Medicare Supplement Plans Wisconsin 2025 – Plans & Rates

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Russell Noga
by Russell Noga | Updated March 11th, 2024

Looking for Medicare Supplement plans in Wisconsin for 2025? Get straight to the point here: We break down the latest options, eligibility guidelines, and enrollment details to help Wisconsin residents ensure they’re making the best choice for their healthcare coverage. No fluff, just the facts you need to choose your Medicare Supplement Plans Wisconsin 2025 with confidence.


Key Takeaways

  • Wisconsin offers a single comprehensive Medigap plan that can be customized with different riders to meet individual health needs. It includes a basic plan structure that covers 40 extra home health care visits, Part B coinsurance, and the first 3 pints of blood annually.
  • Eligibility for Wisconsin Medigap is open to all residents with Medicare Parts A and B, with a crucial six-month initial enrollment period starting at age 65 or when you first enroll in Part B without the need for medical underwriting or pre-existing condition exclusions.
  • Wisconsin’s Medigap plans are provided by private companies and allow beneficiaries to tailor their coverage using various riders, while the Wisconsin State Insurance Department and other resources offer guidance and support to navigate Medigap policies and choices effectively.


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Navigating Medigap in Wisconsin: Understanding Your Options


Navigating Medigap in Wisconsin Understanding Your Options


In the beautiful Dairyland state of Wisconsin, Medicare beneficiaries have a distinct advantage. The state’s Medigap plans help complement Original Medicare by filling in coverage gaps, making it a vital tool for residents to ensure comprehensive healthcare coverage. Imagine it as a safety net, catching those costs that slip through the Medicare coverage, such as the 20% of Medicare-approved charges and deductibles when the correct riders are selected.

But the question remains, how can one navigate this complex web of Medigap in Wisconsin? The answer lies in understanding your options. Let’s dive deeper into the types of Wisconsin Medigap plans, their eligibility and enrollment periods, and how to compare costs and benefits.


Types of Wisconsin Medigap Plans

Wisconsin takes a unique approach to Medigap plans, offering a comprehensive plan to all residents rather than a menu of multiple plan types. It’s like choosing a house that’s already fully furnished rather than having to select each piece of furniture individually. This unified Wisconsin Medigap plan includes coverage for hospital and skilled nursing facility care coinsurance, hospice care, and additional inpatient mental health care, surpassing the benefits of traditional Medicare.

But that’s not all. Wisconsin’s Medigap plan also provides coverage for 40 extra home health care visits, Part B coinsurance or copayments, and coverage for the first 3 pints of blood annually, beyond what Medicare covers. The state even mandates certain benefits, catering to specific health needs such as kidney disease, diabetes, and chiropractic care.

To top it all off, residents have the option to choose Medigap plans with different cost-sharing levels—50% and 25%, akin to standardized Plans K and L—and a high-deductible plan to suit divergent financial preferences.


Eligibility and Enrollment Periods

Eligibility for Wisconsin’s Medigap plans is open to residents with Medicare Parts A and B, including those disabled under 65 at the time of their Part B enrollment. It’s like being invited to an exclusive club, with the only criterion being that you’re a Medicare beneficiary. Even better, disabled Medicare beneficiaries enrolled in Wisconsin don’t miss out on the benefits of Medigap when they turn 65. They receive a Medigap Open Enrollment Period offering the same benefits as those aging into Medicare.

Timing is crucial in the Medicare world, and Wisconsin is no exception. Here, there’s a one-time six-month Medigap enrollment period starting at age 65 and up on Part B enrollment, as opposed to an annual enrollment window. It’s akin to a limited-time offer, but the benefits are immense. Purchasing a Medigap policy during the Initial Enrollment Period ensures guaranteed issues without medical underwriting or consideration of pre-existing conditions. Therefore, it’s essential not to delay enrollment.

