The Best Medicare Supplement (Medigap) Plans in Wisconsin
- Wisconsin Medicare Supplement (Medigap) plans can help you save money on Medicare costs such as copays and deductibles. To learn about the options available, check out our review of Medigap plans in Wisconsin.
Original Medicare (Medicare Part A and Part B) pays for a lot of health care expenses and provides valuable coverage for retirees and other eligible beneficiaries, but it doesn’t cover everything. For those who need more than annual checkups, medical bills can quickly become burdensome.
Wisconsin Medicare Supplement Plans, or Medigap, help fill in the coverage gaps to pay for out-of-pocket Medicaare costs. In Wisconsin, Medigap plans can help pay for your cost-sharing responsibilities for hospital care, medical care, up to three pints of blood annually and hospice care. If you’re looking for more coverage, riders may be added to your policy for an additional monthly premium.
For Wisconsinites seeking an affordable option for expanding their Medicare insurance coverage, Medigap plans are a popular option. This coverage is sold by private health insurance companies that agree to terms and conditions set by the federal government.
Over 47% of Original Medicare beneficiaries in Wisconsin are enrolled in a Medigap plan.1 Understanding what Medigap covers in Wisconsin can help you determine whether you could save money on health costs by enrolling in a plan.
You can find Medicare Supplement plans where you live by comparing plans from several different insurance companies online.
What Are the Best Wisconsin Medicare Supplement Plans?
Most states have 10 types of Medigap plans, all of which are standardized, meaning that everyone with a specific plan has the same coverage regardless of health factors or insurance provider.
Wisconsin is one of only three states that doesn’t offer the standard Medigap plans that are available elsewhere. Instead, you enroll in the Wisconsin Basic Plan, which has benefits that are mandated by the state. Some insurance providers in the state sell riders that you can add to your policy to expand your coverage for an additional monthly premium.
Depending on your policy, Medigap pays your coinsurance or copay and your deductible.
Wisconsin Basic Plan
The Wisconsin Basic Plan has the same coverage for all enrollees. This coverage includes:
- Part A coinsurance, or the portion of the hospital bills you incur after 60 days in the hospital
- Part B coinsurance, or your 20% cost-sharing responsibility you owe for outpatient services
- Up to three pints of blood you need for Medicare-approved surgeries and procedures
- Copays for hospice or nursing home care
- An additional 175 days beyond Medicare’s lifetime coverage for inpatient mental health care, including enriched outpatient mental health services
- An additional 40 home health care visits beyond Medicare’s lifetime coverage for this service
On its own, the Medigap Basic Plan is comparable to Plan A Medigap plans in other states. If you need additional coverage, you can add a rider to your policy. There are seven riders available, and you can pick and choose which ones you want to customize your own plan.
The Medigap riders include:
- Coverage for the Medicare Part A deductible
- Coverage for 50% of the Medicare Part A deductible
- Additional home health care visits
- Coverage for the Medicare Part B deductible
- Medicare Part B copay or coinsurance
- Medicare Part B excess charges (charges you incur if your health care provider doesn’t accept the Medicare-approved price for a covered service)
- Foreign travel emergency
Note that the coverage for the Part B deductible isn’t available for those who became eligible for Medicare on or after January 1, 2020. If you were eligible before 2020 but not yet enrolled in this coverage, you may still be able to add it to your policy.
How Do I Enroll in a Wisconsin Medigap Plan?
If you live in Wisconsin, you have a guaranteed issue right to buy a Medigap policy when you first become eligible for Medicare Part B. This means that you can buy a Medigap plan regardless of your health, without having to go through Medical underwriting.
From your Part B effective date, or the date you first become eligible for this coverage, you have six months to enroll in a Wisconsin Medigap plan without having to answer health questions on your application. At this time, health insurance companies can’t deny coverage, regardless of your health status or pre-existing conditions. This is known as your Medigap open enrollment period.
Your health needs may change as you age, and the coverage you enrolled in at 65 may not be enough when you’re 85. If you miss the six-month initial enrollment window, you can still apply for Medigap. However, those who enroll later on may have to answer health questions, and insurance companies can charge you a higher monthly premium or deny coverage altogether based on pre-existing conditions.
AHIP. (Mar. 2022). The State of Medicare Supplement Coverage: Trends in Enrollment and Demographics. https://ahiporg-production.s3.amazonaws.com/documents/202202-AHIP_MedicareSuppCvg-02_v03.pdf.