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Medicare Supplement Plans in Wisconsin
Wisconsin Medicare Supplement plans are much different than the standard ten letter plans around the nation. The program available in this state includes a Basic Plan with the option of riders. State laws require Medigap insurance carriers to cover specific benefits in addition to the primary benefit coverage. Our Wisconsin Medicare Supplement guide below explains these details in depth.
Medicare Supplement Plans in Wisconsin
Wisconsin carries a Basic Plan, 50% Cost-Sharing Plan, and 25% Cost-Sharing Plan. The best plan for you depends on your budget and needs.
Thankfully, beneficiaries can customize coverage to suit their wishes.
Talking to a broker can make the process go faster and save you money. Let’s take a look at coverage and long-term savings.
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
- Another 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 excellent for covering 20% of care and some other benefits. However, what about the deductibles? Don’t worry; riders are available!
A “rider” is a provision that allows you to add benefits to a basic policy. So, pay a little more for coverage on deductibles, excess charges, home health care, or foreign travel.
Our brokers work with top-carriers in Wisconson. Also, we know which companies have a higher rate increase, saving you 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 helps you imagine the way coverage works and how riders can help you customize your coverage.
In 2020, all first-dollar coverage plans are going away. Those eligible before 2020 can enroll in similar to Plan F coverage anytime.
Anyone eligible in 2020 can select other coverage options, such as insurance, that doesn’t cover the Part B deductible. The reason for these changes is the Medicare Access and CHIP Reauthorization Act (MACRA).
Low and behold, Lauriestill pays 20% of the ENTIRE medical bill. Plus, Laurie didn’t read the Medicare & You handbook; so, she has no idea about Part A and B deductible.
While Laurie is running errands when she has congestive heart failure, the ambulance takes her to the hospital, where she becomes inpatient 6-days.
Laurie is now responsible for $198 Part B deductible for the ambulance transport; then, there is 20% of any remaining balance from the ambulance.
Next, Laurie pays the Part A deductible; this is $1,420 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 specialist costs are lower, as well.
Wisconsin Medigap for the Disabled Under 65
Beneficiaries 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 are eligible for a Special Needs Plan (SNP); this kind of policy accommodates 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 offers more benefits than Medicare.
While it’s not full 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.
Medicare Advantage Plans in Wisconsin
Some Advantage policies cost $0 per month; however, the out of pocket expense can be high. Let’s say Laurie has an Advantage policy when she has 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 six days in the hospital, she pays $1,800 in copayments.
Now, Laurie pays the copayments for every specialist she sees for her condition. The cost is a $40 copayment each time if she needs to go every month that’s almost $500 a year.
These fees add up fast. Laurie could quickly pay $3,000 for the year on this plan.
There is a Maximum Out Of Pocket for these plans is around $5,000. So, if Laurie had an unhealthy year, the most she pays is $5,000. After she reaches that amount, then her plan pays 100%.
Advantage plans are an excellent option for those that can’t afford Medigap because they offer more coverage than Medicare. However, Medigap gives beneficiaries full coverage.
Plus, many times, Medigap ends up costing much less annually than MA plans.
Part D Options in Wisconsin
Many people find PDP coverage for as low as $15 a month; however, the lowest premium isn’t the most economical 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 pills for her heart condition; she is taking a brand name drug because generic is unavailable.
Well, on the $15 a month plan, Laurie pays the full $400 drug deductible the first month; the next month, she spends a $70 copayment, 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 medicine with NO deductible. So, by paying a little more each month, Laurie saves a lot.
Much like when you choose a Medigap plan and pay a premium, spend a little to save a lot.
Wisconsin Resources for Medicare
All recipients should visit the CMS Newsroom for recent information on Medicare topics.
Some people with low-income could qualify for the Medicare Savings Program. If you don’t qualify for MSP, you may be eligible for Extra Help, with help in covering the cost of PDP premiums or copayments.
If you need assistance, the State Health Insurance Program (SHIP) is offering its services to beneficiaries and their families.
Mandated Benefits for Wisconsin Medicare Supplement Plans
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, and Kidney Disease.
Medigap must include 30 days of SNF with no prior hospital stay requirement. The doctor must clarify your needs, and it must be medically necessary.
For HHC 40 visits annually beyond Medicare benefits. The doctor must verify the need and that it’s medically essential. Now, HHC coverage can be extra 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 have coverage inpatient and outpatient; also, transplants and donor-related services insurance covers. 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.
Someone with an employer policy that costs greater than 125% of the Basic Annual Premium for the applicant’s gender, age, and tobacco status qualify for GI rights.
Cost of Wisconsin Medicare Supplement Plans
Supplement plan costs vary because each carrier has a complex rating system, and each person has different health issues. The rate can change from male to female, smoker to a non-smoker, and place to place.
The level of coverage you select affects the price; “Plan F” costs more than “Plan N.” With so many different factors, the best rate might not be your rate; this is mainly true when applying outside of the OEP.
The biggest thing for beneficiaries to evaluate is the cost between “Plan G” and “Plan F.” Some recipients save over $200 each year by paying their own Part B deductible.
How to Compare Medicare Supplement Plans in Wisconsin
Enrollment is simple. Our agents can walk you through policy details and enrollment over the phone; that means you can do this from the comfort of your own home. It’s best to apply sooner than later; get the best premium and the best policy from our agency. Then, long after your plan is active, our client care team can assist with your Medigap needs! Fill out an online rate form and get the process going today!