Original Medicare vs a plan · Marathon County, WI · 2027 plan year
Original Medicare vs Esteem Rx Gold (HMO-POS)
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
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Esteem Rx Gold (HMO-POS)
- Plan premium
- $125 a month
- Yearly limit, in network
- $5,000
- 2027 star rating
- 4 of 5
- Prior authorization needed for
- 13 services
In most states, including Wisconsin, you cannot count on getting Medigap later
You can buy any Medigap plan with no health questions in the 6 months that start when you are 65 or older and have Part B. After that, a Medigap company in Wisconsin can ask about your health. It can say no, or it can charge you more. So if you join a Medicare Advantage plan now, you may not be able to get Medigap later.
One exception is the trial right. If you joined Medicare Advantage when you first got Medicare at 65, or you left a Medigap plan to try Medicare Advantage for the first time, you can switch back within 12 months. Then you can buy a Medigap plan with no health questions.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Medigap plan with Original Medicare
Wisconsin sets its own Medigap plans: a basic plan with optional riders, two cost-sharing plans, and a high-deductible plan. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices for these plans, so the totals show Original Medicare without Medigap. Without Medigap you pay 20% of most costs, with no yearly limit. Check Medigap plans and prices for ZIP 54455 on Medicare.gov
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
Original Medicare
With no Medigap and AARP Medicare Rx Saver from UHC (PDP)
$6,133 a year
- Premiums
- $2,638
- Medical costs
- $1,616
- Drugs
- $1,880
No yearly limit on what you pay for medical care.
Esteem Rx Gold (HMO-POS)
HMO-POS from Security Health Plan of Wisconsin, Inc.
$7,049 a year
- Premiums
- $4,014
- Medical costs
- $1,160
- Drugs
- $1,875
Most you can pay in a bad year, before drugs: $9,014.
With these settings, Original Medicare costs about $916 less a year than Esteem Rx Gold (HMO-POS).
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: no Medigap.
Primary doctor visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Esteem Rx Gold (HMO-POS)
$0 copay
Specialist visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Esteem Rx Gold (HMO-POS)
$40
Lab tests
Original Medicare, no Medigap
$0
most Medicare-covered tests
Esteem Rx Gold (HMO-POS)
$0 copay
Prior authorization
MRI or CT scan
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Esteem Rx Gold (HMO-POS)
$0-$200
Prior authorization
Emergency room
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Esteem Rx Gold (HMO-POS)
$130
Urgent care
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Esteem Rx Gold (HMO-POS)
$0-$40
Outpatient surgery
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Esteem Rx Gold (HMO-POS)
$0-$250
Prior authorization
Ground ambulance
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Esteem Rx Gold (HMO-POS)
$275
Prior authorization
Hospital stay, 5 days
Original Medicare, no Medigap
$1,788
Part A deductible each benefit period; $447 a day for days 61-90
Esteem Rx Gold (HMO-POS)
$1,400
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare, no Medigap | Esteem Rx Gold (HMO-POS) |
|---|---|---|
| Monthly premium | Part B $209.50 + drug plan $10.30 | $125 + Part B $209.50 |
| Yearly limit on what you pay | No yearly limit | $5,000 in network; $8,000 in and out of network |
| Medical deductible | $292 Part B; $1,788 Part A each benefit period | $0 |
| Primary doctor visit | 20%, after the $292 yearly Part B deductible | $0 copay |
| Specialist visit | 20%, after the $292 yearly Part B deductible | $40 copay |
| Lab tests | $0, most Medicare-covered tests | $0 copayPrior authorization |
| MRI or CT scan | 20%, after the $292 yearly Part B deductible | $0-$200 copayPrior authorization |
| X-rays | 20%, after the $292 yearly Part B deductible | $20 copayPrior authorization |
| Emergency room | 20%, after the $292 yearly Part B deductible | $130 copay |
| Urgent care | 20%, after the $292 yearly Part B deductible | $0-$40 copay |
