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Medicare Supplement Plans in Wisconsin – Basic Plan Benefits

How do Wisconsin Medicare Supplement Plans work?

Wisconsin Medicare Supplement Plans are different from those in other states. Medicare Supplement plans in Wisconsin start with a basic plan, then you can add additional riders to enhance your plan.

This is different from Medicare Supplement insurance in other states, which are sold by private insurance companies designated by a letter: Plan F, Plan G, Plan N, for example. However, the purpose of all these plans is the same – to save on out-of-pocket Medicare costs, such as deductibles, coinsurance and copays.

After the federal government pays it’s share for your Medicare coverage, your Medicare Supplement plan or Medigap plan takes care of the rest, depending on the plan you select.

Medigap plans give you flexibility of choice because you don’t have to stay within a network of providers. For this reason, they are useful for people who travel within the U.S. and abroad.

What does Original Medicare cover?

  • Medicare Part A: Inpatient hospital care, skilled nursing facility care, hospice care and some home health care
  • Medicare Part B: Outpatient doctors’ services, outpatient care, medical supplies and preventive services.

Medicare Supplement plans do not cover prescription drugs. You will need to purchase a separate prescription drug plan (Medicare Part D) along with your Medigap policy.

Our licensed insurance agents at Policy Guide look forward to answering your questions about Medigap plans in Wisconsin so we can find the best health plan for you.

How does the Basic Medicare Supplement plan work in 2021?

The basic Medicare Supplement plan in Wisconsin consists of: 

  • Part A coinsurance
  • Part B coinsurance (usually 20 percent of the Medicare-approved payment amount)
  • First 3 pints of blood
  • Skilled nursing facility (SNF) and hospice coinsurance
  • Another 40 home health care visits
  • Extra 175 days of inpatient mental health coverage beyond Medicare
  • Outpatient mental health

What are the mandated benefits on top of the basic benefits?

  • 30 days of skilled nursing care in a skilled nursing facility
  • Kidney disease costs
  • Diabetes services and equipment
  • Chiropractic care
  • Hospital and ambulatory surgery center charges and anesthetics for dental care
  • Breast reconstruction
  • Colorectal cancer screening
  • Coverage of certain health care costs in cancer clinical trials
  • Catastrophic prescription drugs

You can save money through these Medicare SELECT cost-sharing supplement plans in Wisconsin. These plans require you to pay a portion of the costs for Medicare-covered services until you reach an out-of-pocket limit.

  • 50 percent Cost-Sharing Plan: This plan is similar to the national standardized Plan K. Medicare beneficiaries cost-share some of the Part A and Part B costs. For 2021, the out-of-pocket limit for 50 percent cost-sharing plans is $6,220.
  • 25 percent Cost-Sharing Plan: This plan is similar to the national standardized Plan L. Medicare beneficiaries cost-share some of the Part A and Part B costs. For 2021, the out-of-pocket limit for 25 percent cost-sharing plans is $3,110

For another coverage option in Wisconsin, Medicare beneficiaries may want to purchase a high-deductible plan. High-deductible Medicare Supplement plans kick in to help with copays and other expenses after you have paid a  deductible of $2,370 for 2021.

How does the basic Medigap Plan with riders work in Wisconsin for 2021?

You can purchase additional coverage beyond your basic Medigap plan in Wisconsin by purchasing any of these riders to reduce out-of-pocket costs.

  • Medicare Part A deductible
  • Medicare 50 percent Part A deductible
  • Additional home health care (365 visits including those paid by Medicare)
  • Medicare Part B deductible (if you were eligible for Medicare before Jan. 1, 2020)
  • Medicare Part B copayment or coinsurance
  • Medicare Part B excess charges
  • Foreign travel emergency

We also recommend you purchase a Medicare prescription drug plan. Prescription drugs are not covered under Original Medicare or these riders.

What is the best Medicare Supplement plan for 2021?

For the most coverage, equivalent to a Plan G, consider the basic plan and add these riders: 

  • Medicare Part A deductible
  • Medicare Part B excess charges
  • Additional home health care (365 visits including those paid by Medicare)
  • Foreign travel emergency

For additional coverage, add a prescription drug plan (Medicare Part D). Talk to your licensed insurance agent at Policy Guide to build the best coverage options for you.

What is the average monthly cost of a Medicare Supplement plan?

For a female who is 65 years old and a nonsmoker living in the 53215 zip code in Milwaukee, Wisconsin, the average monthly premium cost for a Medicare Supplement insurance plan is $148.29 with a range of $59.68-$204.62.

What is the most comprehensive Medicare Supplement plan?

The basic plan without cost-sharing would be the most comprehensive Medicare Supplement plan in Wisconsin. You can add riders to make the plan equivalent to the Plan G, which is the most robust plan for those who became eligible for Medicare on Jan. 1, 2020, or later.

  • Medicare Part A deductible
  • Medicare Part B excess charges
  • Additional home health care (365 visits including those paid by Medicare)
  • Foreign travel emergency

You will also want to purchase a Part D prescription drug plan.

Is Plan G available in Wisconsin?

No. Wisconsin is one of three states that doesn’t offer the lettered Medigap plans. However, you can build your policy to match Plan G through the riders you can purchase.

