Medicare & Medicaid in Wisconsin (WI)
2026 healthcare costs, coverage, and spending data for Wisconsin.
$9,230
Spending/Capita
1,336,643
Medicare Enrollees
1,815,525
Medicaid Enrollees
7.1%
Uninsured Rate
Medicare Premiums in Wisconsin
Part B Premium
$185/mo
Part D Premium (Avg)
$50/mo
Medigap Premium (Avg)
$267/mo
Medicaid Expansion: Yes - Wisconsin expanded Medicaid under the ACA
Procedure Costs in Wisconsin
Hospital
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Kidney Transplant | $159,890 | $127,912 | $31,978 |
| Liver Transplant | $138,077 | $110,461 | $27,615 |
| Heart Valve Replacement | $80,175 | $64,140 | $16,035 |
| Coronary Artery Bypass Graft (CABG) | $65,300 | $52,240 | $13,060 |
| Spinal Fusion | $59,748 | $47,798 | $11,950 |
| Defibrillator Implantation (ICD) | $50,482 | $40,386 | $10,096 |
| Total Knee Replacement | $37,990 | $30,392 | $7,598 |
| Laminectomy | $30,526 | $24,420 | $6,105 |
| Total Hip Replacement | $30,418 | $24,334 | $6,084 |
| Colectomy | $29,095 | $23,276 | $5,819 |
| Carotid Endarterectomy | $26,708 | $21,366 | $5,342 |
| Cardiac Catheterization with Stent | $22,867 | $18,294 | $4,573 |
| Pacemaker Implantation | $22,760 | $18,208 | $4,552 |
| Stroke Treatment (Acute) | $22,752 | $18,201 | $4,550 |
| Prostatectomy | $21,030 | $16,824 | $4,206 |
Outpatient
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Lithotripsy (Kidney Stones) | $8,353 | $6,683 | $1,671 |
| Endoscopic Sinus Surgery | $8,177 | $6,541 | $1,635 |
| Arthroscopic Knee Surgery | $7,331 | $5,865 | $1,466 |
| TURP (Prostate) | $7,226 | $5,781 | $1,445 |
| Septoplasty | $6,316 | $5,053 | $1,263 |
| Bunionectomy | $5,869 | $4,695 | $1,174 |
| Hemorrhoid Surgery | $5,411 | $4,329 | $1,082 |
| Adenoidectomy | $4,745 | $3,796 | $949 |
| Nasal Polyp Removal | $4,646 | $3,717 | $929 |
| Dialysis Access Surgery | $4,553 | $3,643 | $911 |
| Pilonidal Cyst Surgery | $4,512 | $3,609 | $902 |
| Tonsillectomy | $4,449 | $3,559 | $890 |
| Ganglion Cyst Removal | $4,070 | $3,256 | $814 |
| Carpal Tunnel Release | $3,603 | $2,882 | $721 |
| Breast Biopsy | $3,409 | $2,727 | $682 |
Imaging
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| PET Scan | $2,819 | $2,255 | $564 |
| Nuclear Stress Test | $2,288 | $1,830 | $458 |
| CT Angiography | $1,855 | $1,484 | $371 |
| MRI Knee | $1,493 | $1,195 | $299 |
| MRI Hip | $1,282 | $1,026 | $257 |
| MRI Shoulder | $1,243 | $995 | $249 |
| MRI Brain | $1,234 | $988 | $247 |
| MRI Spine (Lumbar) | $1,129 | $903 | $226 |
| CT Scan Abdomen/Pelvis | $1,128 | $902 | $226 |
| MRI Spine (Cervical) | $1,121 | $896 | $224 |
| Bone Scan | $1,023 | $819 | $205 |
| CT Scan Head | $928 | $742 | $186 |
| CT Scan Chest | $802 | $641 | $160 |
| CT Colonography (Virtual) | $717 | $574 | $143 |
| Echocardiogram | $661 | $529 | $132 |
Physician/Office
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Sleep Study Consultation | $427 | $342 | $85 |
| Allergy Testing | $306 | $244 | $61 |
| Annual Wellness Visit | $296 | $296 | $0 |
| Shingles Vaccination | $244 | $244 | $0 |
| Mammogram (Screening) | $239 | $239 | $0 |
| Psychiatry Visit | $221 | $177 | $44 |
| Office Visit (New Patient) | $188 | $151 | $38 |
| Wound Care Visit | $187 | $150 | $37 |
| Office Visit (Established Patient) | $175 | $140 | $35 |
| Bone Density Test (DEXA Scan) | $164 | $131 | $33 |
| Occupational Therapy Session | $161 | $129 | $32 |
| Mental Health Counseling | $161 | $129 | $32 |
| Speech Therapy Session | $153 | $123 | $31 |
| EKG (Electrocardiogram) | $144 | $115 | $29 |
| Vision Exam (Diabetic) | $130 | $104 | $26 |
Laboratory
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Vitamin D Level | $56 | $45 | $11 |
| BNP (Heart Failure Marker) | $54 | $43 | $11 |
| Blood Type and Crossmatch | $51 | $41 | $10 |
| Comprehensive Metabolic Panel | $48 | $39 | $10 |
| Troponin Level | $47 | $38 | $9 |
| Blood Culture | $46 | $37 | $9 |
| Iron Studies (Ferritin) | $43 | $34 | $9 |
| Glucose Tolerance Test | $37 | $30 | $7 |
| Liver Function Panel | $35 | $28 | $7 |
| Thyroid Panel (TSH) | $35 | $28 | $7 |
| Hemoglobin A1C | $33 | $26 | $7 |
| PSA (Prostate-Specific Antigen) | $32 | $26 | $6 |
| Complete Blood Count (CBC) | $31 | $25 | $6 |
| Urine Drug Screen | $29 | $23 | $6 |
| Basic Metabolic Panel | $29 | $23 | $6 |
Compare Wisconsin With Other States
Frequently Asked Questions
How much does Medicare spend per person in Wisconsin?
In 2026, the average Medicare spending per beneficiary in Wisconsin is $9,230.
How many people are enrolled in Medicare in Wisconsin?
Wisconsin has approximately 1,336,643 Medicare beneficiaries.
Did Wisconsin expand Medicaid?
Yes, Wisconsin expanded Medicaid under the Affordable Care Act.
What is the uninsured rate in Wisconsin?
The uninsured rate in Wisconsin is 7.1%.
What is the average Medigap premium in Wisconsin?
The average Medigap (Medicare Supplement) premium in Wisconsin is $267 per month.