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If you live in Outagamie County and you’re trying to make sense of Medicare, here’s the thing nobody tells you: your options aren’t the same as your sister’s in another state, or even your friend’s one county over. Medicare plans are approved county by county. So let’s look at what’s actually available where you live.
One client put it to me this way: “Retiring is not for the weak.” They weren’t talking about money. They were talking about the paperwork. The good news: the Medicare piece has an order to it, and once you see the order, the overwhelm drops fast.
Whether you’re in Bear Creek, Black Creek, Combined Locks, or anywhere else in Outagamie County, the numbers below are yours. Medicare sets plan availability county-wide.
Medicare Advantage in Outagamie County: the 2026 numbers
- 57 Medicare Advantage plans are approved in Outagamie County for 2026.
- 47 of them have a $0 monthly premium.
- 10 different insurance organizations offer plans here, including UnitedHealthcare, Humana, Network Health Medicare Advantage Plans, Anthem Blue Cross and Blue Shield.
- the highest 2026 overall CMS Star Rating in the county is 4.5 out of 5, and 30 plans are rated 4 out of 5 or higher.
- in-network out-of-pocket maximums range from $1,500 to $9,250, and premiums run from $0 to $205 per month.
- of the county’s 42,418 Medicare beneficiaries (CMS, 2026-March), 73% chose Medicare Advantage, and the rest stayed on Original Medicare, most with a supplement and/or drug plan.
Source: CMS CY2026_Landscape_202607, plan year 2026, retrieved July 22, 2026.
That’s a lot of choices, and that’s exactly the problem. More options doesn’t mean an easier decision. It usually means more ways to pick a plan that looks fine on paper and surprises you at the pharmacy counter.
HMO or PPO? What Outagamie County actually offers
Of the 57 plans here, 25 are HMO-style and 30 are PPO-style. The difference matters more than most people realize. An HMO generally requires you to stay inside its network and often to get referrals. In exchange, costs are usually lower and more predictable. A PPO lets you see out-of-network doctors (at a higher cost), which matters if you split time between states, keep a specialist in another city, or just want the escape hatch.
Here is the question that actually decides it: if your cardiologist or your hospital dropped out of the network next year, how painful would that be? People with deep local roots and flexible doctor relationships often do fine in an HMO. People with established specialists or a snowbird schedule usually sleep better in a PPO.
How the plans here rate
CMS scores every Medicare Advantage plan on a 5-star scale using member complaints, care quality, and customer service. In Outagamie County, 30 of the 57 plans carry a 2026 overall Star Rating of 4 out of 5 or higher, and the highest rating available in the county is 4.5 out of 5. A strong rating is a good sign, but it can’t tell you whether your doctors are in a plan’s network or your prescriptions are on its formulary. That check is personal, and it’s the single most important step before enrolling.
To see how the plans in the county rate side by side, search the plans at your zip code, or bring us your doctor and prescription list and we’ll do the checking with you.
What “$0 premium” really means in Outagamie County
“I got a bill for $19,000.” A real sentence from a real call, from someone whose plan looked fine until it wasn’t. This is why the out-of-pocket maximum matters more than the premium:
47 of the county’s 57 plans charge no monthly premium, and that’s the number the TV ads shout. Here’s the number they don’t: the maximum out-of-pocket. In Outagamie County it runs from $1,500 to $9,250 per year, with a median of $5,350. That’s the amount you could actually be responsible for in a bad health year, and the spread between plans is thousands of dollars.
Drug deductibles are just as uneven: 1 plans charge no drug deductible at all while others charge up to $615 before drug coverage kicks in. Same county, same $0 premium, very different first trip to the pharmacy in January.
The Part B Give-Back in Outagamie County
Here’s a benefit most people first hear about from a TV commercial and assume is a scam: some Medicare Advantage plans include a Part B premium reduction, lowering what you’re responsible for paying toward your Part B premium each month. It’s real. In Outagamie County, 24 plans include a reduction in 2026, and the largest available here is $145 per month. How it shows up depends on how you pay your premium, and processing can take a few months to start.
