Medicare Supplement Plans in Wisconsin
State laws require Medigap insurance carriers to cover specific mandated benefits in addition to the basic benefit coverage.
Medigap coverage protects you from having outrageous medical bill responsibility. To be eligible for Medigap, enroll in Medicare Part A & Part B.
Our Wisconsin Medicare Supplement guide below will explain these details in depth.
Wisconsin Medicare Supplement Plans
Low and behold, Laurie is still responsible for 20% of the ENTIRE medical bill. Plus, Laurie didn’t read the Medicare & You handbook; so, she has no idea about the Part A and B deductible.
While Laurie is running errands when she has congestive heart failure; the ambulance transports her to the hospital where she becomes an inpatient receiver of care for 6-days.
Laurie is now responsible for $185 Part B deductible for the ambulance transport; then, there is 20% of any leftover balance from the ambulance.
Next, Laurie will pay the Part A deductible, this is $1,364 per benefit period. A benefit period is every 60 days; so, a beneficiary could pay this deductible several times in a year.
Then, Laurie needs to pay 20% of the hospital bill. Well, the average cost of congestive heart failure is $11,500 and 20% of that is $2,200!
If Laurie has Medigap, she could pay a fraction of what the hospital bill would cost with congestive heart failure. Plus, her doctor visits and specialists costs will be lower as well.
Wisconsin Medigap for the Disabled Under 65
Medicare recipients under 65 are eligible to enroll in Medigap; state laws require companies to offer at least one policy. Although, insurance companies can charge higher premiums to beneficiaries under 65.
Sometimes disabled beneficiaries will be eligible for a Special Needs Plan (SNP); this kind of policy is tailored to a customer’s specific illness or disease. SNP’s are a form of Medicare Advantage coverage.
Otherwise, under 65 beneficiaries could choose a standard MA plan. An MA policy will offer more benefits than standard Medicare.
While it’s not comprehensive coverage, it’s similar to employer coverage you’ve probably had in the past. There are copayments when you visit the doctor and some plans require deductibles or coinsurances.
Wisconsin Medicare Part C
Some MA policies cost $0 per month; however, the out of pocket expense can be unbearable. Let’s say Laurie has an MA policy when she experiences her congestive heart failure.
Well, the ambulance would cost $275 and the inpatient hospital stay is $300 a day for days 1 through 6. So, after 6 days in the hospital, she pays $1,800 in copayments.
Now, Laurie will also pay the copayments for every specialist she sees for her condition. The specialist is a $40 copayment each time if she needs to go every month that’s almost $500 a year in specialist copayments.
These out of pocket expenses add up fast. Laurie could easily pay $3,000 for the year on this plan.
Now there is a Maximum Out Of Pocket for these plans is usually around $5,000. So, if Laurie had a terribly unhealthy year, the most she pays out of pocket is $5,000. After she reaches that amount then her plan pays 100% of covered services.
The MA plans are a great option for those that can’t afford Medigap because they offer more coverage than Medicare. However, Medigap gives beneficiaries more complete coverage.
Plus, many times Medigap ends up costing much less annually than MA plans.
Wisconsin Medicare Part D
Many people find PDP coverage for as low as $15 a month; however, the lowest premium isn’t the lowest cost. Let’s say Laurie enrolls in the $15 PDP without checking the formulary; she did this because she thinks this plan is the most affordable.
Laurie takes medication for her heart condition; she is taking a brand name drug because generic is unavailable. Well, on the $15 a month plan Laurie will pay the full $400 drug deductible the first month; the next month she pays a $70 co-payment and that continues each month.
Now, with the $30 a month plan Laurie doesn’t have a deductible; she only pays $50 a month for the prescription with NO deductible. So, by paying a little more each month Laurie saves a lot on out of the pocket expense.
Much like when you choose a Medigap plan and pay a premium; spend a little to save a lot.
Wisconsin Resources for Medicare
All Medicare recipients should visit the CMS Newsroom for recent information on Medicare-related topics.
Some beneficiaries with a low-income could qualify for the Medicare Savings Program (MSP). If you don’t qualify for MSP, you may be eligible for Extra Help, with will help in covering the cost of PDP premiums or copayments.
If you need assistance the State Health Insurance Program (SHIP) is offering their services to Medicare beneficiaries and their families.
Mandated Benefits for Wisconsin Medicare Supplement Plans
WI requires insurance companies to offer specific Mandated Benefits that protect beneficiaries and provide adequate coverage. These benefits include Skilled Nursing Facility (SNF) coverage, Home Health Care (HHC), Diabetes and Kidney Disease.
Medigap must include 30 days of SNF with no prior hospital stay required. The doctor must clarify your need and it must be medically necessary.