| Outpatient hospital | 20%, after the $292 yearly Part B deductible | $0-$250 copayPrior authorization |
| Surgery center | 20%, after the $292 yearly Part B deductible | $0-$250 copayPrior authorization |
| Ground ambulance | 20%, after the $292 yearly Part B deductible | $275 copayPrior authorization |
| Hospital stay | $1,788, Part A deductible each benefit period; $447 a day for days 61-90 | $350 per day for days 1-4; $0 per day for days 5-90Prior authorization |
| Skilled nursing facility | $0, days 1-20, then $223.50 a day for days 21-100 | $0 per day for days 1-20; $221 per day for days 21-100Prior authorization |
| Mental health visit | 20%, after the $292 yearly Part B deductible | $40 copay |
| Physical therapy | 20%, after the $292 yearly Part B deductible | $30 copay |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization |
| Medical equipment | 20%, after the $292 yearly Part B deductible | 0%-20% coinsurancePrior authorization |
| Part B drugs | 20% after the $292 Part B deductible | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with AARP Medicare Rx Saver from UHC (PDP) | $300 |
| Drug tiers (one month, retail) | Preferred Generic: $0 copayGeneric: $5 copayPreferred Brand: 20% coinsuranceNon-Preferred Drug: 31% coinsuranceSpecialty Tier: 25% coinsurance | Preferred Generic: $0 copayGeneric: $8 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 30% coinsuranceSpecialty Tier: 30% coinsuranceSelect Care Drugs: $0 copay |
Not sure which of these costs apply to you?
Text us what you have now. We will help you read this comparison and check it with Medicare.gov.
A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In Wisconsin, 8 drug plans are for sale for 2027, from $5.30 to $189.10 a month. Half of them cost $10.85 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules, and you may not be able to get Medigap later.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
Esteem Rx Gold (HMO-POS)
HMO-POS
- You use the plan network. Some care outside the network is covered at a higher cost.
- No referral needed to see a specialist.
Prior authorization for 13 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Home health, Medical equipment, Prosthetics, Diabetic supplies, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | Esteem Rx Gold (HMO-POS) |
|---|---|---|
| Dental | No | Comprehensive, up to $500 a year |
| Eye exam | No | Yes |
| Glasses or contacts | No | Yes, $250 allowance |
| Hearing aids | No | Yes, copays from $499 |
| Over-the-counter allowance | No | $220 a year |
| Fitness benefit | No | Yes |
| Rides to care | No | No |
| Meals after a hospital stay | No | No |
| Emergency care abroad | No, unless your Medigap plan pays for it | No |
| Part B premium giveback | No | No |
What changed for 2027
Esteem Rx Gold (HMO-POS)
New Plan · New for 2027
No change found in the fields we track.
More 2027 plans in Marathon County
- Esteem Rx (HMO), H5211-012
- Compass (HMO), H5211-003
- Humana USAA Honor Giveback (PPO), H5216-355 (page for Cook County, IL)
- Humana Full Access (PPO), H7617-020 (page for Milwaukee County, WI)
- Humana USAA Honor Giveback (PPO), H7617-022 (page for Cook County, IL)
- AARP Medicare Advantage Patriot No Rx WI-MA02 (HMO-POS), H5253-021 (page for Milwaukee County, WI)
- Legacy Rx (HMO-POS), H5211-004
- Humana Full Access (PPO), H5216-410 (page for Milwaukee County, WI)
County guide: 2027 plans in Marathon CountyState guide: Wisconsin
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Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. Wisconsin sets its own Medigap plans: a basic plan with optional riders, two cost-sharing plans, and a high-deductible plan. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices or cost model for these plans, so the totals show Original Medicare without Medigap. You can look up Medigap plans and prices for ZIP 54455 on Medicare.gov. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- Esteem Rx Gold (HMO-POS) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices for ZIP 54455 on Medicare.gov
- Medigap plans in Wisconsin: Medicare.gov, Choosing a Medigap Policy (2026), Section 7
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.