Choosing between Medigap and Medicare Advantage is a significant decision for Wisconsin residents approaching Medicare eligibility. Wisconsin’s unique Medigap system, which allows for customizable riders, adds another layer of complexity.
This guide explores the differences between Medigap and Medicare Advantage in Wisconsin, focusing on how optional riders can impact your coverage and costs.
š Table of Contents
| Section | Jump to Section |
|---|---|
| š§¾ Understanding Wisconsin's Medigap Riders | Go to Section |
| š Comparing Medigap and Medicare Advantage | Go to Section |
| š° Cost Considerations | Go to Section |
| š Choosing the Right Plan for You | Go to Section |
| āFAQ | Go to Section |
š§¾ Understanding Wisconsin's Medigap Riders
Unlike most states, Wisconsin doesn’t use the standardized Medigap plans labeled A through N. Instead, it offers a Basic Plan that can be customized with optional riders to enhance coverage. These riders allow beneficiaries to tailor their Medigap policies to fit specific healthcare needs.
Common Optional Riders in Wisconsin:
Part A Deductible Rider: Covers the hospital deductible.
Part B Deductible Rider: Covers the annual medical deductible (not available to those newly eligible for Medicare on or after January 1, 2020).
Part B Excess Charges Rider: Covers charges exceeding Medicare-approved amounts.
Foreign Travel Emergency Rider: Provides coverage for emergency care outside the U.S.
Additional Home Health Care Rider: Extends coverage for home health services.NCOAMedical News Today+5Office of the Commissioner of Insurance+5Wisconsin Department of Health Services+5Office of the Commissioner of Insurance+3WPS Health Insurance+3Medical News Today+3
These riders are priced separately, allowing for flexibility in customizing your plan.
š Comparing Medigap and Medicare Advantage
Medigap:
Flexibility: Allows you to see any provider that accepts Medicare.
Predictable Costs: With the right riders, out-of-pocket expenses can be minimized.
No Network Restrictions: Ideal for those who travel frequently or live in multiple states.WPS Health Insurance+1WPS Health Insurance+1
Medicare Advantage:
All-in-One Plans: Often include prescription drug coverage and additional benefits like dental and vision.
Lower Premiums: Some plans have low or $0 monthly premiums.
Network-Based: Requires using a network of providers, which may limit choices.Healthline+1Anthem+1WPS Health Insurance
While Medicare Advantage plans may offer additional benefits, they often come with network restrictions and varying out-of-pocket costs. Medicare Rights Center+1WPS Health Insurance+1
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Medigap with Riders:
Premiums: Higher monthly premiums, especially with multiple riders.
Out-of-Pocket Costs: Lower and more predictable, as many expenses are covered.Office of the Commissioner of Insurance
Medicare Advantage:
Premiums: Generally lower, with some plans offering $0 premiums.
Out-of-Pocket Costs: Can be higher and less predictable due to copayments and coinsurance.Healthline
In Wisconsin, the choice between Medigap and Medicare Advantage often comes down to balancing monthly premiums against potential out-of-pocket expenses.
š Choosing the Right Plan for You
When deciding between Medigap and Medicare Advantage in Wisconsin, consider the following:
Healthcare Needs: Do you require frequent medical services or have chronic conditions?
Provider Preferences: Is it important to keep your current doctors?
Travel Habits: Do you travel often or live in multiple states throughout the year?
Budget: Can you afford higher monthly premiums for more predictable costs? WPS Health Insurance
Evaluating these factors can help determine which plan aligns best with your lifestyle and healthcare needs.
āFAQ
No, Medigap plans don't include prescription drug coverage. You'll need to enroll in a separate Part D plan.
Yes, but switching may require medical underwriting, and acceptance isn't guaranteed outside specific enrollment periods.
Coverage is typically limited to emergency services when outside the plan's service area.
No. Medigap policies and their riders only apply to Original Medicare. You can't combine them with Medicare Advantage.
Medigap is often better for travelers since it allows access to any provider nationwide that accepts Medicare and can include a foreign travel emergency rider.