It would look like this: 

  • Wisconsin Medicare Supplement Insurance basic benefits
  • Medicare Part A deductible
  • Medicare Part B excess charges
  • Additional home health care (365 visits including those paid by Medicare)
  • Foreign travel emergency

Wisconsin Medigap FAQ:

How much does Medicare cost in Wisconsin?

Medicare costs in Wisconsin vary widely depending on the type of Medicare Supplemental insurance plan you choose, the insurance company and where you live.

For a female who is 65 years old and a nonsmoker living in the 53215 zip code in Milwaukee, Wisconsin, the average monthly premium cost for a Medicare Supplement insurance plan is $148.29 with a range of $59.68-$204.62.

Of note, because of a change in federal Medicare laws, Medicare Supplement plans sold to people whose eligibility for Medicare began on Jan. 1, 2020, or later cannot cover Part B deductible. As a result, the Part B Deductible rider won’t be available to you. The Part B deductible is $203.

How do I apply for Medicare in Wisconsin?

As with other states, you must be enrolled in Original Medicare, Part A and Part B, to be eligible for Medigap insurance in Wisconsin.

Then, you can purchase a Medicare Supplement Insurance plan or Medicare SELECT plan for six months beginning with the date you enroll in Medicare Part B. This six-month period is called the open enrollment period.

Remember to purchase your plan during this time frame because you will have guaranteed issue rights. During the time, insurance companies cannot deny you a policy or charge more based on your health status, claims experience or medical condition.

If you are under age 65 and enrolled in Medicare due to disability or end-stage renal disease, you are entitled to another six-month open enrollment period when you turn 65.

When can I change Medigap plans?

You can change your Medigap plan anytime, but if you change it outside of your open enrollment period, you will not have guaranteed issue rights.

This means the health insurance company can deny a policy or charged higher rates because of your: 

  • Health status
  • Claims experience
  • Receipt of healthcare
  • Medical conditions
  • Tobacco use

Can I be denied Medigap coverage?

If you try to purchase or change a Medicare Supplement insurance plan outside of your six-month open enrollment period, insurance companies can deny Medigap coverage or charge significantly more.

What is the difference between Medigap and Medicare Advantage?

Medigap is a way to bridge out-of-pocket costs after the federal Medicare program pays for its Part A and Part B benefits.

Medicare Advantage plans, also known as Part C, work differently. Under these plans, the health insurance company administers Part A and Part B benefits. On top of that, Medicare Advantage plans also offer prescription drug coverage (Part D plan) and additional coverage, such as dental, vision, hearing and fitness benefits.

Please speak to one of our licensed agents at Policy Guide so we can sort though your healthcare needs and budget constraints to select the health insurance that’s best for you.

Do Medicare Supplement plans in Wisconsin cover dental care?

One of Wisconsin’s mandated benefits under a Medicare Supplement Insurance policy is anesthetics for dental care. However, Medicare beneficiaries would have to purchase a dental insurance policy for comprehensive dental coverage.

Do Medicare Supplement plans cover chiropractic care?

Yes. Under state Medicare mandates, a Medicare Supplemental insurance plan in Wisconsin must cover “usual and customary expense for services”  provided by a chiropractor under the scope of the chiropractor’s license. This benefit is available even if Medicare doesn’t cover the claim. The care must meet the insurance company’s standards as medically necessary.

Original Medicare also covers manual manipulation of the spine provided by a chiropractor or other qualified provider if medically necessary.

Do Wisconsin Medigap plans cover foreign emergency travel?

No. Foreign emergency travel would be covered under a rider that you could purchase for your Medigap plan in Wisconsin.

How is Wisconsin different than other states for Medicare Supplement plans?

Wisconsin doesn’t offer the 10 standards letter plans that most other states offer, such as Part F, Part G and Part N. However, it offers many of the same benefits under its basic plan coupled with riders.

Can Medicare Companies raise rates in Wisconsin?

Yes, rates can change for Medicare Supplement policies in Wisconsin depending on how the rate was set to begin with. In some cases, your rates will go up as you age. Rates can also change because of higher medical costs, deductibles and copayments.

Do Wisconsin Medigap plans use provider networks?

With a basic Medigap plan in Wisconsin, you don’t have to stay within a network, as you would under a Medicare Advantage plan. However, you will want to check to see if your provider accepts Medicare.

If you chose a cost-sharing Medicare SELECT plan, you will be required to stay in a network. Medicare SELECT policies are supplemental policies that pay health insurance benefits only if you obtain your covered services through network medical providers selected by the insurance company or health maintenance organization (HMO).

Related Topics

Ready to learn more?

My Medigap Plans is a rapidly growing resource for Medicare beneficiaries. We specialize in educating consumers on their options and guiding them through the process of plan selection. We work closely with some of the nations top rated carriers such as AetnaCigna and Mutual of Omaha. Compare our list of the 10 Best Medicare Supplement Insurance Companies or take a deeper look at the plans by reviewing our Medicare Supplement Plans Comparison Chart. Learn more or about Medicare Part D Prescription Drug plans, or request a Medicare Supplement Plan Quote.

Key Take Aways
  • Wisonsin has mandated benefits on top of the basic benefits.
  • The average cost for a Medigap Plan in WI is $148.29 with a range of $59.68-$204.62.
  • With a basic Medigap Plan in Wisconsin, you don't have to stay within a network.
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