Medicare Supplement
Medicare Supplement
What is it and how does it work?
In Wisconsin, Medicare Supplement plans—also known as Medigap—operate under a unique structure compared to most other states because we are known as a waiver state. Instead of offering the standardized Plans A through N, Wisconsin provides either a Basic Plan or a Basic Plan with Copays that covers essential benefits, with the option to add optional riders to customize coverage to individual needs.
The Basic Plan includes coverage for:
- Part A coinsurance for hospital stays, extending coverage for an additional 365 days after Medicare benefits are exhausted
- Part B coinsurance or copayments, covering the 20% of outpatient services that Medicare doesn’t pay
- The first three pints of blood needed annually
- Skilled nursing facility care coinsurance for days 21–100
- Hospice care coinsurance or copayments
- An additional 175 days of inpatient mental health care beyond Medicare’s coverage
An extra 40 home health care visits beyond what Medicare cover
The Basic Plan with Copays includes coverage for all the same services as the Basic Plan but has one core difference:
- A $20 copay required for an office visit and a $50 copay required for an ER visit
RIDERS
To tailor a supplement plan to specific preferences, beneficiaries can add optional riders. These riders provide additional benefits such as coverage for:
- Part A Deductible
- Part B Deductible (only eligible if your Medicare began prior to January 2020)
- Part B Excess Charges
- Foreign Travel Emergency
- And more
Wisconsin also offers cost-sharing plans, similar to Medigap Plans K and L in other states, along with high deductible Medicare Supplement options. These plans cover a percentage of out-of-pocket costs and include an annual out-of-pocket limit, providing financial predictability for beneficiaries.
It’s important to note that Medicare Supplement Plans do not include prescription drug coverage. To obtain this, individuals need to enroll in a separate Medicare Part D plan.
Additionally, in order to avoid medical underwriting, the best time to enroll in a Medicare Supplement plan is during your six-month Medigap Open Enrollment Period, which is a 6 month window from when your Medicare Part B begins. Or when you are leaving Employer Group coverage. During this period you have guaranteed issue rights, meaning you can purchase a Medicare Supplement without being required to go through underwriting.
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