available in their area. Most plans are available in multiple areas. The following list of plan IDs link to each plan's master page.
Plan Availability
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in Larsen, Menasha, Neenah, Omro, Oshkosh, Pickett, Winneconne, and all other areas of Winnebago County, Wisconsin, including the following zip codes: 54901, 54902, 54903, 54904, 54906, 54914, 54915, 54923, 54927, 54940, 54947, 54952, 54956, 54957, 54963, 54964, 54971, 54979, 54980, 54985, 54986.
Citations & References
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 19 March, 2025
- CMS.gov, "Special Needs Plans (SNP)", Last Accessed 24 May, 2024
- Medicare.gov, "What's Medicare Supplement Insurance (Medigap)?", Last Accessed 19 March, 2025
- Plan and enrollment data provided by the Centers for Medicare & Medicaid Services (CMS)
- Data processed and interpreted by MedicareWire.com editorial team.
- Read our methodology and sourcing policy.