October 6, 2016
Medicare Supplement plans, also called Medigap plans, are standardized insurance policies you may purchase to help cover the out-of-pocket costs (“gaps”) in Original Medicare coverage. Medicare Supplement plans in Wisconsin have different standardized benefits than those offered in the other parts of the United States. Medicare beneficiaries in Wisconsin may have a wide range of choices in Medigap plans, depending on the county and zip code they reside in.
What Wisconsin Medicare beneficiaries need to know
As you may know, Original Medicare consists of Medicare Part A (hospital coverage) and Medicare Part B (medical coverage). Out-of-pocket expenses can quickly add up in Original Medicare, so beneficiaries may purchase Medicare Supplement insurance to help offset those costs. Medicare Supplement insurance isn’t comprehensive health insurance; it’s only meant to supplement Original Medicare, hence the name “Medicare Supplement plan.”
In Wisconsin, as in all states, you must stay enrolled in Original Medicare to join a Medicare Supplement plan; and you’ll still get your health coverage through Medicare Part A and Medicare Part B. Further, you must continue to pay your Medicare Part B premium.
Medigap plans can only be used to pay for Original Medicare costs. Be aware that Medigap plans don’t include prescription drug coverage, so you’ll still need to enroll in a stand-alone Medicare Part D Prescription Drug Plan if you need this coverage. Plus, Medigap plans don’t work with Medicare Advantage (Medicare Part C). If you have a Medigap plan and later decide to enroll in a Medicare Advantage plan, you may not have to drop your Medigap plan, but you won’t be able to use its benefits any longer.
For eligibility and enrollment, Medigap plans in Wisconsin work the same way as in the rest of the country. You’re first eligible to join a Medicare Supplement plan during your Medigap Open Enrollment Period, which starts automatically when you’re both age 65 and enrolled in Part B. During your Medigap Open Enrollment Period, you have guaranteed-issue rights, meaning that private insurance companies offering Medigap plans aren’t allowed to require medical underwriting or charge you a higher premium because of any health issues. You may find that the Medigap Open Enrollment Period is a good time to enroll, especially if you have any disabilities or pre-existing conditions.
Unlike other types of Medicare insurance, Medicare Supplement plans are open for enrollment at any time of the year, but if you enroll outside of your Medigap Open Enrollment Period, you may not have a guaranteed-issue right, meaning insurance companies may deny you coverage or have you pay a higher premium based on your health status.
If you decide to switch Medigap plans, you’re given a 30-day “free look” period when you can try out a new plan while keeping your old Medigap plan policy. You’ll have to pay both premiums for that month, and you must cancel your old policy when you apply for the new plan.
There are also a few other limited situations when you may be able to join a Medicare Supplement plan with guaranteed-issue rights. One such situation is if you dropped your Medigap policy because the insurance company didn’t follow the rules.
Medigap plans offered in Wisconsin
While most of the US states offer 10 standardized types of Medigap plans, those offered in Wisconsin are a bit different. Within Wisconsin, all Medigap plans of a particular type must be standardized, or, in other words, offer the same coverage and benefits.
All Medigap plan types in Wisconsin cover the following basic benefits:
- Medicare Part A coinsurance for inpatient hospital care
- Medicare Part B coinsurance (typically 20% of the Medicare-approved amount)
- First three pints of blood each year
Wisconsin offers a Medigap Basic Plan that includes the following benefits:
- All basic benefits
- Medicare Part A skilled nursing facility coinsurance
- Medicare Part A inpatient mental health coverage (175 days per beneficiary’s lifetime in addition to the Medicare benefit of 190 lifetime days)
- Medicare Part A home health coverage (40 visits in addition to those covered by Medicare)
- State-mandated benefits such as preventive services
Wisconsin Medicare beneficiaries can also add optional riders to the Medigap Basic Plan, for an additional cost, to cover the following:
- 100% or 50% of the Medicare Part A deductible
- Medicare Part B copayment or coinsurance
- Medicare Part B deductible
- Medicare Part B excess charges
- Overseas emergency travel coverage
- Home health care coverage (365 visits including those covered by Medicare)
In addition to the Medigap Basic Plan and optional riders, Wisconsin also offers two kinds of Medigap plans that supplement your Original Medicare benefits on either a 25% or 50% cost-sharing basis. (For comparison, these Medigap cost-sharing plans are similar to Medicare Supplement Plan K and Plan L offered in other states.) These two cost-sharing plans offer benefits similar to the Basic Plan benefits, but don’t cover the full cost for the skilled nursing facility coinsurance or the first three pints of blood.
Depending on which of the two cost-sharing plans you join, your cost-sharing expenses will be either 25% or 50%. For example, if you join the Medigap plan that supplements benefits on a 25% cost-sharing basis, the insurance company pays 75% of the cost for the skilled nursing facility coinsurance and first three pints of blood.
Medigap insurance companies in Wisconsin also sell Medicare Select plans, which is a type of Medicare Supplement plan that requires members to use network providers. The basic benefits, optional riders, and cost-sharing versions are different for Medicare Select plans.
In general, if you go outside the plan’s network for any medical care, the Medicare Select plan won’t pay for the service or will pay only a partial amount, unless it’s an emergency situation. However, your coverage under Original Medicare isn’t impacted by whether you go out of your Medicare Select plan’s network, as long as the services are covered under Medicare. So, even if your Medigap Select plan doesn’t cover a service, your Original Medicare may do so.
Some Medicare Select plans also have cost-sharing versions, similar to the two cost-sharing Medigap plans we described above. Visit the Wisconsin state website for more information on these types of plans.
One additional type of Medigap plan available in Wisconsin is a high-deductible Medigap plan that doesn’t pay for costs until you’ve reached the deductible amount, which in 2017 is $2,000. This plan is similar to the high-deductible version of Medigap Plan F that is offered in other states.
Choosing a suitable Medigap plan in Wisconsin
As you can see, there are many different Medigap plans available in Wisconsin. Because Medicare Supplement coverage is standardized, with each specific plan type required to offer the same coverage, the only difference between Medigap plans of the same type is the price of the plan. For each specific plan type, you’ll get the same benefits no matter which county you reside in or which insurance company you buy from, so it can be important to shop around to find the price that’s right for you
When comparing Medigap plans, pay attention not just to the current cost, but the method the insurance company uses to price its Medigap plan premiums. This can affect how much you pay both now and in the future. For example, some insurers use an attained-age method, meaning the premium cost will increase every year as you age.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.