Medicare 2026

Waukesha Medicare Support Through SHIP and Licensed Agencies

WAUKESHA, Wis. — If Medicare feels like a maze, you are not alone. With more than 84,000 residents age 65 or older in Waukesha County, thousands of neighbors are working through the same questions every year: What does Part D cover? Should I stay with Original Medicare? When can I switch?

Free, unbiased Medicare help is closer than you think

The good news is that Waukesha has trained, unbiased help available at no cost — and you don't have to sit through a sales pitch to get it.

Start with SHIP — Wisconsin's free counseling service

Every state has a State Health Insurance Assistance Program (SHIP). It's federally funded, and its counselors do not sell insurance or earn commissions. Their job is simply to help you understand your options.

In Wisconsin, SHIP is called the Medigap Helpline, run by the Wisconsin Board on Aging and Long Term Care. Counselors can help you:

• Compare Medicare Advantage, Medigap, and Part D options
• Understand what a plan actually covers before you enroll
• Check whether you qualify for programs that help pay premiums or drug costs
• Sort out billing problems or claim denials

Wisconsin Medigap Helpline: 1-800-242-1060 (weekdays) Wisconsin Medigap Part D and Prescription Drug Helpline: 1-855-677-2783

Local help right here in Waukesha County

The Waukesha County Aging and Disability Resource Center (ADRC) is another trusted local resource. ADRC staff and volunteers can walk you through Medicare basics, help you use the Plan Finder on Medicare.gov, and connect you with benefits programs.

Waukesha County ADRC: 262-548-7848 Location: Health and Human Services Center, 514 Riverview Ave., Waukesha

Because ADRC counselors are not tied to any insurance company, they can give you a straight answer about what fits your situation — even if the answer is "keep what you have."

When a licensed agent makes sense

SHIP and ADRC counselors are terrific for education and comparisons, but they cannot enroll you in a plan. That's where a licensed independent insurance agent comes in.

A few tips if you go this route:

• Ask which carriers they represent. An independent agent who works with multiple carriers can show you a wider range of options than a captive agent tied to one company.
• Ask how they are paid. Agents are paid by the insurance company, not by you — but you deserve to know that up front.
• You are never required to enroll on the spot. A good agent will let you take notes home and think it over.

According to CMS Landscape data, Waukesha County residents had 57 Medicare Advantage plans available through 9 carriers offering MA-PD coverage in 2026. The 2027 lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder. That's a lot to sort through, which is why so many people find it helpful to talk with someone before choosing.

Key numbers worth knowing

Whether you meet with SHIP, ADRC, or an agent, these program-level figures apply to everyone on Medicare:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027 — once you hit that, you pay nothing for covered drugs the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• Coverage gap ("donut hole"): eliminated as of 2025.
• Medicare Prescription Payment Plan: lets you spread drug costs into level monthly payments instead of paying big bills at the pharmacy counter.
• IRMAA surcharges: kick in above $109,000 in income for a single filer in 2026.

Mark these enrollment windows

• Annual Enrollment Period: Oct. 15 – Dec. 7 (changes take effect Jan. 1)
• Medicare Advantage Open Enrollment: Jan. 1 – March 31 (for people already in an Advantage plan who want to switch or return to Original Medicare)

If you miss these windows, you may have to wait a year — unless you qualify for a Special Enrollment Period after a move, job change, or loss of coverage.