What Are Medigap Plans?
Medigap plans are Medicare Supplement Insurance offered by Medicare-approved private insurance companies to help cover cost sharing requirements of Original Medicare Parts A and B.
While Medicare pays for a large percentage of the health care services and supplies you may need, you are still responsible for a portion of the costs in the form of deductibles, copays, and coinsurance. Medigap policies help with these costs and sometimes offer more coverage for excess charges and foreign travel health emergencies.
Medigap plans are standardized by Medicare and regulated by state laws and insurance commissioners. You pay a monthly premium for Medigap. Costs and availability of Medigap plans vary depending on several factors including your age and gender, the insurer, and your state of residence.
Learn about Medigap in Wisconsin so you can determine which plan best meets your needs.
- Wisconsin offers two cost sharing plans, a Medigap basic plan, and a high-deductible plan.
- Monthly premiums for Medigap plans for a 65 year old female who doesn’t use tobacco range from $45 to $337.
- Wisconsin requires Medigap insurers to offer plans to disabled Medicare beneficiaries under age 65, however monthly premiums are much higher.
Medicare Supplement Plans in Wisconsin
|Compare ratings of some of Wisconsin’s Medigap providers:|
|Insurance company||A.M. Best rating||NAIC complaint index||BBB rating||Consumer Affairs|
|Blue Cross Blue Shield||A||Above average||F||1.2/5|
|Cigna||A||Below average||No rating||3/5|
What Medicare Supplement Plans Cover
Medigap policies serve as your secondary source of insurance after Medicare pays. Medigap fills in the “gaps” between what Medicare pays for covered services and what you are charged. Some plans offer extended coverage for Part B excess charges and foreign travel emergency costs.
There are 10 standardized Medigap plans that are regulated by federal and state governments. Two of the ten plans (F and G) are the most comprehensive plans and also offer high-deductible versions. All plans are not available in all states. In Wisconsin, you can choose from a Medigap 25% Cost Sharing Plan, Medigap 50% Cost Sharing Plan, Medigap Basic Plan, or Medigap High Deductible Plan.
Standard Medigap policies may include the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- The first three pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible (only certain plans for people eligible for Medicare before January 1, 2020)
- Part B excess charges
- Foreign travel emergency services
- Out-of-pocket limits
Do You Need a Medicare Supplement in Wisconsin?
|Should you consider a Medicare supplement?|
|Yes, if you:
||No, if you:
What Medigap Plans Cost in Wisconsin
Expect to pay about $45 to $337 each month for a Medigap plan in Wisconsin if you enroll during your open enrollment period. Premiums will vary depending on your insurer and how your premium is rated.
Medigap policies can be rated in three ways:
- Community rated (or no age-rated): Your premium isn’t based on your age and may only increase due to inflation or other factors. Everyone, regardless of age, is charged the same premium.
- Issue-age rated (or entry age-rated): Your premium is based on your age when you buy the policy and won’t increase as you grow older. Your premium may only increase due to inflation or other factors.
- Attained-age-rated: Your premium is based on your age and can increase as you grow older and due to inflation and other factors.
Medigap vs. Medicare Advantage Plans
Medigap and Medicare Advantage Plans are very different. You are eligible for either type of plan when you are enrolled in Medicare Part A and B, but you cannot have both at the same time. Both Medigap and Medicare Advantage Plans are offered by Medicare-approved private insurance companies. You can only choose to join plans that are available in your area. In Wisconsin, the state offers two Cost Sharing Medigap Plans, a Basic Medigap Plan, and a High Deductible Medigap Plan.
Compare your options:
|Plan type||Medigap||Medicare Advantage|
|What it is||Medigap is insurance designed to supplement Original Medicare and helps cover your out-of-pocket expenses, like deductibles, copays, and coinsurance you incur when you access your Medicare services. You pay a monthly premium for Medigap. Medigap plans are standardized across the U.S. Benefits, costs, and availability of plans vary depending on your age, gender, tobacco use, and state of residence.||Medicare Advantage Plans, on the other hand, are an alternative way to receive your Medicare benefits. These plans must offer all the services Original Medicare does, and frequently add on prescription drug coverage and other services, such as hearing, vision, and dental.|
|What it covers||Covers:
|What it works with||
|When it’s best||If you frequently access your Part A and B benefits, want your out-of-pocket expenses covered, and want to choose your providers.||If you want all of your health and drug coverage through one plan, want extra benefits, and are willing to follow your plan’s rules and network restrictions.|
Types of Medigap Plans in Wisconsin
Wisconsin does not offer standardized Medigap plans. Instead, you can choose from a 25% Cost Sharing Medigap Plan, a 50% Cost Sharing Medigap Plan, Basic Medigap Plan, and a High Deductible Medigap Plan.
Compare Medicare Supplement Options
|Medigap Benefits||Plan A||Plan B||Plan C||Plan D||Plan F*||Plan G*||Plan
|Plan M||Plan N|
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes***|
|Blood (first 3 pints)||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A hospice care coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled nursing facility care coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B deductible||No||No||Yes||No||Yes||No||No||No||No||No|
|Part B excess charge||No||No||No||No||Yes||Yes||No||No||No||No|
|Foreign travel exchange (up to plan limits)||No||No||80%||80%||80%||80%||No||No||80%||80%|
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,700 in 2023 before your policy pays anything. (Plans C and F aren’t available to people who were newly eligible for Medicare on or after January 1, 2020.)