A larger reduction doesn’t automatically make a plan the better choice. Networks, drug coverage, and out-of-pocket limits differ plan to plan and can outweigh the monthly amount. Ask us which reductions apply to your situation, or see the plans at your zip code.
Who’s on Medicare in Outagamie County
42,418 people in Outagamie County are enrolled in Medicare as of CMS’s 2026 March Monthly Enrollment data; 31,131 of them (73%) chose a Medicare Advantage plan while 11,287 stayed on Original Medicare. That split matters: it tells you roughly how your neighbors weighed the same decision you’re making, though the right answer is personal, not popular.
4,386 county residents qualify for both Medicare and Medicaid. The county has 13 Dual-Eligible Special Needs Plans (D-SNPs) built specifically for that situation, often with benefits regular plans don’t include, and most people who qualify have no idea they exist.
Dental, vision, and hearing in Outagamie County plans
Original Medicare covers none of these, which surprises almost everyone. Among Outagamie County’s Medicare Advantage plans: 56 include dental benefits, 55 include vision, and 55 include hearing coverage. The fine print varies enormously: annual maximums, in-network dentist availability, and whether “dental” means cleanings only or actual crowns and dentures. If dental work is on your horizon, this comparison alone can be worth hundreds of dollars a year.
Stand-alone drug coverage (Part D) in Wisconsin
If you stay on Original Medicare, with or without a supplement, you’ll want a stand-alone Part D drug plan. Wisconsin has 10 PDPs for 2026. Premiums run from $0 to $113.90 per month (median $0), and 4 plans price at or below the regional benchmark, meaning people who qualify for Extra Help can get them for $0.
A pattern worth knowing: the cheapest Part D premiums usually pair with the highest deductibles. The only way to know which drug plan is actually cheapest for you is to price your exact prescription list against each plan. That’s precisely what we do on a consultation call, and it takes about ten minutes. Or run the comparison yourself at your zip code.
Extra Help with drug costs in Outagamie County
Extra Help is the federal program that cuts Part D costs for people with limited income and savings. For 2026, the limits are $23,940 a year in income and $18,090 in resources for a single person, or $32,460 and $36,100 for a married couple. If you qualify, a benchmark drug plan has a $0 premium, there’s no drug deductible, and covered drugs cost no more than $5.10 for a generic or $12.65 for a brand name.
In Outagamie County, 4,386 of the 42,418 people on Medicare (10%) also have Medicaid, per CMS enrollment data for March 2026. They get Extra Help automatically. People over the Medicaid line can still qualify for Extra Help on their own if they fall under the limits above.
If you’re close to those numbers, it’s worth a short call to check before you pick a drug plan.
A Wisconsin rule worth knowing
Wisconsin uses its own standardized Medigap structure (a Basic plan plus riders) instead of the lettered plans used in most states.
When you can actually enroll
Availability means nothing if you miss your window. The three that matter for most people in Outagamie County:
- Initial Enrollment Period: the 7 months around your 65th birthday (3 before your birthday month, your birthday month, 3 after). Missing it can mean permanent late-enrollment penalties on Part B and Part D.
- Annual Enrollment Period (Oct 15 to Dec 7): when anyone can switch Medicare Advantage or Part D plans for the following year. This is when the plan numbers above get reshuffled, and when reviewing your plan against next year’s version actually pays.
- Still working past 65? If you have credible employer coverage, you may be able to delay Part B without penalty, but the rules are specific, and getting them wrong is one of the most expensive Medicare mistakes there is. This one is worth a conversation before your birthday, not after.
Disaster declarations and Medicare in Outagamie County
FEMA has issued 2 major disaster or emergency declarations covering Outagamie County since October 2024. That matters for Medicare because a declaration can open a Special Enrollment Period for people whose enrollment window got interrupted by the event.
- Severe storms and tornadoes (DR-4949, major disaster, declared Oct 7, 2026). Incident period: Jul 27, 2026 to Jul 27, 2026. Disaster SEP window: closed Sep 30, 2026.
- Severe storms, tornadoes, and flooding (DR-4923, major disaster, declared Jun 30, 2026). Incident period: Apr 13, 2026 to Apr 23, 2026. Disaster SEP window: closed Jun 30, 2026.
