Medigap Plans in Wisconsin

Wisconsin Medigap Plans

Medigap plans, also known as Supplement plans, are standardized health insurance policies that you can buy to help manage the out-of-pocket costs (“gaps”) in Original Medicare plans. Medigap plans in Wisconsin have the same standardized benefits than the benefits that are offered in the other areas of the United States, they are just not standardized using the lettered plans. You can get a free Medigap Quote by calling us at 920-545-4884 or further down this page.  Keep reading for more information on Medigap (Medicare Supplemental) in Wisconsin.

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Medicare beneficiaries living in Wisconsin typically have a wide variety of choices in Medigap plans, depending on where they live in the state.  There are several companies offering Medigap plans in Wisconsin and several different benefit plan combinations.

Important Information for Wisconsin Medicare Beneficiaries

As you probably already know, Original Medicare is composed of Medicare Part A, the hospital coverage, and Medicare Part B, the medical coverage. Out-of-pocket costs can rapidly add up using Original Medicare, so beneficiaries can purchase Medigap insurance coverage to help transfer those expenses.

Medigap insurance isn’t comprehensive health insurance; it is designed to fill in the gaps in Original Medicare, hence the name "Medigap" insurance.

In Wisconsin, as in every other state, you have to be enrolled in Original Medicare to sign up for a Medigap plan; and you will continue to get your health coverage from Medicare Part A and Medicare Part B. Additionally, you must keep paying the Medicare Part B premium.

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Medigap plans can be used only to pay for your Original Medicare expenses. Beneficiaries should be mindful that Medigap plans will not provide drug coverage; therefore you will still want to enroll in a Part D Prescription Drug Plan if you desire this coverage.

Furthermore, Medigap plans will not work in conjunction with Medicare Advantage (Medicare Part C). If you have purchased a Medigap plan and then later choose to purchase a Medicare Advantage plan, you may not need to cancel your Medigap plan, but you will definitely not be able to use those benefits going forward.

Medigap Enrollment

For enrollment and eligibility, Medigap plans in Wisconsin function the same means as in the rest of the nation. You first become eligible to register with a Medigap plan during the Open Enrollment Period, which starts instantly when you are both age 65 and enrolled in Medicare Part B. During the course of your Medigap Open Enrollment Period.  

You enjoy a guaranteed-issue right, which means that insurance companies offering Medigap plans won't be allowed to require any medical underwriting or command a higher premium based on health concerns. You're likely to find that the Medigap Open Enrollment Period is an ideal time to enroll, particularly if you suffer from any pre-existing health conditions.

Compared with other forms of Medicare insurance, Medigap plans are open for enrollment any time of the year, but if you sign up outside of the Medigap Open Enrollment Period, you might not have a guaranteed-issue right, which means insurance companies could deny you insurance coverage or require you to pay a steeper premium because of your health status.

Medigap "Free Look"

In the event that you choose to change your Medigap plan, you are provided a 30-day “free look” period where you can consider a new plan and keep your old plan active. You’ll have to pay both plans’ premiums during that 30-day period, and you must then cancel your old policy when you submit an application for the new plan.

There are also a handful of other limited situations when you might be able to enroll in a Medigap plan with guaranteed-issue privileges. One such scenario is if you terminated your Medigap policy because the insurer didn’t adhere to the rules.

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Medigap Plans Wisconsin

Although most states provide ten standardized types of Medigap plans, the ones offered in Wisconsin are somewhat different. In Wisconsin, every Medigap plan of a particular type must be standardized, meaning they must offer the same coverage and benefits.

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Medigap plans offered in Wisconsin

Although most states provide ten standardized types of Medigap plans, the ones offered in Wisconsin are somewhat different. In Wisconsin, every Medigap plan of a particular type must be standardized, meaning they must offer the same coverage and benefits.


All Medigap policies in Wisconsin must offer the following basic benefits:

  • Medicare Part A coinsurance
  • Medicare Part B coinsurance
  • First 3 pints of blood each year

Wisconsin offers the Medigap Basic Plan that includes the following:

  • All of the basic benefits
  • Part A skilled nursing facility coinsurance
  • Part A inpatient mental health coverage (an additional 175 days per beneficiary’s lifetime to the 190 days that Original Medicare benefit)
  • Part A home health coverage (40 visits on top of those provided by Original Medicare)

There are optional riders available at an additional cost to cover the following:

  • 100% or 50% of the Part A deductible
  • Part B coinsurance
  • Part B deductible
  • Part B excess charges
  • Emergency travel coverage while overseas
  • Home health care (365 visits on top of those covered by Original Medicare

Along with the Medigap Basic Plan and optional riders, the state of Wisconsin also offers two types of Medigap plans that complement the Original Medicare benefits on either a 25% or 50% cost-sharing basis (similar to the Medicare Supplement Plan K and L which are available in other states).


These cost-sharing plans provide benefits comparable to the Basic Plan benefits, but will not cover the entire cost of the skilled nursing facility coinsurance or the first three pints of blood.

Based upon which of the two cost-sharing plans you sign up for, your cost-sharing costs will be either 25% or 50%. For instance, if you sign up for the Medigap plan that supplements benefits on a 25% cost-sharing basis, the insurer will pay 75% of the cost for the skilled nursing facility coinsurance and first three pints of blood.


One additional kind of Medigap plan offered in Wisconsin is a high-deductible Medigap plan that will not pay for out-of-pocket expenses until you’ve hit the deductible amount, which in 2017 is $2,000. This plan is comparable to the high-deductible version of Medigap Plan F that is offered in other states.

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Get Help with choosing a suitable Medigap Plan in Wisconsin

Medigap and Medicare Supplement insurance can be confusing no matter which state you live in. To get help with finding the best and most affordable policy for your situation, contact the experts on the Medicare Solutions Team at (920) 545-4884 or contact us through our website at your convenience.

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