But what if you miss this golden period? You may face a waiting period for pre-existing conditions unless you have prior continuous coverage. To ensure customer satisfaction, Medigap policies in Wisconsin come with a 30-day free-look period, granting a full refund if the policy is returned within 30 days without any claims made.


Comparing Costs and Benefits

Understanding the costs and benefits of Medigap plans is like piecing together a puzzle. Each piece, from the guaranteed plan benefits to the varying premiums, fits together to create the complete picture of your healthcare coverage. Guaranteed benefits include Medicare Part A and B coinsurance, including hospice and hospital coinsurance, and coverage for the first three pints of blood annually. It’s like a safety net, catching those healthcare costs that could otherwise leave you financially vulnerable.

But as with any insurance plan, costs are a major consideration. The higher the coverage of a Medigap plan, typically, the higher the premium it carries. It’s akin to buying a luxury car – the more features it has, the more it costs. And just as your car’s maintenance costs increase over time, so do Medigap premiums. Factors such as the age at policy purchase influence plan costs, making it crucial to understand how each plan is priced.

On average, the monthly rate for Medigap plans is below $200 nationally. However, premiums vary across insurance companies, emphasizing the importance of comparison. Therefore, it’s essential to compare the varying premiums and coverage options of Medigap plans to ensure the right fit for your healthcare needs.


Customizing Your Coverage: Wisconsin’s Unique Medigap Features


Customizing Your Coverage Wisconsin's Unique Medigap Features


Wisconsin’s Medigap policies are like a custom-made suit. They are structured around a single Basic plan, which beneficiaries can then customize by adding optional riders for additional coverage. State mandated benefits included in Wisconsin Medigap policies cover services such as non-Medicare skilled nursing home stays, home health care, chiropractic care, and preventive health services. Additionally, innovative Medigap benefits, approved by the Office of the Commissioner of Insurance (OCI), incorporate perks such as nurse hotlines, annual physical exams, preventive dental and vision care, drug discount cards, and routine hearing exams. These policies also cover Medicaid services, ensuring comprehensive health care for beneficiaries, including supplemental benefits.

Let’s dive into the details about how you can customize your coverage. We’ll explore the addition of riders for extra protection and the option of high-deductible plan options.


Adding Riders for Extra Protection

Riders are like additional tools in your healthcare toolkit. They enhance your Medigap policy, covering your specific healthcare needs. For instance, the Part A deductible rider and Part B excess charges rider cover hospital deductibles for each benefit period and charges beyond Medicare’s approved amounts, respectively. It’s like having an extra layer of protection against unexpected healthcare costs.

In addition, you can consider adding an additional home healthcare rider, which covers up to 365 extra home healthcare visits per year beyond what Medicare provides. Moreover, for those with a love for travel, the Foreign Emergency Travel Healthcare Rider offers financial protection against medical costs when traveling abroad, with limits typically at $50,000 per lifetime.


High-Deductible Plan Options

High-deductible plans are like a seesaw. On one side, you have lower monthly premiums, and on the other side, higher out-of-pocket costs. Wisconsin Medigap offers a high-deductible version of the Basic plan, covering Medicare Part A and B deductibles, Part B coinsurance, and other costs after deductible payment. In addition to high-deductible options, Wisconsin provides 50% and 25% cost-sharing plans that mirror the cost structure of Medigap Plans K and L available in other states.

This seesaw effect means that beneficiaries are required to pay all costs until the deductible is met, resulting in lower monthly premiums. It’s a trade-off that can work well for those who are comfortable taking on higher out-of-pocket costs in exchange for lower premiums.



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The Role of Private Companies in Medigap Provision

The Role of Private Companies in Medigap Provision


In the world of Medigap, private company providers are the key players. They provide supplemental insurance, known as Medigap, to help cover expenses that Medicare does not pay for. They are like the manufacturers of a car, providing the vehicle (in this case, the Medigap plans) that can take you to your destination (comprehensive healthcare coverage).

In Wisconsin, all Medigap plans are mandated to offer certain basic benefits, and many plans also offer additional benefits beyond the basic coverage. It’s like every car comes equipped with essential features like brakes and seatbelts, with options for added extras like a sunroof or leather seats. But how is the cost of these plans determined? Medigap insurers in Wisconsin employ either attained-age rating or issue-age rating to determine premiums for policyholders. Let’s delve deeper into how to choose a trusted insurer and understand the contract terms.


Choosing a Trusted Insurer

Choosing a trusted insurer for your Medigap plan is like selecting a reliable builder for your dream home. It’s a big decision that can significantly impact your healthcare coverage. But it’s not just about the insurer’s reputation. It’s also about understanding the nuances of the plan, such as:

  • payments required for certain services or conditions, even with zero-dollar premiums in Medicare Advantage plans
  • coverage for prescription drugs
  • out-of-pocket costs, such as deductibles and copayments
  • network restrictions, if any

Taking the time to research and compare different insurers and their plans will help you make an informed decision and find the best coverage for your needs.

Additionally, the difference in enrollment numbers, premium costs, and the use of rebate dollars between Stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug plans (MA-PDs) can influence your choice of a Medicare Advantage Plan with the right prescription drug coverage.


Understanding the Contract Terms

Understanding the terms of your Medigap contract is like reading the fine print before signing a new phone contract. It’s crucial to know what you’re agreeing to. All Medigap plans in Wisconsin must include certain basic benefits as mandated by law, although the terms and additional benefits can vary between plans. It’s like the standard terms and conditions in a phone contract, with different add-ons available depending on the provider.

Moreover, the Affordable Care Act left intact the potential for a 6-month waiting period for coverage of pre-existing conditions under Medigap if the beneficiary did not have prior creditable coverage. It’s like waiting for a certain period before you can upgrade your phone or access certain features. Understanding these terms can help you make the best decision for your healthcare needs.


Impact of Recent Legislation on Medigap Plans in Wisconsin


Impact of Recent Legislation on Medigap Plans in Wisconsin


Much like the changing seasons in Wisconsin, legislation affecting Medigap can also change over time. Recent federal government legislation might impact Medigap plans in Wisconsin, with potential changes to cost-sharing and provisions for low-income beneficiaries.

It’s like a changing weather forecast, requiring you to adjust your plans accordingly.


Changes to Cost-Sharing and Premiums

The Inflation Reduction Act, like a gust of wind, might influence cost-sharing and premiums for Medigap plans. Starting to phase in from 2023, the Act includes provisions to lower prescription drug spending by Medicare and beneficiaries. It’s like a windfall that could potentially lower your healthcare costs.

However, just like the annual increase in living costs, Medigap premiums also increase over time. The average annual increase in Medigap premiums is approximately 7.85%, reflecting both regular inflation and an age rating that accounts for older beneficiaries requiring more medical services. It’s like the annual inflation rate, affecting your healthcare costs as well.


Provisions for Low-Income Beneficiaries

For low-income beneficiaries, the Part D Low-Income Subsidy (LIS) program is like a helping hand. Beneficiaries with low incomes and modest assets receive additional premium and cost-sharing assistance as part of the program. This assistance helps to make healthcare more accessible and affordable for those in need. It’s like a scholarship, providing financial support to those in need.

The LIS program provides premium and cost-sharing assistance to an estimated 13.4 million Part D enrollees. This support helps individuals afford their prescription medications. It’s a significant provision, helping many beneficiaries afford their healthcare costs.


Planning for the Future: Medigap and Long-Term Health Care Needs


Planning for the Future Medigap and Long-Term Health Care Needs


Planning for future healthcare needs is like planting a tree for future shade. Medigap plans can offer customizable coverage for long-term care and retirement health expenses. It’s about ensuring you have the coverage you need when you need it most.