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.
What’s the most popular Wisconsin Medigap plan in 2023?
Plan B, because for a standard premium, it covers outpatient care, medical equipment, and other services. Plan A is the second most popular in Wisconsin. In the state, 292,885 Medicare-eligible individuals are waivered.
When to Sign Up for Medicare Supplement Plans in Wisconsin
In general, you will get the best price for Medicare Supplement Insurance if you purchase a plan as soon as you are eligible for Medicare and enrolled in Parts A and B.
Medigap Open Enrollment starts on the first day of the month that you turn 65 and are enrolled in both Parts A and B and lasts for six months. An insurance company is not allowed to use medical underwriting to decide whether to accept your application or change the price during this time.
To enroll in a Medigap Plan, contact the insurance company to make sure you are in your open enrollment period or have guaranteed issue rights. Complete the application and determine when you want your policy to start.
There are certain situations which may give you guaranteed issue rights to purchase a Medigap policy, regardless of your health conditions or any preexisting health conditions.
- Moving out of the coverage area while in a Medicare Advantage Plan or Medicare SELECT Plan
- Your existing Medicare Advantage Plan leaving Medicare coverage
- Your other insurance plan outside of Medicare is ending
- You are within your trial right period
- Your plan coverage ends through no fault of your own
How to Choose a Medigap Plan in Wisconsin
Consider these factors as you compare Medicare Supplement Insurance plans available in your area:
|Monthly premium||This is in addition to your Part B monthly premium, so it affects your monthly cash flow. You pay whether or not you access your benefits. Your premium amount is determined based on the type of plan you get, your age, gender, tobacco use, and state of residence.|
|Benefits||Basic coverage for Part A copays and coinsurance and at least a portion of Part B copays and coinsurance, three pints of blood, and hospice care are offered with every type of plan. Other benefits may not be included, so check to see which benefits are most important to you.|
|Insurance provider||Look at ratings and past experience, either your own or other consumers, with the carrier you are considering. Contact a company representative to get an idea of their customer service and responsiveness.|
|Extra discounts||Some plans and insurers offer added perks or discounts once you become a member. You may have access to discounted hearing aid providers or eyeglass suppliers, for instance.|
Medicare Supplement Resources in Wisconsin
If you’re feeling confused by the multitude of plan options available, getting in touch with trained, unbiased counselors can be a good first step. Wisconsin is home to several organizations that can help you make an informed decision.
|Wisconsin Department of Health Services||Website | (608) 266-2536||The Wisconsin Department of Health Services offers assistance with understanding and completing benefit enrollment applications. Its resources are federally funded through a grant with the State Health Insurance Assistance Program (SHIP). The program’s trained and certified counselors are available to provide objective advice regarding how Medicare’s specific benefits align with individual needs. Staff and volunteers also assist individuals with completing forms and ensuring deadlines are met.
SHIP’s staff and volunteers are committed to empowering individuals through education to make informed decisions about their own care. They provide a variety of resources, formats, and availability options to satisfy individual schedules and preferences. The department’s educational outreach programs include workshops and seminars to help participants understand their options. Additionally, Wisconsin’s DHS offers departments dedicated to assisting with specific concerns, such as Medicare Advantage and Medigap.
|Kenosha County Aging & Disability Resource Center||Website | (262) 653-2600||Kenosha County’s Medicare benefit specialists are available to evaluate individual benefit questions, offer unbiased counseling, and assist with completing required paperwork on time. The department’s counselors work with seniors and younger individuals with qualifying disabilities who have questions about Medicare coverage, including Medicare Advantage and Part D benefits. In addition to one-on-one assistance, the Medicare specialists provide workshops that help individuals understand terminology, deadlines, regulations, and the appeals process. Kenosha County ADRC also offers online resources, such as the self-guided Medicare series..|
|N.E.W. Community Clinic||Website | (920) 437-9773||The Green Bay-based N.E.W. Community Clinic delivers a wide range of services to area residents. The clinic’s health benefit coordinators and benefits specialists are available by appointment and can answer questions, help organize records, and identify the appropriate Medicare program for eligible enrollees. In addition to providing Medicare and Medicaid benefits coordination, the clinic’s professionals can help residents understand each of the plan’s requirements and complete the appropriate application forms for other types of benefits. As a community clinic, N.E.W. also provides healthcare benefits, including mental health care, medical and dental treatments. Additionally, N.E.W. is part of Wisconsin’s Well Woman Program.|
Learn More From Our Sources
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed February 2023
- Medicare | Find a Medigap policy that works for you | Last accessed February 2023
- Medicare | Costs of Medigap policies | Last accessed February 2023
- Medicare | How to compare Medigap policies | Last accessed February 2023
- Medicare | Guide to Choosing a Medigap Policy | Last accessed February 2023