If you’re a Medicare beneficiary in Wisconsin, don’t go anywhere! We’re going to go over how Medigap plans in Wisconsin are different from the rest of the country.
Wisconsin Medicare Supplement Basic Plan (0:24)
Medicare Supplement Riders (0:33)
Wisconsin Medigap Basic Benefits (0:43)
Wisconsin Medigap State Mandated Benefits (1:28)
Skilled Nursing Facility Care (1:44)
Extra Coverage For Kidney Disease Care (2:00)
Diabetic Treatment & Chiropractic Care (2:20)
Additional State Mandated Benefits (2:50)
Riders Available in Wisconsin (3:24)
Wisconsin is one of three states where Medicare Supplement plans are standardized differently. The state offers a Basic Plan along with additional riders you can pair it with for additional coverage.
The Basic Plan is excellent for covering what Medicare doesn’t. Riders allow you to add additional benefits to a policy. They can help you with deductibles, copays, and other coverage gaps.
The Basic Benefits included in Wisconsin Medigap plans include:
• Coverage for the coinsurance under Part A and Part B for both inpatient and outpatient services
• Coverage for the first three pints of blood each calendar year
• Coverage for the Part A hospice coinsurance or copayment
• Coverage for the coinsurance at a skilled nursing facility
• Additionally, benefits for 40 home health care visits that are added to the amount already paid for by Medicare plus an extra 175 days of inpatient health care beyond Medicare
There are also state-mandated benefits that Wisconsin Medigap plans must include. Wisconsin requires insurance companies to offer specific mandated benefits that provide additional coverage to protect beneficiaries. These state-mandated benefits include:
• Extra coverage for skilled nursing facility care
• Kidney disease care
• Diabetic treatment
• And more
State-mandated skilled nursing facility care coverage:
• Must include coverage for 30 days of care at a skilled nursing facility with no prior hospital stay requirement
• The facility does not have to be certified by Medicare and the stay does not have to meet Medicare’s definition
The state-mandated benefits also include extra coverage for kidney disease care:
• Coverage for both inpatient and outpatient dialysis treatment
• Coverage for transplants and donor-related expenses
• Up to $30,000 of coverage for kidney disease care in any calendar year
State-mandated diabetic treatment coverage includes diabetic supplies including self-management training and insulin infusion pumps. Lastly, the state mandates chiropractic care; Medigap policies cover the usual and customary expense for services provided by a chiropractor under the scope of a chiropractor’s license. In Wisconsin, this benefit is available even if Medicare doesn’t cover the claim. The care must also meet the insurance carrier’s standards as medically necessary.
Some additional state-mandated benefits include:
• Breast reconstruction surgery
• Colorectal cancer screening
• Coverage of certain health care costs in cancer clinical trials
Please note that Medicare Advantage plans aren’t required to provide coverage for the above-listed, state-mandated benefits. The seven additional benefits that you can pair with your Basic Benefits in Wisconsin are available à la carte and can be added to the Basic Plan to customize coverage. If you stick to the Basic Benefits, the plan is similar to Plan A.
The Wisconsin riders include:
• Coverage for the Part A deductible
• Coverage for 50% of the Part A deductible
• Additional home health care
• Coverage for the Part B deductible (available only to beneficiaries eligible prior to 2020)
• Coverage for Part B excess charges
• Additional coverage for foreign travel emergency
• Coverage for any copayments or coinsurance under Part B
You can add these riders to make your coverage equivalent to the most popular standardized Medigap plans. If you prefer a cost-sharing plan with a lower monthly premium, there are plan options that include 25% and 50% cost-sharing, similar to Plans K and L. A high deductible plan that is similar to High Deductible Plan G is also available in Wisconsin.
We hope you enjoyed this video and found it informative!
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