Wisconsin Medicare Supplement Plans (Medigap)

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Medigap insurance is available for Wisconsinites currently carrying Medicare. These supplemental insurance plans are offered by the various private insurance carriers and provide extra benefits outside of Traditional Medicare.

Out of pocket (OOP) costs associated with deductibles, copayments and coinsurance are included in these plans. The Supplement Plans and Traditional Medicare are separated into parts and plans and will be broken down here.

Wisconsin Medicare Plans ExplainedWisconsin Medicare Plans Explained

The 4 parts of Medicare:

  • Medicare Part A is your basic hospital coverage. This includes any costs associated with inpatient care.
  • Medicare Part B is your basic outpatient benefits. This includes coverage on any doctors visits, diagnostic testing, labs or outpatient procedures.
  • Medicare Part C is considered a Medicare Replacement Plan as it takes over coverage of Original Medicare Part A and Part B with certain policy limitations.
  • Medicare Part D is prescription drug coverage.
  • Wisconsin Medigap Plans: There are separate plans available for Wisconsin residents that provides additional insurance for those with Medicare coverage.

What Does Medicare Cover in Wisconsin

Medicare Part A or Medicare Part B, while providing coverage for inpatient and outpatient services, both only provide coverage at 80%. This leaves the remaining 20% leftover for the Medicare beneficiary.

A Medigap Plan can be beneficial with providing additional coverage to your Traditional Medicare benefits and also lower your OOP expenses each month.

Eligibility for Medigap Plans in Wisconsin

To be considered eligible for a Medigap Plan, you must be at least 65 years of age and currently enrolled in Medicare Part B. The time in which you are eligible to enroll in Medicare Part B is called your Open Enrollment Period (OEP).

To avoid the Part B Late Penalty, you must enroll as soon as you become eligible. The Part B penalty increases your $134.00 a month premium, so the longer you go without coverage the more this will increase. Make sure to enroll as soon as possible to avoid any additional OOP expenses.

Wisconsin Medicare Benefits for the Disabled Under 65

Those currently receiving Social Security Disability benefits, have End Stage Renal Disease or certain Railroad Retirement Benefits are automatically enrolled in Medicare Parts A and B after 24 months.

Federal law doesn’t require the individual states to offer Medigap Plans however, each individual state law determines whether or not to offer this coverage.

Luckily for you, Wisconsin is one of these states to offer Medigap Plans. Call today and one of our licensed insurance agents can help you find the best insurance plan if your disabled and residing in Wisconsin.

How to Enroll in a Medicare Supplement Plan in Minnesota

During your OEP is the best time to obtain a Medicare Supplement Plan. Your OEP begins the 1st day of the month after turning 65 and carrying Medicare Part B and then carries through the next 6 months.

For example, if your birthday was March 28th and your Medicare Part B effective date was April 7th, then your OEP begins May 1st.

During this time you have what is called is called your Guaranteed Issue (GI) right. What the GI ensures is that you cannot be denied insurance coverage regardless of any pre-existing health issues.

Enrolling outside of your GI, you are subject to the underwriting process which can result in higher monthly premiums or coverage denial due to current health conditions.

Medigap Plan Pricing In Wisconsin

Medigap Plan Pricing In WisconsinEach insurance carrier determines how to set their premium pricing. Determining factors  include age, sex and location.

For example, a woman living in Madison, WI will have different premium rates from a gentleman living in Milwaukee, WI.

Another way to determine premium pricing is the 3 different methods that the insurance carriers rely on.

Those 3 different pricing methods are community rated pricing, issue-age rated pricing and attained-age-rated pricing.

You can find out about the different pricing methods including which option your particular state uses by clicking here.

Wisconsin Medigap Plan

Wisconsin is unique as it is 1 of the 3 states that carry their own set of a Medigap Plans. Rather than most states that carry 10 separate letter plans for Medigap, WI carries the Basic Plan, 50% Cost-Sharing Plan and 25% Cost-Sharing Plan.

