Medicare is a helpful government health insurance program for people who are 65 or older, or those with certain disabilities. However, it doesn’t cover all healthcare costs, which can lead to big bills. To help fill in these gaps, many people choose to get supplemental insurance called Medigap. In this article, we will discuss the Medigap plans available in Wisconsin and how to choose the right one for you.
Medigap plans in Wisconsin are designed to supplement the original Medicare program but don’t replace it entirely—you still need Part A and Part B of Medicare for full benefits. And although some states allow folks over 65 years old to apply outside of open enrollment periods, anyone under 65 will have to wait until then when applying for one of these plans. With that said, if you’re eligible and interested in exploring medigap plans in Wisconsin further, read on!
Understanding Medigap Coverage
Medigap is a type of health insurance that helps cover the costs Medicare doesn’t pay, like copayments, coinsurance, and deductibles. There are different types of Medigap plans, each with different benefits. The main goal of Medigap is to make healthcare more affordable for those who need extra help.
In most states, there are 10 standardized Medigap plans, labeled A through N. These plans are designed to cover various gaps in Medicare coverage, making it easier for people to choose a plan that fits their needs. However, in Wisconsin, Medigap plans are unique and have their own set of standardized benefits, which we will discuss later in this article.
It’s important to know that Medigap plans only work with Original Medicare, which includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). If you have a Medicare Advantage Plan (also known as Medicare Part C), you cannot use a Medigap plan. Medicare Advantage Plans are an alternative to Original Medicare and often include additional benefits, like prescription drug coverage or vision and dental care. If you’re considering a Medigap plan, make sure you have Original Medicare, not a Medicare Advantage Plan.
Overall, Medigap can be a valuable addition to your healthcare coverage, as it helps to reduce out-of-pocket costs and provide peace of mind. Understanding the various types of Medigap plans and how they work with your existing Medicare coverage is key to making an informed decision about your healthcare needs.
Wisconsin Medigap Basics
Wisconsin has unique Medigap plans that are different from those in other states. These plans come with standardized benefits, meaning they offer the same basic coverage. Here are the four main types of Wisconsin Medigap plans:
- Basic Plan: This plan covers the most important gaps in Medicare, such as hospital and medical costs.
- 50% and 25% Cost-sharing Plans: These plans cover half or a quarter of certain costs, depending on the plan you choose.
- High-Deductible Plan: This plan has a higher deductible, meaning you must pay more out-of-pocket before the plan starts covering your costs.
- Wisconsin Rider options: These are additional benefits you can add to your Medigap plan for extra coverage.
In addition to these standardized plans, Wisconsin allows insurance companies to offer “riders,” which are optional add-on benefits you can purchase to further customize your coverage. Riders can help cover expenses such as additional hospital days, at-home recovery, or foreign travel emergencies. By combining a Medigap plan with riders, you can tailor your coverage to meet your unique healthcare needs and budget.
To enroll in a Medigap plan, you must be at least 65 years old or have certain disabilities. There are specific enrollment periods when you can sign up, so it’s important to be aware of these deadlines.
Coverages Provided by the Wisconsin Basic Plan
The Basic Wisconsin Medigap Plan provides coverage for several gaps in Original Medicare (Part A and Part B). The coverage includes:
- Part A coinsurance: Covers the daily hospital coinsurance costs for Medicare Part A after the initial deductible is met, and extends hospital coverage for an additional 365 days after Medicare benefits end.
- Part B coinsurance: Covers 20% coinsurance for Medicare-approved Part B expenses, which include outpatient services, doctor visits, and durable medical equipment.
- Blood coverage: Covers the cost of the first three pints of blood needed for a medical procedure, which Original Medicare does not cover.
- Part A hospice care coinsurance or copayments: Covers hospice care coinsurance or copayments for services and supplies provided under Medicare Part A.
- Skilled Nursing Facility (SNF) coinsurance: Covers the coinsurance costs for days 21 to 100 in a skilled nursing facility, after the initial 20 days covered by Original Medicare.
- Part A deductible: Covers the deductible for Medicare Part A, which applies to each benefit period for hospitalizations.
It’s important to note that the Basic Wisconsin Medigap Plan does not cover the Medicare Part B deductible, Part B excess charges, or foreign travel emergency care. You may be able to find additional coverage for these gaps through optional riders offered by insurance companies in Wisconsin.
Broaden Your Medigap Plan with Optional Riders
Riders are optional add-on benefits that can be purchased to enhance your Basic Wisconsin Medigap Plan. The availability of riders may vary between insurance companies, but some common riders that can be added to the Basic Plan in Wisconsin include:
- Part B Deductible Rider: Covers the annual deductible for Medicare Part B, which applies to outpatient services, doctor visits, and other medical expenses. This rider is only available to enrollees who became eligible for Medicare before January 1, 2020.
- Part B Excess Charges Rider: Covers the difference between the Medicare-approved amount and the amount charged by healthcare providers who do not accept Medicare assignment.
- Additional Home Health Care Rider: Provides coverage for additional home health care services beyond what is covered by Medicare.
- Foreign Travel Emergency Rider: Offers coverage for emergency medical care received outside the United States, typically up to a lifetime maximum limit.
- Preventive Care Rider: Covers the cost of routine preventive care services that may not be covered by Original Medicare.
- Additional Hospitalization Rider: Provides coverage for extra hospital days beyond the 365 additional days covered by the Basic Plan.
- At-Home Recovery Rider: Covers the cost of at-home recovery services, such as assistance with daily living activities, following a hospital stay or skilled nursing facility care.
Keep in mind that each insurance company may offer different riders, and the costs associated with these riders can vary. Be sure to check with your chosen Medigap provider for the specific riders they offer and their costs to customize your Medigap plan according to your needs.
What about Coverage for Prescription Drugs?
Since Wisconsin Medigap plans do not offer coverage for prescription drug expenses, you should consider purchasing Medicare Part D to help cover your retail prescription drug out-of-pocket expenses.
Part D coverage is also offered by authorized private insurance companies and your monthly premium will generally depend on the insurance company you choose and the prescription drugs you are currently taking.
Residents of Wisconsin also have the option of a state program called SeniorCare. SeniorCare is an affordable prescription drug benefit program offered by the Wisconsin Department of Health Services specifically designed for Wisconsin residents age 65 and older who meet eligibility guidelines.
This program pays for most drugs prescribed by doctors or other health professionals and includes both generic and name-brand medications. With SeniorCare, participants pay a low monthly premium and co-payments based on income level.
Frequently Asked Questions
How is Wisconsin Medigap different from Medigap plans in other states?
Can I purchase a Wisconsin Medigap plan if I have a Medicare Advantage Plan?
When is the best time to enroll in a Wisconsin Medigap plan?
When is the best time to enroll in a Wisconsin Medigap plan?
Are prescription drugs covered under Wisconsin Medigap plans?
Choosing the right Wisconsin Medigap plan is important for your health and financial security. By understanding your options and working with a reliable provider, you can find the best plan for you. Don’t forget to do your research and take advantage of a reputable broker like Wisconsin Medicare Supplement Plans.
Since independent Medigap Insurance brokers represent many of the top Medigap providers but are not employed by them, your broker will always put your needs and budget first and foremost.
Call us at 844-528-8688 or contact us through our website 24/7.
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