Addressing Long-Term Care

Long-term care is a significant consideration for many Medicare beneficiaries. Some Medigap plans in Wisconsin offer an at-home recovery benefit designed to cover short-term custodial care services following an illness, injury, or surgery. It’s like having a safety net, providing additional support when you need it most.

However, it’s important to note that the at-home recovery benefit within Medigap plans has specific limits on the number of home care visits and the amount that is payable per visit. It’s like a capped data plan, providing coverage up to a certain limit.


Preparing for Retirement Health Expenses

Preparing for retirement health expenses involves planning for the future financial costs associated with healthcare needs. It’s like saving for a rainy day, ensuring you have funds set aside for unforeseen expenses. In fact, a couple enrolled in traditional Medicare plus a Medigap supplement plan will need to save an estimated $351,000 to have a 90% chance of covering their medical expenses in retirement. It’s a significant number, emphasizing the importance of planning ahead for retirement health expenses.


Wisconsin State Resources and Support

Navigating Medigap can feel like navigating a ship in a storm. But fear not; Wisconsin offers state resources and support for Medigap beneficiaries, including the Medigap Helpline and the Office of the Commissioner of Insurance (OCI).

It’s like having a compass and a map guiding you through the complexities of Medigap.


Contacting the Wisconsin State Insurance Department

Reaching out to the Wisconsin State Insurance Department can provide personalized assistance and information crucial for making informed decisions about Medicare Supplement Plans. It’s like having a personal guide helping you navigate the Medigap landscape.


Educational Programs and Workshops

Educational programs and workshops are like a user manual, helping beneficiaries understand their Medicare options and select the best Medigap plan for their needs.



Navigating the complexities of Medigap in Wisconsin might seem daunting at first, but with a deep understanding of the options available, the process becomes much simpler. The state offers a unique approach to Medigap, providing comprehensive plans with customizable options. These plans, offered by private companies, can be tailored to fit your specific healthcare needs and financial preferences. With recent legislation potentially impacting cost-sharing and premiums, keeping informed is essential. And with state resources and support readily available, securing your health future with Wisconsin’s Medigap plans is a journey you don’t have to embark on alone.

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Frequently Asked Questions

What is the CMS rule for 2025?

The CMS rule for 2025 includes updates such as the out-of-pocket cap being lowered to $2,000 and the removal of cost sharing for certain adult vaccines and enrollees in a catastrophic range, as well as limitations on cost sharing for insulin products.


  What changes to Medicare in 2025?

In 2025, Medicare Part D will introduce an annual out-of-pocket cap of $2,000 for prescription drug costs, with adjustments for inflation in subsequent years. However, this cap does not apply to out-of-pocket spending on Part B drugs.


  Are Medicare Supplement plans being phased out?

Yes, Medicare Supplement Plan F is being phased out starting January 1, 2020. However, individuals currently enrolled in Plan F can keep their plan as long as they want. If eligible for Medicare after January 1, 2020, they cannot purchase Plan F.


  What is unique about Wisconsin’s Medigap plans?

Wisconsin’s Medigap plans are unique because they offer customizable cost-sharing levels and optional riders for additional coverage, providing a comprehensive plan to all residents.


  What is the eligibility and enrollment period for Medigap in Wisconsin?

If you are a Wisconsin resident with Medicare Parts A and B, you are eligible for Medigap. You have a one-time six-month enrollment period that starts at age 65 and upon enrollment in Part B.

Speak to the Professionals about Medigap Plans and Original Medicare

If you find understanding the benefits involved with Original Medicare and Medigap Plans challenging, you’re not alone. Whether it’s a Medigap plan, or you want to know more about Medicare Supplement Plans Wisconsin in 2025, we can help. Call our team at 1-888-891-0229 for a free consultation or complete the contact form on this site, and an expert will call you back at a convenient time.

We have decades of experience advising our clients on the complexities of Medicare and Medigap plans, the benefits, cost and deductibles. We’ll ensure you get the best rate in your state and advice you can trust.

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