Wisconsin Medicare supplement plans differ from those for sale under federal law in other states. Wisconsin is one of only three states in the nation that doesn’t offer the standard 10 plans for Medigap that you find elsewhere.
Instead, the Wisconsin Basic Plan offers a set of benefits outlined by the state. You can add optional riders to expand that coverage through your chosen Wisconsin Medicare supplement insurance carrier.
The Wisconsin Medigap Basic Plan covers:
- Your Part A coinsurance – the daily hospital copays you begin to incur after 60 days in the hospital
- Your Part B coinsurance – the 20% that Medicare does not cover for outpatient services
- Blood as needed for Medicare-approved surgeries and other procedures
- Hospice and Skilled Nursing Facility copayments
- 175 days on inpatient mental health care beyond the lifetime benefit covered under Medicare. Enriched outpatient mental health coverage too.
- 40 extra home health care visits beyond what Medicare already covers
Wisconsin Medicare Supplement Riders
You can purchase riders for additional benefits such as foreign travel, deductibles, excess charges and extra home health. Individual insurance companies in Wisconsin can decide which riders they choose to offer. Some carriers may offer additional features inside the Wisconsin Medicare supplement plans that they sell.
If the Basic Plan does not appeal to you, check out options for enrollment into Plan K or Plan L now offered in Wisconsin.
Many insurance companies offer Medicare Supplement plans in Wisconsin. Our agency works with several of the most highly-rated carriers. We can provide you current rate quotes but we can also tell you which companies have had the highest rate increases in recent years. This is particularly helpful if you are comparing two insurance companies with similar current rate quotes. While you can’t foretell future rates, you can at least view the history and make an educated decision.
Wisconsin Medicare Supplement Plans – Mandated Benefits
The state of Wisconsin requires that Medicare Supplement policies contain certain “mandated” benefits. These are designed to protect you and make sure you will have enough coverage.
Skilled Nursing – Wisconsin Medicare supplements must cover 30 days of skilled nursing care in a skilled nursing facility (SNF). No prior hospital stay is required. The facility does not need to be certified by Medicare, but must be a licensed SNF. Care must meet the insurance carrier’s standards as medically necessary.
Home Health Care – Wisconsin Medicare supplements must also cover up to 40 home care visits each year beyond those provided by Medicare. To qualify, your doctor must certify that you would need to be in a hospital or SNF if home care was not available to you. Home nursing and necessary home health aide care is also covered intermittently, along with other kinds of physical therapy. Furthermore, Wisconsin Medigap plans must offer coverage for 365 home health care visits in a policy year. Insurance companies can charge a premium for this additional coverage. Again, all care must be medically necessary.
Kidney Disease – Wisconsin Medigap plans must cover inpatient and outpatient expenses for dialysis, transplants and donor-related services. The coverage can be no less than $30,000 EVERY calendar year. This is to ensure enough benefits to last through each calendar year.
Diabetes – Medicare supplement plan in Wisconsin must cover customary costs for installation and use of an insulin infusion pump or other equipment and supplies for the treatment of diabetes. Self-management training is also a covered expense. This benefit must be made available to the Medicare beneficiary even if Medicare doesn’t cover the claim.
Other coverage mandates for Wisconsin Medicare Supplements include chiropractic care, surgery center care, breast reconstruction, colorectal cancer screening, and certain costs in clinical trials for cancer.
You can find more about these mandates in the Wisconsin Guide to Health Insurance for People with Medicare.
Wisconsin Medicare Supplement Plan Chart:
Here’s a chart to help you visualize how the most popular Medigap plans in Wisconsin work. Since most other states use the standardized Medigap plan models, we’ve created this infographic to help demonstrate which riders you would need in Wisconsin to build a plan that is equivalent to the 3 national top-selling Medigap plans.
How Do I Enroll in a Wisconsin Medicare Supplement Plan?
When you first enroll in Medicare Part B, Medicare will assign you a Part B effective date. You have six months from that date to enroll in a Wisconsin Medicare Supplement plan without any underwriting. This means you do not have to answer health questions on your application. The insurance company cannot turn you down for this coverage. It’s easy to see why Medicare’s own Choosing a Medigap Policy booklet calls the Medigap open enrollment period the best time to get a Medigap plan.
If you miss this window, you can still apply for Medicare Supplement plans in Wisconsin later on. However, you’ll have to answer health questions and the insurance company could decline you for pre-existing health conditions. When that happens, you will still be able to consider a Medicare Advantage plan in Wisconsin.
Medicare Advantage Plans in Wisconsin
Medicare Advantage plans are a type of policy that pays instead of Medicare. You get all the same covered benefits as Original Medicare. However, you will access them differently. Medicare Advantage plans generally have networks of providers. You seek medical treatment from the local network providers. You’ll have lower premiums than Medigap, but you’ll pay copays for your services as you go along.
You must be enrolled in both Part A and B to be eligible for a Medicare Advantage plan in Wisconsin. You must also live in the plan’s service area and not have End-Stage Renal Disease. Before enrolling in a Medicare Advantage plan, it’s important to check with your doctors. Find out if they participate in the plan’s network. Review the plan’s summary of benefits to see if you can afford the copays that will be expected of you.
Medicare Advantage plans in Wisconsin often include Part D benefits as well. This allows you to have just one card that you use at the pharmacy or doctor’s office.
Wisconsin Medicare Facts
The Kaiser Family Foundation reports that nearly a million people have enrolled in Medicare in Wisconsin. About 30% of them have chosen to enroll in a Wisconsin Medicare Advantage plan. Many of the rest have original Medicare combined with a Part D plan and/or a Medigap policy. For those choosing standalone Part D drug programs, there are dozens to choose from.
If you need assistance with choosing an appropriate Medicare supplement in Wisconsin, please don’t hesitate to call our agency. We’ll provide information, education and free quotes. You can reach us at 1-855-732-9055 or complete this online request form: