Coverage guides and answers
Plain-English answers to the questions people ask most. The explainer pages go deeper on specific situations.
Explainers
What's new for 2026
IRA Part D OOP cap update, ACA subsidy cliff, insulin cap, WI Medicaid unwinding status, 2026 FPL.
ReadHit the ACA cliff? Here's what to actually do
Above 400% FPL in 2026 = zero APTC. Wisconsin-specific playbook of every legitimate option (lower MAGI, Catastrophic plan, split household), with the traps to avoid.
ReadMedicare Advantage vs Medigap — which one?
The biggest Medicare decision: managed-care MA plan with extras, or Original + Medigap supplement. Includes WI's no-birthday-rule warning.
ReadHow to read your Medicare card
Every field on the red, white, and blue card explained — what the MBI means, why effective dates differ, common scams to ignore.
ReadThe Part D donut hole — what changed for 2026
The donut hole is gone. Replaced by a $2,100 IRA cap. Here's the timeline so you know which rules apply.
ReadMedicare vs Medicaid — what's the difference?
Eligibility, coverage, and how they work together for dual-eligibles in Wisconsin.
ReadBadgerCare Plus, explained
WI's Medicaid for low-income adults, kids, and pregnant residents — eligibility, costs, how to apply.
ReadCOBRA and Medicare — the trap people miss
Why COBRA doesn't 'count' as creditable coverage, and the late-enrollment penalty if you assume it does.
ReadSeniorCare vs Extra Help vs Part D — which one?
Wisconsin's three prescription help programs side-by-side, with a decision tree for your situation.
ReadMedicare denied my care — what do I do?
MA insurers denied 4.1M services in 2024. 80.7% of appeals win — but only 11.5% appeal. The 5-level appeal ladder, what wins at each, and where to start in Wisconsin.
ReadWisconsin Medicaid spend-down, explained
Over the income limit for EBD Medicaid? Unpaid medical bills count against your income. How it works in WI.
ReadFamily Care vs IRIS — long-term care
Same eligibility, two ways to get long-term care: agency-managed (Family Care) vs self-directed (IRIS).
ReadVA benefits and Medicare
VA care doesn't replace Medicare, and Part B late-enrollment penalties apply if you skip it. The penalty trap, plus how TRICARE for Life fits in.
ReadTribal health benefits and Medicare
Wisconsin's 11 tribes + IHS + PRC + Medicare. Special AI/AN protections in the Marketplace and LIS.
ReadGlossary — IEP, AEP, MSP, LIS, FPL, and 30+ more
Every alphabet-soup acronym you'll see in a Medicare letter, in plain English.
ReadFAQ
Is MediNav a broker?
No. MediNav is a free, neutral comparison tool. We don't sell plans, take commissions, or connect you with anyone unless you specifically ask. Our goal is to help you understand your options — not to sell you one.
Do I pay anything?
No. Everything on this site is free. We don't run ads against your health data and we don't sell anything.
How do you pick the 'best match'?
We score every Medicare plan against your answers: true annual cost (premium + expected visits + medications), CMS star rating, network fit for your doctors, formulary coverage for your meds, and benefits you flagged as must-have. The exact weights come from a profile card you pick on the priority step.
What about my privacy?
Your answers are stored in your browser (sessionStorage) and a per-visit cookie on the server. Health details (conditions, prescriptions, doctors) never leave your browser unless you explicitly request a broker contact, in which case they're sent to MediNav's founder by encrypted email. Photos uploaded for vision extraction (insurance card, prescription bottle) are sent to the AI Gateway with zero retention and never persisted on our side.
When can I enroll?
Medicare Annual Enrollment runs Oct 15 – Dec 7. The MA Open Enrollment Period runs Jan 1 – Mar 31 for switching MA plans. ACA Marketplace open enrollment typically runs Nov 1 – Jan 15. Medicaid is year-round. Life events trigger Special Enrollment Periods. See our /when-can-i-enroll page for an interactive walkthrough.
Why Wisconsin only?
Plan availability, formularies, and rules vary state-by-state. We launched in WI to get the data right for one state before expanding. The eligibility engines and explainers here are WI-specific, but we cover federal Medicare rules accurately for everyone.
What if you miss something or are wrong?
Plans change every year and CMS data has its own quirks. If you spot something wrong, file an issue on our GitHub repo or talk to a Wisconsin SHIP counselor (1-800-242-1060) — free, no commission. We try hard to be accurate but we are not a substitute for the carrier's Summary of Benefits or a licensed broker for enrollment.