Oct. 24, 2025
VIROQUA, Wis. — Navigating the system of Medicare and public benefits can be daunting, and with pretty major changes happening it can be a nerve racking for beneficiaries and their families. It can be hard to know where to turn for help. We reached out to some area resources to see what help is available to those wondering what the changes are all about.
Medicare’s annual Open Enrollment Period (OEP) is currently active, providing individuals the opportunity to review and select coverage options for the coming year, with several significant drug cost changes taking effect and key plan options leaving Vernon County.
The Medicare Open Enrollment period runs from October 15 through December 7, 2025 for most plans. However, individuals enrolled in Quartz, Anthem BCBS, or AARP UHC plans have an extended window, until December 31, 2025, to select a new plan.
Most of the information below can be found on the Vernon County Aging and Disability Resource website.
Federal Plan Updates Feature New Financial Protections
Several improvements and new features are available through Medicare this enrollment cycle, particularly concerning prescription drug costs.
A major change effective in 2025 is the introduction of a $2,000 cap on annual out-of-pocket costs for prescription drugs covered by a Medicare plan. Once beneficiaries reach this $2,000 cap, they will pay nothing for covered Part D drugs for the remainder of the year. This calculation includes out-of-pocket spending for covered Part D drugs, plus certain payments made on behalf of the individual, such as those by Medicare’s Extra Help program.
Additionally, a new Medicare Prescription Payment Plan is being offered by all plans. This option helps beneficiaries manage their Part D drug costs by spreading payments across the calendar year, from January through December. While this plan helps manage the timing of payments, it does not save money on overall drug costs. Individuals reviewing plan details can see what their estimated monthly costs might look like both with and without this payment option.
The Medicare Plan Finder tool has also been improved this year to offer more support for those seeking financial assistance. Users can now select “learn more about these programs” to get information about programs like Medicaid or Extra Help, which may lower health or drug costs. If a user is logged in to their online Medicare account, any help they receive is automatically saved and included in the plan cost estimates they view.
Vernon County Faces Local Coverage Adjustments
For residents of Vernon County, specific Medicare Advantage plans are exiting the market for 2026. These plans include Quartz Medicare Advantage, AARP United Health Care, and Anthem BCBS (excluding Duals).
Medigap insurance is designed to fill the “gaps” in Original Medicare (Parts A and B), covering out-of-pocket costs that Original Medicare does not.
Key features of Medigap include:
• No network restrictions; beneficiaries can see any doctor nationwide that accepts Medicare.
• No referrals are necessary.
• The insurance often results in higher premiums but little to no copays.
• Medigap does not include prescription drug coverage; beneficiaries must purchase a separate Part D plan.
Summary of the Medicare Plan Selection Process
Finding and comparing plans can be done primarily using the Medicare Plan Finder.
1. Access Plan Finder: Begin by visiting medicare.gov/plan-compare.
2. Enter Location and Plan Type: Users can search as a guest by entering their zip code and county. If searching as a guest, the user must manually input their prescription drugs and preferred pharmacies to receive specific cost estimates.
3. Log In for Better Accuracy: Using an online Medicare account is recommended as it makes the process faster, automatically includes saved drug lists, and integrates any financial help the individual receives (like Extra Help or Medicaid) into the cost estimates.
4. Compare Options: The Plan Finder allows users to compare plans and see estimated costs based on the drugs they take and the pharmacies they choose.
5. Review Drug Costs: Users can select “plan details” on the results page to see a breakdown of estimated drug costs, including costs before deductible, after deductible, and after the out-of-pocket cap.
6. Review Payment Options: When reviewing plan details, users can scroll to the yearly Drug Costs by Pharmacy section and select “find out what your drug cost might look like” with the new Medicare Prescription Payment Plan option to compare monthly costs.
Sites and Tools for Easier Enrollment
• Medicare Plan Finder: medicare.gov/plan-compare
• Official Medicare Website: medicare.gov
• Customer Support Line: 1-800-MEDICARE (1-800-633-4227)
• State Health Insurance Assistance Program (SHIP): ship.help.org (to find local phone numbers) shiphelp.org
• Plan Finder User Guides: cmsnationaltrainingprogram.cms.gov/resources
• Vernon County ADRC Contact: 608-637-5201 or 1-888-637-1323, or email ADRCVC@vernoncountywi.gov (for local assistance)
Upcoming Medicare Enrollment and Assistance Events
Enrollment Assistance Sessions (Hands-On Sign Up)
The Aging and Disability Resource Center (ADRC) of Vernon County offers large group, hands-on sessions where Benefit Specialists assist attendees with signing up for their 2026 Medicare plan. These sessions are explicitly noted as NOT informational meetings.
Spaces for these sessions are limited, as each class holds 20 participants, and attendees must call the ADRC of Vernon County at (608) 637-5201 or 1-888-637-1323 to sign up.
Required Materials for Hands-On Sessions: Attendees are asked to bring their laptop, iPad, tablet, or smartphone, along with their Medicare card and prescription drugs.
Upcoming ADRC Large Group Sessions:
• Date: November 19
◦ Time: 1:00 p.m. – 2:00 p.m.
◦ Location: Erlandson Bldg. 1st Floor Conf Room
• Date: December 1
◦ Location: VMH Medical Office Conference Room (downstairs via elevator or stairs, entering main lobby of clinic).
◦ Time Slots: 9:00 AM – 10:00 AM presentation, followed by two large group sessions (10:15 AM – 11:30 AM and 11:45 AM – 12:45 PM).
• Date: December 3
◦ Location: Gundersen St. Joseph Hillsboro Conference Room (right off main lobby, main entrance).
◦ Time Slots: 9:00 AM – 10:00 AM presentation, followed by two large group sessions (10:15 AM – 11:30 AM and 11:45 AM – 12:45 PM).
(Note: Previous ADRC dates on October 22nd and October 24th had already reached full capacity)
Medicare Help and Guidance Event at VFW
Strive Medicare is a private broker who is providing a local event to support beneficiaries impacted by several Medicare health plans discontinuing coverage effective January 2026.
“We recognize how important health coverage is to our community,” said Rick Teska-Owner/Broker-Strive Medicare. “Our priority is to support impacted beneficiaries through this transition by providing clear guidance, resources, and one-on-one assistance with choosing a new plan to meet their needs.”
• Date: October 25
◦ Time: 10:00 a.m.
◦ Location: Viroqua VFW.
◦ Purpose: Local Medicare Help Event to support affected members reviewing their options
Medicare Help and Guidance Event at Coon Prairie Church
Inspire Medicare is a private broker who is providing a local event to support beneficiaries impacted by several Medicare health plans discontinuing coverage effective January 2026.
• Date: November 2
◦ Time: 03:00 p.m.
◦ Location: Coon Prairie Church in Westby.
◦ Purpose: Local Medicare Help Event to support affected members reviewing their options
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