Can a FEMA disaster declaration let me change my Medicare plan in Outagamie County, Wisconsin?
Not from the FEMA declarations listed for Outagamie County. Their disaster Special Enrollment Period windows have closed. If you missed a change you meant to make, another window may still fit your situation; the fall Annual Enrollment Period is the one most people have.
How the window is set: under 42 CFR 422.62(b)(18) (Medicare Advantage) and 42 CFR 423.38(c)(23) (Part D), it starts on the declaration date or the incident start date, whichever comes first, and runs through the end of the second full calendar month after the incident period ends. With no end date set, it can run up to 14 full months. State and local declarations can set their own dates, and the plan decides each request, so confirm with the plan before you count on it.
Not sure whether this touches your situation? Book a quick call with Michael and we’ll check your dates together.
Source: OpenFEMA Disaster Declarations Summaries, retrieved Oct 10, 2026. Major disaster and emergency declarations only; fire management assistance declarations do not open this window.
Questions people actually ask me, in their own words
“What is Part A and Part B, actually?” Part A is hospital coverage (usually $0 premium), Part B is medical/doctor coverage (standard premium applies). Everything else (Advantage plans, supplements, drug plans) builds on top of those two.
“Can I start earlier?” Your Initial Enrollment Period opens 3 months before your 65th birthday month. Starting the homework 6 months out is the sweet spot: enough time to compare without deadline pressure.
“Even with Plan G?” Plan G covers most of what Original Medicare doesn’t, but it doesn’t include drug coverage, and it can’t be compared to an Advantage plan on premium alone. Different tools for different situations.
“This is such a racket.” I’ve heard that more than once, and I understand where it comes from: the mail, the commercials, the calls. Here’s my answer to it: real numbers from the government’s own plan file, and a conversation where I’ll tell you if staying put is your best move.
Quick answers for Outagamie County
Do all 57 plans include drug coverage? No. 46 of them do. If you pick one of the others, you generally cannot add a stand-alone drug plan on top of it, which surprises a lot of people.
Is the biggest carrier automatically the best here? No. UnitedHealthcare offers the most plans in Outagamie County, but plan count isn’t quality. The right plan depends on your doctors, your pharmacy, and your prescriptions, and it’s often not from the biggest name on the list.
Can I get help without being sold something? Yes. A consultation with me is a conversation, not a pitch. We look at your doctors, your prescriptions, and your timeline, and you leave knowing exactly where you stand. If a plan change doesn’t make sense for you, I’ll tell you that too.
Where can I get local Medicare help in Outagamie County? Right here. Guardian Health & Wealth works with Outagamie County residents by phone or video at (270) 721-5069, so you get local guidance without leaving home. Consultations are free, and there’s never an obligation.
The towns of Outagamie County
Everything on this page applies across the county, including Bear Creek, Black Creek, Combined Locks, Hortonville, Kimberly, Little Chute, New London, Nichols, Seymour and Shiocton, because Medicare plan availability is set at the county level.
We do not offer every plan available in your area. Currently we represent 5 organizations which offer 48 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Get your free Outagamie County Medicare Snapshot
I put the Outagamie County plan landscape into a one-page snapshot: what’s available, what it costs, and the deadlines that apply to your situation, in plain English, specific to where you live.
Prefer to just talk it through? Schedule a free Medicare enrollment consultation: a one-on-one call about your specific doctors, prescriptions, and timeline. Or if you’d rather learn first, the free workshop walks through the decisions in order.
Ready to see actual plans side by side? Search and compare the plans available at your zip code. You can review details and even enroll directly online.
Getting to know Outagamie County
Outagamie County covers about 638 square miles of Wisconsin.
Most residents live in or around Bear Creek, with Black Creek, Combined Locks, Hortonville, Kimberly, Little Chute making up much of the rest. At about 66 Medicare beneficiaries per square mile it’s one of the more densely settled parts of Wisconsin, which usually means more provider choice inside a single plan’s network.
According to the CMS hospital registry, 2 Medicare-registered hospitals serve the county: Ascension Ne Wisconsin – St Elizabeth Campus (Appleton); Thedacare Regional Medical Center – Appleton Inc (Appleton). 2 operate emergency services.
