Medigap in Wisconsin

Medicare supplemental insurance, sometimes called Medigap, refers to private health insurance plans sold and serviced by third-party insurance companies under the direction of the United States Federal government. Medigap takes its name from the fact that the various plans are designed to fill the gaps in Original Medicare Part A and Part coverage. Medigap plans come into 10 flavors, which are standardized to provide a range of supplemental options over a wide range of monthly premium costs.

Though the federal government oversees Medigap standardization, some of the plans and policies vary based on which state a patient lives in. Wisconsin, for example, differs from most other states. However, Wisconsin residents are still guaranteed the ability to purchase Medigap policies.

One basic plan

Unlike states such as Minnesota, Wisconsin’s Medigap plans only come in one basic flavor as opposed to basic and extended options. Wisconsin’s basic Medigap benefits include inpatient hospital care, which covers the co-insurance on Medicare Part A. It also covers general medical costs in the form of Medicare Part B’s co-insurance (which is typically around 20 percent of Medicare’s approved coverage amount for a particular procedure). It covers the first three pints of blood each year as well as Part A hospice co-payments and co-insurance.

Wisconsin’s basic plan features also include Medicare Part A skilled nursing facility co-insurance. Additionally, it includes 175 days of inpatient mental health care coverage. It is important to note that the 175 days is the sum total available over the patient’s lifetime. Wisconsin Medigap plans also provide for 40 home health care visits in addition to the ones already covered by Medicare, as well as various state-mandated benefits.

Wisconsin Medigap plans include those known as 50% and 25% cost-sharing plans. These plans are similar to standardized Medigap Plan K and Plan L offerings. There is also a high-deductible plan with a $2000 deductible.

Additional policy riders

Finally, Wisconsin insurance providers are allowed to offer additional “riders” on their Medigap policies. These riders include:

  • Medicare Part A deductible
  • additional home health care with 365 visits
  • Medicare Part B deductible
  • Part B excess charges
  • foreign travel emergency coverage
  • 50% of the Part A deductible
  • Part P co-payment and co-insurance assistance.

It’s worth noting that Medicare Supplement/Medigap plans don’t include prescription drug coverage. To claim prescription drug benefits, you can enroll in Medicare Part D. Medigap coverage may not be used in conjunction with Medicare Part C (sometimes called Medicare Advantage). Medigap is only to be used as a supplement to Original Medicare Part A and Part B coverage. For more information, contact your local Medigap providers or Medicare itself at 1-800-633-4227.

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