Wisconsin Medigap: Overview, Tips, & Tricks

Wisconsin Medigap policies have their own set of rules and regulations. While most states offer the traditional A-N Medigap plans, the Badger State is one of three states that offers a unique Medigap model. There is only 1 main Medigap policy to choose from in Wisconsin called the Basic plan. WI offers a few variations and optional riders on this plan to allow you to create the coverage that is right for you. This ability to tailor your coverage in WI is why our Senior65.com “Wisconsin Medigap Tips and Tricks” article can save you time and money.

What is the Medigap Basic Plan?

All Wisconsin Medigap revolves around the Basic Plan (sometimes called the Basic Benefits Plan). This core Medigap plan must offer the following:

• 100% of Part A coinsurance or copayment for:
  • Inpatient hospital care
  • Skilled nursing facility care
  • Hospice care
• 175 days of inpatient mental health care per lifetime, in addition to what Medicare covers
• 40 home health care visits, in addition to what Medicare covers
• The Part B coinsurance for medical costs
• 3 pints of blood each year
• Wisconsin State-mandated benefits coverage for
  • Skilled Nursing,
  • Home Health,
  • Kidney Disease,
  • Diabetes Treatment,
  • Chiropractic Care,
  • Hospital and Anesthetics,
  • Breast Reconstruction,
  • Colorectal Cancer Screening, and
  • Cancer Clinical trials

Wisconsin State Mandated Benefits are explained in detail in a section below.

Basic Plan Without Riders

While the list of Medigap required benefits is impressive, it doesn’t cover everything. This chart can show you what you will end up paying should you purchase the Basic plan.

* means “riders” are available to cover these benefits for an additional fee.

What are the variations of the Wisconsin Basic Medigap Plan?

While the Basic Plan explained above is the only Medigap plan available in Wisconsin, insurance companies are allowed to offer 50% cost share, 25% cost share, and high deductible versions of this plan. While these variations are technically available, many insurance providers do not offer them. In most cases, you are better off focusing on the optional riders listed below rather than the cost-sharing variations. If you’re looking for help switching plans, we recommend reading our Ultimate Guide.

Wisconsin Medigap Basic Plan optional riders

A “rider” is an insurance product you “add-on” to your Medigap coverage. Wisconsin offers many Medigap riders. You can choose from an a la carte menu of covered benefits by paying an additional monthly fee for each optional rider. Here are the riders you can currently choose from:

• Medicare Part A deductible Rider: This rider pays the $1,676 deductible for hospital stays for each 90-day benefit period. (Learn more about the Medicare Part A deductible)

• Medicare Part A 50% deductible Rider: This rider covers half of the Medicare Part A deductible of $1,676

• Home Health Care Rider: This rider covers 365 days of coverage including those paid by Medicare

• Medicare Part B deductible Rider: This rider pays $257 and is only available to Medicare beneficiaries who became eligible before January 1, 2020 (Learn more about the Medicare Part B deductible)

• Medicare Part B Excess Charges Rider: This rider covers the maximum a doctor or other provider who does not accept assignment may legally charge for a Medicare-covered service. This is usually 15% over Medicare’s approved amount ​and you are responsible for 100% of the excess charges without this rider. (Learn more about Medicare Part B Excess Charges)

• Medicare Part B Copayment/Coinsurance Rider. While most riders increase your premium this rider will decrease it by agreeing to copays for doctor or ER visits. This rider states you pay the lesser of $20 per office visit or the Medicare Part B coinsurance and the lesser of $50 per emergency room visit or the Medicare Part B coinsurance.

• Foreign Emergency Travel Healthcare Rider: This rider can help pay for medical costs when traveling out of the country. The benefit limit on this rider must be at least $50,000 per lifetime and may have a deductible of up to $250. The insurance provider must pay at least 80% of billed charges for Medicare-eligible expenses for medically necessary emergency care received abroad. Foreign travel emergency care must begin during the first 60 days of a trip outside the U.S. (Learn more about Foreign Emergency Travel healthcare)

(Source)

Which Wisconsin Medigap Rider should you choose?

Good question. The answer, like most things in life, depends on the price and your needs. If you never plan on traveling abroad then you probably can skip the Foreign Travel Emergency Rider regardless of the price. Others, like the Part A Deductible and Excess Charges Rider, could save you a lot of money so they should be considered.

Some riders will protect your wealth better than others, but first, you need to see how much they cost. Our online quote engine currently doesn’t give pricing for riders so please give us a call at 800-930-7956 to discuss the cost and value of each rider available.

