Medicare Supplement Insurance (also called Medigap) helps senior and disabled Wisconsin residents pay for some Medicare out-of-pocket costs.
Wisconsin Medicare Enrollment Quick Facts:
- Over 660,000 Wisconsin residents were enrolled in Medicare Part A and/or Part B in 2017, according to data from the Centers for Medicare and Medicaid Services (CMS)
- 267,315 Wisconsin residents had a Medigap policy in 2015, according to data from America’s Health Insurance Plans (AHIP)
- More than 40 percent of Medicare beneficiaries in Wisconsin were also enrolled in a Medigap plan in 2015, according to AHIP
How Medigap Plans in Wisconsin Differ From Those of Other States
Medigap plans sold in Wisconsin work like Medigap plans sold in other states. However, insurance companies offer different plan options in Wisconsin than they do in most other states.
Insurance companies in most states offer up to 10 standardized Medigap plan options to Medicare beneficiaries (plans A, B, C, D, F, G, K, L, M and N). In Wisconsin, Medicare beneficiaries can purchase a Basic Plan with the option to purchase additional riders to customize a plan that meets their needs.
The Basic Plan
The Basic Plan covers:
- Part A coinsurance plus coverage for 365 additional days after Medicare coverage ends*
- Part B coinsurance*
- The first three pints of blood each year*
- Part A hospice coinsurance or copayment*
- Part A skilled nursing facility (SNF) coinsurance
- An additional 175 days per lifetime on top of Medicare’s inpatient mental health coverage benefit
- An additional 40 home health care visits on top of Medicare’s covered visits
- State-mandated benefits (check with your plan for specific benefits)
*These are known as “basic benefits” and are offered by every Medigap plan.
Riders and Other Options
In addition to the Basic Plan, insurance companies in Wisconsin can sell plans known as “50 percent and 25 percent Cost-sharing Plans” and a high deductible plan ($2,000). These plans are similar to Plan K (50 percent) and Plan L (25 percent) in other states.
If you would like additional coverage not offered by the Basic Plan, you can purchase a rider on top of your policy. Insurance companies in Wisconsin can offer riders to cover:
- The Part A deductible
- An additional 365 home health visits on top of Medicare’s benefit
- The Part B deductible
- Part B excess charges
- Foreign travel emergency coverage
- 50 percent of the Part A deductible
- Part B copayments or coinsurance
Medicare Supplement Insurance Pricing Methods
Medigap pricing methods are important because they dictate how your premiums may increase in future years. There are 3 different pricing methods:
- Attained-age rated: The premium increases as you age
- Issue-age rated: The premium is based on your age when you buy the policy and it may increase due to inflation and other factors, but not due to your age
- Community rated: The same premium is charged to all Medigap policyholders
The majority of Medigap policies issued in Wisconsin are attained-age rated, according to the Kaiser Family Foundation (KFF).
Under-65 Enrollment Rules
Although Medicare Supplement Insurance is primarily for senior citizens, it’s also available to disabled people and those with end-stage renal disease (ESRD) in some states. Each state’s insurance department dictates the rules governing Medicare beneficiaries under the age of 65.
According to the KFF, insurance companies selling Medigap plans in Wisconsin must offer at least one Medigap plans to under-65 Medicare beneficiaries.1 Medigap insurers in Wisconsin must charge under-65 policyholders the same premiums as all other under-65 beneficiaries, but they may charge different premiums for senior policyholders.
To learn more about Medicare Supplement Insurance, read through the guides below.