Medicare Supplement Plans in Wisconsin

If you live in the Badger State and are age 65 or over, or if you have a qualifying disability, you may be in the market for the Best Medicare Supplement insurance plans in Wisconsin. Seniors typically sign up for Original Medicare within a three-month time span before their 65th birthday, and their original Medicare coverage begins on the first day of their birth month. Since Medicare typically covers 80% of most medical charges, recipients might research the best Medicare Supplement insurance plans in Wisconsin to help them pay the remaining 20% of out-of-pocket costs.

Upon enrolling in original Medicare, every senior citizen receives Medicare Part A coverage free of charge (hospital coverage). In order to qualify for a Supplement Plan (Medigap), it is necessary to have Part B coverage which requires payment of a monthly premium.

Medicare Supplement plans help pay many expenses not covered by original Medicare Part A and Part B. Because they fill in the gap between the amount owed and the amount paid, they are referred to as Medigap plans. Regardless of what type of health plans you choose, you will be looking for the best coverage you can get for the following things:

• Part A excess charges
• Part B deductible
• Part B excess charges
• Coinsurance amounts with Parts A and B
• Copayments for doctor visits

Excess charges are the added amount (up to 15%) that doctors are allowed to charge above Medicare’s predetermined reasonable and customary fees.

To help you understand the unique plan design of Wisconsin Medigap plans, it is important to know some basic facts about Supplement plans in general. There are currently 10 Medigap plans offered in the United States, Plans A, B, C, D, F, G, K, L, M, and N.

Wisconsin does not offer all the plans listed above. They have a base plan that includes all elements that the Centers for Medicare and Medicaid Services (CMS) require of all states and add riders to customize the plan to fit each recipient’s specific health and financial needs. We will look at these riders and how they apply to the plans below.

What Are Medicare Supplement Plans in Wisconsin

Residents of Wisconsin sign up yearly for Supplement plans that meet their medical and financial needs. Many of the new enrollees are from the five largest counties which include:

• Milwaukee County
• Dane County
• Waukesha County
• Brown County
• Racine County

The Centers for Medicare and Medicaid Services (CMS) report that over 660,000 Wisconsin residents were enrolled in Medicare in 2017.

Information from America’s Health Insurance Plans indicates that over 267,000 Medicare participants, about 40 percent of the state’s enrollees, had Medicare Supplement insurance coverage in 2015.

As stated in the Wisconsin Family Health Survey (FHS), over 99 percent of Badger State residents had some kind of health insurance in 2015.

The total population is currently reported as 1,180,000. At least 80 percent of Medicare participants are qualified for both Medicare Part A and Part B based on age alone.

Best Medicare Supplement Plans in Wisconsin

The unique thing about Medigap policies in the Badger State is that there is really only one plan available, referred to as the Base Plan. Every person who wants a cost-sharing Medigap plan signs up for the Base Plan to help curtail out of pocket expenses. The Base Plan is offered by various private insurance companies who set their rates in different ways.

Some choose to charge the same rate to all customers who enroll in their health plans. Others start with an age-based rate and increase the amount as the enrollee gets older. Still others offer a starting rate and guarantee that it will never increase based on aging.

Medicare Base Supplement plans will feature a range of benefits and plan rates, but all will include the following:

• Deductible and coinsurance for Medicare Part A
• Copays and coinsurance for Medicare Part B
• Copays and coinsurance for Hospice care
• Covers the first 3 pints of blood
• Covers extended hospital admissions

Medicare plans can be custom-designed by adding Riders to the Base Plan to make them resemble the letter-named plans that most states can choose from. For example, Plan F had been the top choice of supplement plans nationwide for many years. Starting in 2020, this plan is no longer available for Medicare recipients who turn 65 this year, but can be retained by those who had enrolled in it in 2019 or before.

Medicare Plan F in Wisconsin

With a Base Plan, an enrollee could access many Plan F features by adding the following riders:

• Medicare Part A deductible
• Part B deductible
• Part B excess charges
• Foreign travel
• Added home health care

Medicare Plan G in Wisconsin

With the Base Plan and Riders, it would be possible to create a Medicare Supplement plan with your insurance company that would give you the same coverage as Medigap Plan G in Wisconsin. The following riders would need to be applied:

• Medicare Part A deductible
• Medicare Part B excess charges
• Additional home health care
• Foreign travel

Medicare Plan N in Wisconsin

A similar plan could closely match Plan N in Wisconsin by purchasing riders for these benefits:

• Medicare Part A deductible
• Medicare Part B coinsurance
• Added home health coverage
• Foreign travel

Other benefits that riders could provide would be care in a skilled nursing facility (SNF) and mental health coverage. A skilled nursing facility is an institution that satisfies national standards for Medicare and Medicaid reimbursement for vital nursing care under the supervision of a physician.

A skilled nursing facility employs at least one full-time registered nurse and maintains careful daily records of the condition and care of each patient. Nursing care is available on a 24/7 basis.

When Can I Enroll in a Wisconsin Medigap Plan

Once you have done adequate research (if you choose) and talked to a Medicare representative, it is time to enroll in the Medigap policy of your choice.

The first opportunity you will have is during the open enrollment period (OEP) which starts on the first day of the month you turn 65 and ends six months later.

During your initial OEP, you will have guaranteed issue rights with no required medical underwriting. Private insurance companies providing Medigap plans cannot increase rates because of pre-existing conditions during this six-month period.

After the OEP ends, the insurance company can charge a higher rate, demand medical underwriting, or even refuse to cover the applicant.

If you did not sign up for your Medigap plan during your initial enrollment period, under certain circumstances, such as loss of insurance, you may be eligible for a special guaranteed-issue period. Guidance from an insurance agent would be needed to determine your qualifications for a special guaranteed-issue period.

Each year between October 15 and December 7, Medicare offers an open enrollment period. During this OEP, Medicare recipients can enroll in or change their Medicare Supplement to a different plan.

Either OEP would be an ideal time to consult a Medicare representative about purchasing prescription drug coverage through a Prescription Drug Plan. Supplemental plans do not cover prescription drugs, and the cost of buying all prescriptions out of pocket could be phenomenal. Purchasing a Part D Medicare Prescription Drug plan can eliminate this worry and expense.

Once enrollment is completed and you have your chosen Medigap policy, you will have on-going coverage for as long as your premiums are paid monthly. The insurance company cannot terminate your policy due to changes in your health status.

Wisconsin Medicare Resources

Choosing the right Medicare supplement plan for you in Wisconsin is a rewarding endeavor, but you will not want to go it alone.

A good way to arrive at the right choice is to search the Internet for information to give you an overall understanding of how the plans with riders can match your needs.

But don’t stop there. Contact an insurance agent for comprehensive help from an expert who can help you optimize your Medicare benefits.

Ask your insurance agent about Medicare Advantage before making your final decision. For some Medicare recipients, Medicare Advantage may be the best, most comprehensive and economical choice.

The goal of Medicare Advantage plans is to give you the best possible Medicare preventive care for the lowest possible price. With Medicare Advantage, you would choose the Home Health Organization (HMO) that best meets your needs with reasonable monthly premiums.

Medicare Advantage plans usually include drug coverage. Different advantage plans will cover varying amounts on particular programs such as dental, vision, or hearing.

While talking with your insurance agent, consider getting information on life insurance policies as well.

Learn more: https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies/medigap-in-wisconsin