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Medicare Supplement Insurance Plans in Wisconsin


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If you’re a Medicare beneficiary in Wisconsin, Medicare Supplement (Medigap) insurance may help with certain costs that Original Medicare (Part A and Part B) doesn’t cover. While Original Medicare covers a variety of hospital and medical services, the federal program doesn’t cover all expenses, and you’ll still be responsible for paying certain medical costs out of pocket.

For example, you’ll need to pay cost sharing (such as copayments and coinsurance costs) after Original Medicare has paid its share of covered benefits. Depending on your health and how often you require certain health-care services, these costs can get expensive over the course of a year.

That’s where Medicare Supplement insurance comes in. Also known as Medigap, Medicare Supplement insurance plans in Wisconsin cover some of the costs not paid for by Original Medicare. These plans are offered by private insurance companies. While most states offer 10 standardized Medigap plans, Medicare Supplement coverage is standardized differently in Wisconsin.

All Medicare Supplement insurance plans in Wisconsin must cover the following “basic benefits”:

  • Medicare Part A coinsurance for inpatient hospital care
  • Medicare Part A hospice copayment or coinsurance
  • Medicare Part B coinsurance for medical services
  • First three pints of blood used each year

One of your Medigap options in Wisconsin is the “Basic Plan,” which covers:

  • All basic benefits
  • Medicare Part A skilled nursing facility coinsurance
  • An additional 175 days of inpatient mental health coverage per lifetime, on top of what Medicare covers
  • An additional 40 home health care visits, on top of what Medicare covers
  • State-mandated benefits, such as preventive services

Beneficiaries in Wisconsin also have the option to add on “riders” to their Medigap coverage. These riders are optional benefits that help with costs like the Part A deductible, Part B deductible, Part B excess charges, and more.

Wisconsin also offers two Medigap plans that help with your Original Medicare costs on a 25% or 50% cost-sharing level. These plans are similar to Medigap Plan K and Plan L available in other states.

Medicare Supplement insurance plans don’t cover prescription medications, but you can enroll in a Medicare Prescription Drug Plan to get this benefit with your Original Medicare coverage. Keep in mind that Medigap coverage can’t be used with Medicare Advantage plans; you can only use them to pay for costs related to Original Medicare.

Enrolling in Medicare Supplement coverage in Wisconsin

In Wisconsin, as in the rest of the country, you must be enrolled in Original Medicare, Part A and Part B, to be eligible for Medigap insurance. In Wisconsin, insurance companies must offer at least one Medigap plan to certain beneficiaries under 65. However, you may have more options available if you enroll when you’re 65 or older.

If you’re considering Medicare Supplement coverage, keep in mind that the best time to enroll in a plan is during your Medigap Open Enrollment Period. This is the six-month period that starts automatically once you’re enrolled in Medicare Part B and are 65 or older. During this one-time period, you can join any Medigap plan offered in your service area with guaranteed-issue rights. This means that insurance companies can’t deny you coverage or charge higher premiums based on pre-existing conditions*. If you have health issues or disabilities, you’ll generally have the most plans available to you if you enroll when you have guaranteed-issue rights.

Once this Medigap Open Enrollment Period is over, you can’t get it again. You may have guaranteed-issue rights in certain situations, but if you don’t, insurance companies may refuse to enroll you in a Medigap plan based on your health status. You may be required to submit to medical underwriting before enrolling in a plan. If you can find a Medigap plan that will accept you, you may have to pay higher premiums if you have health issues.

Selecting Medicare Supplement insurance plans in Wisconsin

While Medicare Supplement insurance plans in Wisconsin offer the same benefits for plans of the same type, the cost of the plan may vary by insurance company and location. For example, a Medigap plan offered in Douglas County, Wisconsin, could cost more or less than the exact same Medigap plan offered in Clark County.

When comparing Medicare Supplement insurance plans in Wisconsin, consider the full cost of the plan, rather than just the monthly premium amounts. It is possible that Medigap plans with lower monthly premiums may end up costing more once you add up your out-of-pocket costs for the whole year. It is important to compare all the costs associated with a plan to get a true value of each individual option.

It can be difficult to navigate how Medicare works and all the different coverage options available to you. Would you like help figuring out Medicare plan options that may work for your situation? Contact eHealth to get personalized assistance with a licensed insurance agent.

*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.

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