Medicare Supplement in Sussex Wisconsin
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Sussex, WI Medicare Supplement Plans
A Medicare supplement in Sussex and the rest of Wisconsin does not follow the lettered plans like the rest of the country. We have a base plan and then you add riders to equal the benefits of the lettered plans (or better). Keep reading for details on Medicare supplement plans in Sussex or call us at 920-545-4884. You can also view rates on our quote tool on this page to find the best Medicare supplement plan in Sussex WI for your needs and budget.
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Medicare Supplement Plans in Sussex
We will go through all the details of the riders in just a bit, but first there are some requirements you need to be aware of, to qualify for a Sussex Medicare supplement plan. The very first requirement is that you must be a Wisconsin resident.
You Need Medicare Part A and B
You can not get a Medicare supplement plan in Sussex without having Medicare part A and B. That is the second requirement and there are two different scenario's.
- If you are receiving Social Security payments, your Medicare card will be mailed you you 90 days prior to your 65th birthday.
- If you are not receiving Social Security benefits, you will need to contact Social Security to signup for your Medicare benefits.
You will continue to pay your Medicare Part B premium, there is no way to change or eliminate this.
Medicare Part A
This part of Medicare, helps pay for care in a hospital, skilled nursing facility, some home health care, and hospice care.
Part A is $0 for most people
Has a "Per Period" Deductible
Medicare Part B
This part of Medicare, helps pay for doctor bills, outpatient hospital care and other medical services not covered by Part A.
Part B is $134.00 per month for most
Has a small annual deductible
Medicare Supplement Enrollment Periods
With a true Medicare supplement plan (not an Advantage plan), you can join, change, or drop anytime you like in Wisconsin. If you do not have a certain enrollment period you will however be medically underwritten an could be denied. The best time to get a Medicare supplement plan in Sussex is during your initial open enrollment period.
Medicare Supplement open enrollment period
You will get a Medicare supplement open enrollment period one of three ways in Wisconsin:
- You turn 65 and start Medicare part B
- You first start part B that you had on hold while on group coverage
- You were on Medicare for a disability under age 65 and now turn 65
Open Enrollment time period
Your open enrollment period, starts on the first of the month when you first turn 65 (the month prior if your birthday is on the first of the month) or start part B and runs for 6 months.
During your Medicare supplement open enrollment period, all Medicare supplement companies must approve you for any Medicare supplement plan they offer with no medical underwriting.
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Medicare Supplement Guaranteed Issue Periods
The other way to get a Medicare supplement plan in Sussex without going through underwriting is, if you qualify for a guaranteed issue enrollment period. You can qualify for guaranteed issue if you fall under one of the following situations.
- Your Medicare Advantage plan or cost plan, no longer participates in Medicare or stops providing coverage in your area.
- You move outside of your Medicare advantage geographic service area.
- Your health plan failed to meet its contractual obligations
- Your employer plan ends your coverage
- You terminate your employer group plan to join a Medicare advantage plan and then leave the advantage plan with-in 12 months of your enrollment in the advantage plan.
- Your Medicare supplement provider ends your Medicare supplement or select plan and you are not at fault, such as the company goes bankrupt.
- You dropped your Sussex Medicare supplement plan to join a Medicare advantage plan, Medicare cost plan or a Medicare select policy for the first the time and leave the plan with-in 12 months after joining. (With this period, you will most likely need to return to the company and Medicare supplement plan you were originally on if it is available.)
- You have joined a Medicare advantage plan when you first became eligible for Medicare part A and B at age 65 and within one year of joining you leave the advantage plan.
- You have Medicare part A and B and are covered by financial assistance and lose your eligibility for assistance.
During a guarantee issue period, you cannot be declined coverage and all preexisting conditions must be covered with no waiting period. The Medicare Supplement provider cannot charge you more for any past or present health conditions.
Guaranteed Issue Enrollment time period
Your open guaranteed issue enrollment period, last for no longer than 63 calendar days after your previous policy ends.
Sussex Wisconsin Medicare Supplement Insurance Plans (Medigap)
As we said earlier, Wisconsin is one of 3 states that do not follow the lettered plans. We have a base and we pick from a series of riders to match the benefits of a lettered Medicare supplement plan.
The Medicare Supplement Base
The base is the basic part of the Medicare supplement plan in Sussex and it covers the 20% or coinsurance of Part A and Part B that Medicare does not cover. The base also covers 40 home health care visits in addition to what is paid for my Medicare. and the first 3 pints of blood. To expand the coverage we add riders that cover other various gaps left by Medicare.
The Wisconsin base plan must also offer coverage for the following state mandatory benefits:
- 30 days of skilled nursing care in a skilled nursing facility, no prior hospitalization may be required and the care must meet the standards of "medically necessary.
- Kidney Disease: Must cover inpatient and outpatient expenses for dialysis, transplant or donor related services of kidney disease in an amount not less than $30,000.00 in any year. They are not required to duplicate Medicare payments for kidney disease treatment.
- Diabetes Treatments: Must cover the usual and customary expenses incurred for installation of an insulin infusion pump or other equipment or non-prescription supplies for the treatment of diabetes. Self managed services are also considered a covered expense, even if Medicare does not cover the claim.
- Chiropractic care: Coverage for the usual and customary expense for chiropractor services that meets the standards of medically necessary.
- Breast Reconstruction: Reconstruction of the affected tissue incident due to a mastectomy
For a full explanation, see our Medigap plans in Wisconsin article.
The Medicare Supplement Riders
To increase the coverage over just the base, we attache the following riders:
- Part A deductible rider (100% or 50%)
- Part B coinsurance rider: This rider actually gives you a copay at the doctor and the emergency room, but it does significantly lower the monthly premiums.
- Part B deductible rider
- Part B excess rider
- Emergency travel rider
- Home Health care rider
The Best Medicare Supplement Plan in Sussex Wisconsin
When it comes to the best Medicare supplement in Sussex, there really is no correct answer. This is due to everyone's needs and budget is not the same. The best Medicare supplement is the one that fits YOUR budget and health care needs.
That being said the most popular plans are the Wisconsin equivalent of the plan G and plan N. Plan F was the most popular but is quickly dropping due to the discontinuation of the plan and equivalent not being offered to new enrollments in 2020 and we do not recommend this plan.
We highly recommend the Medicare supplemental plan G or N, with the Medicare supplement plan N being the lowest cost monthly. The beautiful about the Medicare supplement Plan N in Sussex, Wisconsin is that we can add the Part B excess rider that the rest of the country does not have, making the Plan N even more attractive.
There is never a fee for our services and we carry all the top rated Medicare supplement companies for Sussex and the state of Wisconsin