For HHC 40 visits annually beyond Medicare benefits. The doctor must verify need and that it’s medically necessary. Now, HHC coverage can be additional costs; however, the plan covers 365 HHC visits each year.
Coverage for diabetic supplies is mandatory; including self-management training and insulin infusion pumps. The company must cover this, even if Medicare doesn’t approve the claim.
Dialysis treatment must be covered inpatient and outpatient; also, transplants and donor-related services must be covered. Coverage must be at least $30,000 annually.
Some other included Mandated Benefits include surgery center care, chiropractic care, colorectal cancer screenings, some clinical trials for cancer, and breast reconstruction.
Wisconsin Medicare Supplement Plan Guide
Nearly a million people have chosen Part A & B of Medicare. Medicare beneficiaries will need Medicare Part B to enroll in Medigap.
Upon receiving the Medicare card with the Part B effective date, you can pre-enroll in Medigap coverage with Guarantee Issue (GI) rights. The month of the Part B effective date will begin the Open Enrollment Period (OEP); this only lasts for 6-months and is a once in a lifetime opportunity.
Combining Medicare with Medigap will give you the most complete coverage. However, waiting past the OEP opportunity means insurance companies can deny coverage or charge more for pre-existing conditions.
Most beneficiaries are good during underwriting; however, the best way to get a low rate and good coverage is to apply during OEP.
Just because you experienced denial with one company doesn’t mean another company won’t approve you; our agents have experience with the underwriting guidelines of the top insurance carriers in your area.
Someone with an employer policy that costs greater than 125% of the Basic Annual Premium for the applicant’s gender, age, and tobacco status will also qualify for GI rights.
Give us a call at the number above and learn about plans you may be eligible for applying.
Medicare Supplement Plans in Wisconsin
Wisconsin is unique as it carries a Basic Plan, 50% Cost-Sharing Plan and 25% Cost-Sharing Plan. The best plan for you depends on your budget and healthcare needs.
Thankfully, resident beneficiaries can really customize coverage to suit their desires.
Talking to a licensed broker can make the process go faster and save you money. Let’s take a look at the coverage available and how it can save you money long-term.
Wisconsin Medicare Supplement Basic Benefits Plan
- Part A coinsurance
- hospital copayments are after 60 consecutive days of inpatient services
- Skilled Nursing Facility (SNF) and Hospice
- Part B coinsurance
- First 3 pints of blood
- Additional 40 home health care visits
- Extra 175 days of inpatient mental healthcare beyond Medicare
Wisconsin Medicare Supplement Basic Benefit Plan Riders
The Basic Benefit Plan is great for covering the 20% of care that Medicare isn’t covering. However, what about the deductibles? Don’t worry, additional riders are available!
A “rider” is a provision that allows you to add benefits to a basic policy. So, pay a little bit more and have coverage for deductibles, excess charges, home health care, or foreign travel.
Our brokerage works with the top-rated carriers in Wisconson. Also, we understand which companies have higher rate increases, saving you more money in the long-term.
Wisconsin Medicare Supplement Plan Comparison Chart
Below is a chart that shows the way other state Medigap policies can be similar to WI state-specific plans. This chart will help you visualize the way coverage works and how riders can help you customize your coverage.
Cost of Wisconsin Medicare Supplement Plans
Medicare Supplement plan costs vary because each carrier has a different rating system and each person has different health issues. The rate can change from male to female, smoker to a non-smoker, and location to location.
The level of coverage you select will also affect the price; “Plan F” will obviously have higher premiums than “Plan N”. With so many different factors, the best rate might not be your rate; this is especially true when applying outside of the OEP.
The biggest thing for beneficiaries to evaluate is the cost between “Plan G” and “Plan F”. Some beneficiaries save over $200 each year by paying their own $185 Part B deductible.
If you talk with one of our brokers they’re very familiar with plan evaluation; they can find the best plan, with the best company in minutes. Save yourself hours of online search and call an agent to get this done in minutes!
First Dollar Medicare Supplement Plan Changes in Wisconsin for 2020
In 2020, first-dollar coverage plans will retire. This means insurance companies can’t cover the Part B deductible. Massachusetts, Minnesota, and Wisconsin all have a different Medigap set up than the other states.
These states haven’t given any information on new policies available for 2020. Although, these states must adopt the changes.
Compare Medicare Supplement Plans in Wisconsin
Enrollment is simply a phone dial away. Our brokers can walk you through policy details and enrollment telephonically; that means you can do this from the comfort of your own home.
Plus, nobody needs to come over! Call us today at the phone number above!
Applying early is better than applying late; get the best premium and the best policy from our agency. Then, long after your policy is active if you want to shop or have questions, our client care team will be here to assist with your Medigap needs!