Standard Insurance Benefits include:

  • Part A coinsurance for inpatient hospital care
  • Part B coinsurance for the 20% of Medicare approved medical costs after Medicare pays their 80%>
  • First 3 pints of blood for a medical procedure
  • Part A coinsurance and copays for hospice care

Wisconsin Medigap Basic Plan Benefits Include:

    • Basic benefits listed above
    • Part A coinsurance for skilled nursing facility
    • In addition to Medicare’s inpatient mental health care coverage, this plan includes an extra 175 days of inpatient care per lifetime
    • In addition to Medicare’s home health care benefits, this plan provides an additional 40 home health care visits
    • State mandated benefits

Additional Plan Information

There are two additional plans called 50% Cost-Sharing Plan and 25% Cost-Sharing Plan.The two plans are comparable to two of the letter Medigap Plans.Plan K is similar to the 50% Cost-Sharing Plan and Plan L being similar to the 25% Cost-Sharing. There is also a  high-deductible plan ($2,000) available.

Many of the insurance companies also allow beneficiaries the option to add on riders to their Medigap policy. These riders cover additional benefits such as:

  • Part A hospital deductible
  • 50% of Medicare Part A deductible
  • An additional 365 of home health care
  • Part B outpatient deductible
  • Copays and coinsurance for Medicare Part B
  • Excess charge coverage for Medicare Part B
  • Foreign travel emergency healthcare coverage

For more information regarding the Medigap Plans offered in your great state of Wisconsin, call or complete the online rate comparison form today.

Medicare Advantage Plans in Wisconsin

Medicare Part C or Medicare Advantage plans are also offered by the individual insurance carriers. Oftentimes referred to as a Medicare Replacement Plan as it, “replaces” your Original Medicare Part A and Part B coverage.

An Advantage Plan cannot be combined with any of the Supplement Plans and also comes with restrictions. Coverage limitations may include cancellation restrictions and  in-network providers just to name a couple.

While typically cheaper than a Medigap Plan, overtime your OOP costs are higher. As most seniors are on a fixed income, they find that purchasing a Medigap Plan over an Advantage Plan provides better benefits with less OOP costs.

Prescription Drug Plans in Wisconsin

Prescription Drug Plans in WisconsinA Medicare Part D, or Prescription Drug Plan (PDP), is vital to include in your insurance trifecta as Traditional Medicare or any of the Supplement Plans do not offer prescription medication coverage. Similar to Part B there is also a Part D penalty.

Your PDP penalty begins after your IEP has expired and will be added to your monthly premium.

The longer you go without drug coverage the higher your monthly premiums will become.

Here is another instance in which you want to enroll as soon as you become eligible to avoid yet another additional OOP charge.

Compare Medicare Supplement Plans in Wisconsin

If you are trying to obtain information or compare pricing for any of the Medicare Supplement Plans, compare Traditional Medicare to a Medicare Part C Plan or obtain pricing for a PDP, we can help! Our services are are always 100% free so call.

Wisconsin Resources for Medicare

Not only in Wisconsin, but across the country, the federal Medicare program has free counseling for seniors in need of financial assistance. The national program, endorsed by the US government is theCenters for Medicare and Medicaid.

The individual state programs can be found on the SHIP (Senior Health Insurance Counseling Program) Center website.

Wisconsin Fun Facts

In 2015, the total number of Medicare beneficiaries reached over 1 million, that’s 18% of the total population in the state.

2013, 85% of residents became eligible for Medicare due to attaining the age of 65 and the other 15% became eligible due to being disabled.

In that same here, less than 7,000 beneficiaries that became eligible were diagnosed with end-stage renal disease.

Wisconsin Medicare FAQs

  • Can Medicare Supplements raise rates in WI? The Centers for Medicare and Medicaid Services (CMS) can choose to raise their deductibles at any time. Once they do so, the Medicare Supplement Plans tend to follow suit. The different insurance companies will change at various times and it also depends on the specific Medigap policy.
  • Did WI reject expanding Medicare? Yes, Scott Walker refuses funding for expanding Medicare.
  • Can people in WI have both Medicare and Medicaid? Yes, you can have both Medicare and Medicaid. It’s called Dual Advantage and comes with certain qualifications.