For any US senior citizen age 65 and above, you have the option to enroll in the Federal Medicare program to help offset the exorbitant cost of your health care expenses. Unfortunately, however, the gaps in Medicare Parts A and B coverage can still become impossibly expensive if you aren’t careful. However, by purchasing a Medicare supplement insurance policy (a.k.a. “Medigap” policy), you can protect yourself from these expenses.
Federal Regulations for Medicare Supplements
The Centers for Medicare and Medicaid Services (CMS) are responsible for regulating the number of available Medigap supplements, and their coverage options. To make things simple, most of the 50 states offer 10 standardized plans – except for Wisconsin. For Wisconsinites, you can choose from the following Medicare supplement options:
- The Medigap Basic Plan. The Medigap Basic Plan adds Part A Skilled Nursing Facility Coinsurance, and additional (lifetime) 175 days of inpatient mental health coverage, 40 additional home health care visits, and whatever additional state-mandated benefits are required to your Original Medicare plan.
- The Medigap Cost-Sharing Plan. Purchasing a cost-sharing plan means you could be responsible for as much as 50%, or as little as 25%, of your medical costs (very similar to Medigap Plans K and L, respectively). You should also ask your local insurance agent about high deductible cost-sharing plans.
- Optional Medigap “riders”. These riders allow you to add specific benefits while avoiding others in order to keep your plan simple and affordable. You can choose from: Part A deductible (either the full deductible or a 50% deductible), Part B deductible, Part B excess charges, Part B copayment/coinsurance, Foreign travel emergency, and/or additional home health care visits.
Medigap Enrollment In Wisconsin
There are nearly a quarter million retirees in Wisconsin who have chosen to get their Medicare supplemented from a Medigap or similar policy. Most of these plans start by covering your Medicare Part A coinsurance, a percentage of your Part B coinsurance, and your first 3 pints of blood. Whether you choose to add riders, subscribe to a cost-sharing plan, or choose a Medicare Select plan will determine your additional coverage benefits.
Plan Coverage & Cost
The unique Medigap options offered in Wisconsin make finding an affordable Medicare supplement policy a little more complicated than in other states. In addition, getting an affordable rate will be heavily influenced by your location, age, gender, and health habits (such as tobacco use or exercise frequency). The rates below can, however, give you an idea of what to expect:
Most Popular Medicare Supplement Plans in Wisconsin
It’s hard to say which plans in Wisconsin are the most popular. Obviously, seniors have to strike a balance between finding the most comprehensive coverage available, and finding an affordable price given the fact that many retirees are living on a fixed income. Your best bet is to contact one of our friendly insurance agents. They can sit down with you, take all of your personal circumstances into account, and get you the coverage you need at the best possible price.
Helpful Medigap Tips & Tricks
Doctor/Provider Network Restrictions
Usually, Medigap policies don’t come with any doctor or provider network restrictions (unlike other supplements, such as Medicare Advantage). However, the Medicare Select plans available to Wisconsin seniors will limit your access to care should you apply for such a plan. This can become inconvenient and expensive very quickly, especially if you like to live in the south during the harsh Midwestern winters and your network doesn’t travel with you.
Drug, Vision and Dental Coverage
You can consult with a local insurance agent near you for more information, but it is unlikely that vision or dental coverage will be provided by your Medigap policy. It will not be provided by Medicare either. For prescription drug coverage, look into Medicare Part D. Ever since the inception of the Part D program, Medigap plans have not needed to provide this type of coverage to their members.
Enrollment Options & Best Time To Enroll
Enrolling in your Medicare supplement plan around the same time that you enroll in Medicare Parts A and B is the quickest and easiest way to get covered. However, there are additional enrollment periods which you can take advantage of.
- Initial Enrollment Period: Within your first 6 months of enrolling in Medicare, this window will also make you eligible for automatic Medigap enrollment and coverage.
- Guaranteed Issue: If you miss your IEP because you are already insured by an employer or group plan, you can take advantage of the Guaranteed Issue enrollment should you find yourself losing that employer or group coverage and wish to switch to a Medigap policy.
- Annual Enrollment Period (AEP): The AEP rules do not apply to Medicare supplement plans, so don’t worry about an AEP.
- Underwritten: If you miss the IEP and the Guaranteed Issue window, you may have to undergo the complicated and invasive underwriting process. This enrollment has the highest likelihood of being rejected.
Free Look Period
Every Medigap policy sold in the US comes with a 30 day Free Look period. Should you decide within those 30 days that you are unhappy with your policy, you can cancel it and receive a full refund.