WI State-Mandated Coverage for Medigap

The state of Wisconsin has mandated that Medicare Supplement Policies cover the following:

Skilled Nursing Facilities—Under Medicare Supplement plans you’re covered for 30 days of skilled nursing care in a facility, regardless of Medicare certification or their definition of skilled care. Hospitalization prior to this stay isn’t necessary, but the facility must be licensed for skilled care, and the treatment should meet the insurer’s medical standards.

Home Health Care—Medigap plans must extend coverage for up to 40 home care visits annually beyond what Medicare provides. Your doctor must certify the need for these visits to prevent hospitalization or skilled nursing care. Services include nursing and necessary home health aide support on an intermittent basis, along with therapy sessions. Medicare Supplement insurance must also offer an option to purchase additional coverage for 365 extra home health care visits per year.

Kidney Disease—Medigap plans must cover inpatient and outpatient expenses related to dialysis, transplantation, or donor-related services, with a minimum coverage of $30,000 yearly. Policies don’t duplicate Medicare payments for kidney disease treatment.

Diabetes Treatment—Medigap plans must cover expenses for insulin infusion pumps, equipment, supplies, and self-management services related to diabetes treatment, even if not covered by Medicare.

Chiropractic Care—Medigap plans must offer chiropractic services deemed medically necessary by the insurer, even if not covered by Medicare.

Hospital and Ambulatory Surgery Center Charges— Medigap plans must include coverage for charges for hospital or ambulatory surgery center care, and related anesthetics, for individuals with chronic disabilities or conditions requiring hospitalization or general anesthesia for dental care, provided they meet medical necessity standards.

Breast Reconstruction—Medigap policies must cover breast reconstruction following mastectomy.

Colorectal Cancer Screening—Medigap coverage must include examinations and laboratory tests for colorectal cancer, subject to policy cost-sharing provisions and limitations.

Health Care Costs in Cancer Clinical Trials—Certain services, items, or drugs administered in cancer clinical trials must also be covered by Medigap.

(Source)

When to enroll in a WI Medigap plan

Like most states, Wisconsin offers one Medigap open enrollment period. This is also called your initial enrollment period and it is the guaranteed enrollment six-month period that starts the day your Medicare Part B starts. Usually, you can apply up to 3 months before your part B effective date.

During this time, you cannot be denied or charged more for preexisting conditions. There can be a preexisting condition waiting period of up to 6 months if you did not have coverage leading up to your Medigap enrollment. This just means that your Medigap plan will not extend coverage to your preexisting conditions, however, you will be covered for any other care.

There are other Wisconsin Medigap guaranteed issuance periods, such as loss of employer-based insurance or moving out of your plan’s coverage area.

Wisconsin Medigap Free Look period

All Medicare Supplement and Medicare SELECT insurance policies sold in Wisconsin include a 30-day free-look period. During this time, if you find yourself dissatisfied with the policy for any reason, you have the option to return it to the insurance company within 30 days of purchase and receive a full refund, provided that no claims have been made.

Senior65.com Wisconsin Medigap Tips

Tip 1) Don’t get distracted by the initial Basic plan cost before looking at the rider prices. Some companies offer a low cost for the basic plan but charge a lot more for riders.

Tip 2) Get the Part A Deductible Rider. Without it, you can end up paying $1,676 multiple times in the same year. While you are at it make sure you add the excess charges rider since it can protect you from getting a surprise 15% increase on your medical bill.

Tip 3) Consider the Copayment Rider to save money. If you don’t go to the doctor or hospital very often this plan can save in lower monthly premiums. You may end up paying $20 a doctor’s visit or $50 to the ER with this rider but you could be saving much more than that each month.

Tip 4) Be Wary of the SELECT Basic Benefit plan. The SELECT Basic Benefit plan has a smaller network of doctors and facilities which could limit your options when you are looking for care.

Tip 5) Shop around since WI Medigap Basic prices can vary dramatically. Senior65.com can run quotes at multiple companies at no cost to you. Give us a call at 800-930-7956. There is no charge or hidden fee to work with up.

What if you move after signing up for Wisconsin Medigap

Good news. In most cases, you will be able to keep your Wisconsin Medigap even if you move to another state. (source)

Next Steps for WI Medigap

Get a Wisconsin Medigap quote by calling one of our Senior65 team members at 800-930-7956. The price will be the guaranteed lowest available by law.