Why this matters for Medicare: every Medicare Advantage plan has a network, and the same hospital can be in-network on one plan and out on another. Knowing which facilities serve Outagamie County is step one; checking how the plan you’re considering treats them is step two, and it’s exactly the kind of thing we verify on a consultation call.
Health context matters to plan choice, too. CDC county data shows about 10% of Outagamie County adults live with diabetes, 6% with coronary heart disease, and 6% with COPD. If you manage one of these conditions, it’s worth knowing the county has 2 Chronic-Condition Special Needs Plans, Medicare Advantage plans designed around specific conditions, with care coordination most standard plans don’t include. Whether one fits you is a network-and-medications question we can answer on a call.
The broader health picture from the same CDC dataset: 33% live with high blood pressure, 27% with arthritis, 24% with depression among Outagamie County adults. These aren’t just statistics. They map directly to what matters in a plan: tier placement of blood-pressure and antidepressant medications, physical-therapy coverage, and whether your specialists are in network.
For longer-term care, Medicare’s Care Compare registry lists 7 certified nursing homes in the county: Rennes Health And Rehab Center-Appleton (Appleton, 5-star CMS rating); St Paul Elder Services, Inc (Kaukauna, 5-star CMS rating); Good Shepherd Services Ltd (Seymour, 4-star CMS rating); Brewster Village (Appleton, 4-star CMS rating), plus 3 more. (Facility ratings are CMS’s own 5-star quality ratings, worth knowing about even if you hope never to need them, because Original Medicare and Advantage plans cover skilled nursing stays differently.)
The county is also served by 3 Medicare-certified hospice providers. Hospice care is covered under Part A regardless of whether you choose Original Medicare or Medicare Advantage, one of the few benefits that works the same either way.
A wider lens from CMS’s Geographic Variation data: Medicare spent about $10,521 per beneficiary in Outagamie County in 2024 (standardized, so it’s comparable across regions); local beneficiaries made about 544 emergency-room visits per 1,000 people; and 13% of hospital stays led to a readmission within 30 days. Numbers like these shape what care access and costs actually look like where you live, and they’re part of why the same national plan can perform differently county to county.
How Outagamie County compares to the rest of Wisconsin
Averages hide the local picture, so here’s where Outagamie County actually sits against the other 71 counties in Wisconsin: 73% of Outagamie County beneficiaries are in Medicare Advantage, well above the Wisconsin median of 52%.
- Medicare spends $10,521 per beneficiary here, about the same as the statewide median of $10,518.
- Emergency-room use runs below the state median (544 visits per 1,000 beneficiaries vs. 631).
- You have 57 plans to choose from, well above the 36 a typical Wisconsin county sees.
When most of your neighbours have already moved to Medicare Advantage, it’s usually because the local networks work well here. That’s a useful signal, but it doesn’t answer whether your doctors are in the plan you’re considering.
Medicare in the counties next to Outagamie County
Plan availability stops at the county line. Cross into a neighbouring county and the plan list, the premiums, and sometimes the carriers all change. If you’re helping a parent or comparing for a move, here are the counties bordering Outagamie:
- Medicare in Milwaukee County, about 54 miles away · 52 plans, 47 at $0
Or see the full Medicare in Wisconsin guide for every county in the state.
Before you choose: the three questions that decide the rest
The plan counts above tell you what Outagamie County has on the shelf. They do not tell you which shelf you should be shopping from. These three guides answer that, in the order the decision actually gets made:
What clients say
Written and reviewed by Michael Smith, licensed insurance broker, founder of Guardian Health & Wealth (Bowling Green, KY), and author of 64+: Your Ultimate Guide to Medicare & Retirement Planning.
We do not offer every plan available in your area. Currently we represent 5 organizations which offer 48 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Plan data: CMS Landscape file CY2026_Landscape_202607 and CMS 2026 Plan Benefit Package files, plan year 2026, retrieved July 22, 2026. Data last verified 2026-07-22. Figures are for Outagamie County, Wisconsin and can change; always confirm details with the plan before enrolling. Star Ratings are the 2026 overall CMS ratings, measured on a 5-star scale.