Medicare Supplement Plans in Wisconsin

Wisconsin is one of three states where Medicare Supplement plans are standardized differently. This state offers a Basic Plan and additional riders that you can pair with it for more coverage. The best choice for you depends on your budget and needs.

If you prefer a cost-sharing plan, 50% and 25% Cost-Sharing plans are also available. These are similar to Plans K and L. Talking to an agent can make the process go faster and help you save money. First, let’s go over what the Basic Plan offers.

Wisconsin requires insurance companies to offer specific mandated benefits that protect people and provide enough coverage. These benefits include skilled nursing facility coverage, home health care, diabetes management, and kidney dialysis treatments.

Medigap in Wisconsin must include 30 days of care at a skilled nursing facility, with no prior hospital stay requirement. Yet, this stay must be medically necessary to receive coverage.

For home health care, the state mandates up to 40 visits annually beyond Medicare benefits. The doctor must verify that the need is medically essential.

Dialysis treatment must have inpatient and outpatient coverage. Also, transplants and donor-related expenses must receive coverage. Coverage must be at least $30,000 annually.

Coverage for diabetic supplies is mandatory, including self-management training and insulin infusion pumps. The insurance company must cover this, even if Medicare doesn’t approve the claim.

Some other included Mandated Benefits include surgery center care, chiropractic care, colorectal cancer screenings, some clinical trials for cancer, and breast reconstruction.

Also, catastrophic prescription drugs must receive coverage in Wisconsin. For those with policies issued prior to the origin of Part D in 2006, at least 80% of the charges for outpatient prescription drugs must receive coverage if they don’t have Part D. Additionally, this requires the beneficiary to meet a deductible of $6,250 in a calendar year.

The Basic Plan is excellent for covering what Medicare doesn’t. Riders are available to help with the deductibles, copays, and other coverage gaps. If you’re looking for additional coverage, a rider is a provision that allows you to add benefits to a basic policy.

There are seven options available for riders in Wisconsin. These are available à la carte for you to customize your own plan. Without any riders, your Basic Plan will be similar to Plan A. You can add riders to make your coverage equivalent to the best Medicare Supplement plans. For example, to obtain coverage similar to Medigap Plan G, start with the Basic Plan. Then, add the following riders: Part A deductible, Part B excess charges, additional home health care, and foreign travel emergency.

Below is a chart that shows what the Basic Plan covers, as well as the optional riders. This chart helps you imagine the way coverage works and how riders can help you customize your coverage.

All first-dollar coverage plans are going away for those newly eligible. If you’re not newly eligible, you can enroll in coverage similar to Plan F anytime. Meaning, you can elect to cover the Part B deductible. Anyone newly eligible can select the other coverage options that don’t cover the Part B deductible.

Wisconsin requires insurance companies to offer a Medigap policy to those under 65. However, the prices are considerably higher than for those who are over 65. Thus, these individuals can benefit from Medicare Advantage plans for additional coverage. Disabled beneficiaries are sometimes eligible for a type of Advantage plan known as a Special Needs Plan (SNP), which accommodates a beneficiary’s specific illness or disease.

Each beneficiary’s monthly premium costs differ due to a variety of factors. One of these factors is the level of coverage you select. The more coverage you select, the higher your monthly premium will be. Selecting the equivalent of Plan F coverage costs more than if you select the equivalent of Plan N.

The best rate might not be your current rate. This is mainly true if you’ve signed up outside of the Medicare Supplement Open Enrollment Period. Additionally, in Wisconsin, you may qualify for guaranteed issue if your employer plan’s annual premium is 125% or more of the Basic Plan for your age and gender. If you lose Medicaid, you qualify for a guaranteed issue with select carriers.

Those with lower incomes can utilize a Medicare Savings Program. If you’re not eligible for an MSP, you might still qualify for Extra Help with your prescription drug costs. Beneficiaries eligible for an MSP are always entitled to Extra Help.

Wisconsin’s State Health Insurance Program (SHIP) is through the Wisconsin Department of Health Services. The SHIP organization offers counseling services for Medicare beneficiaries. This can be particularly useful during the Annual Enrollment Period.