Wisconsin is one of three states where Medicare Supplement Insurance looks vastly different than it does in the rest of the country. This page explains Medicare Supplement plans in Wisconsin and how to compare your options.
What Is Medigap in Wisconsin?
Medicare Supplement Insurance is commonly known as Medigap, a name that caught on because the plans are said to "cover the gaps" left by Original Medicare. This includes Medicare Part A, which covers inpatient services, and Medicare Part B, which covers medical services.
"Gaps" refers to your out-of-pocket costs. It does not mean you can join a Medigap plan to pay for services not covered by Original Medicare, such as prescription drugs and routine dental care. There is no limit to your annual out-of-pocket costs under Original Medicare.
How Is Medigap Different in Wisconsin?
In most states, beneficiaries have 10 standard Medigap plans to choose from (A, B, C, D, F, G, K, L, M, and N). Wisconsin has only one basic plan. Riders are available if you want more comprehensive coverage.
What Do Wisconsin Medigap Plans Cover?
Medicare Supplement plans help pay a variety of costs. The basic benefits with Wisconsin Medigap are:
- Medicare Part A coinsurance for inpatient hospital services and hospice care
- Medicare Part B coinsurance for medical services
- First 3 pints of blood in a calendar year
- Medicare Part A coinsurance for skilled nursing facility (SNF) care
- 175 lifetime days for inpatient mental health care
- An additional 40 home health visits
- State-mandated benefits
Wisconsin also made cost-sharing plans available that are similar to Medigap Plan K and Medigap Plan L.
Medigap insurers in Wisconsin can also sell riders. Options include:
- Medicare Part A deductible
- Home health care (a total of 365 visits, including the standard Medicare benefit)
- Medicare Part B deductible (no longer available to people who qualify for Medicare on or after January 1, 2020)
- Medicare Part B excess charges
- Emergency care needed during foreign travel
- 50 percent of the Part A deductible
Who Qualifies for Medicare Supplement Insurance in Wisconsin?
Nationwide, anyone who has Original Medicare and is age 65 or older may sign up for a Medicare Supplement plan. Wisconsin extends this coverage to those who qualify for Medicare due to a disability. However, Wisconsin is not one of the states that requires insurers to offer plans to under-65 Medicare beneficiaries who have end-stage renal disease (ESRD).
Just because you qualify for Medigap, though, does not mean insurers have to offer you a policy. If you apply for a Medigap plan when you don't have a guaranteed issue right, your application goes through medical underwriting. You may be denied coverage or charged a higher premium if you have preexisting medical conditions, smoke, or are otherwise considered high-risk.
When Is the Best Time to Join a Medicare Supplement Plan in Wisconsin?
We nearly always recommend people join a Wisconsin Supplement plan during their 6-month Medigap Open Enrollment Period (OEP). It starts the day you're enrolled in Original Medicare and age 65 or older. During Medigap Open Enrollment, your application does not go through medical underwriting. This means that you cannot be denied coverage nor charge a higher premium, even if you have preexisting medical conditions.
Wisconsin guarantees access to Medicare Supplement Insurance for under-65 beneficiaries, but insurers may charge you more.
If you qualify for Medicare due to a disability, you'll get a second Open Enrollment Period when you turn 65.
In 2018, Wisconsin Democrats introduced legislation (WI SB615) that would grant guaranteed issue rights year-round. Only a few states offer this protection. The bill was vetoed in April of 2020.
How to Choose a Medigap Plan in Wisconsin
We nearly always recommend choosing a Medigap plan with the most comprehensive coverage you can afford. Medical underwriting may make it impossible later. In Wisconsin, this means adding various riders to the basic plan.
Medigap premiums vary according to the insurance provider you choose. Understanding the pricing method used helps you estimate the lifetime cost of your policy. Wisconsin Medigap insurers use one of three pricing methods:
- Attained-age rated: Premiums are based on your age at the time you join the plan and will rise as you get older. You pay more over the life of your policy with this pricing method.
- Community rated: Also known as no-age rated, these plans charge the same premium regardless of age. Over time, you'll pay less for a community rated Medigap plan.
- Issue-age rated: Premiums are based on your age at the time you join the plan, not your age throughout the life of the policy. They may rise over time due to inflation, though.
Our Find a Plan tool makes it easy to compare Medigap plans in Wisconsin. Simply enter your location information and coverage start date to review Medicare plan options in your area.
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