Your Medicare Community - MedicareFAQ

Wisconsin Medicare Supplement Plans & Additional Riders

March 19, 2021 Lindsay
Your Medicare Community - MedicareFAQ
Wisconsin Medicare Supplement Plans & Additional Riders
Show Notes Transcript

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 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.

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If you're a Medicare beneficiary in Wisconsin, don't go anywhere. In today's video, we're going to go over how Medigap plans in Wisconsin are different. Hi Medicare Community. My name is Lindsey Engle im the Medicare expert for Elite Insurance Partners and MedicareFAQ.com. Wisconsin is 1 of 3 states where Medicare Supplement plans are standardized differently. The state offers a basic plan as well as additional riders that you can pair with for additional coverage. The basic plan is excellent for covering what Medicare doesn't. If you're looking for additional coverage, riders are a provision that allows you to add additional benefits to a policy. Riders can help you with deductibles, co-pays, as well as other coverage gaps. Let's go over the basic benefits included in Wisconsin Medigap plans. The basic benefits that must be included in all Wisconsin Medigap plans include, coverage for the coinsurance under Part A and Part B for both inpatient and outpatient services. Coverage for the first 3 pints of blood each calendar year. Coverage for the Part A hospice coinsurance or co-payment. As well as coverage for the coinsurance at a Skilled Nursing Facility. In addition, they must include benefits for 40 Home Health Care visits that are added onto those already paid by Medicare, as well as an extra 175 days of inpatient mental health care beyond Medicare. There are also State-mandated benefits that these Medigap plans must also include. Wisconsin requires that insurance companies offer specific mandated benefits that offer additional coverage to protect beneficiaries. These State-mandated benefits include extra coverage for skilled nursing facility care, kidney disease care, diabetic treatment, and more. For Skilled Nursing Facility care, it 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 state does not have to meet medicare's definition. The state-mandated benefits also include extra coverage for kidney disease care. This includes coverage for both inpatient and outpatient dialysis treatment. It also must include coverage for transplants and donor-related expenses. In addition, plans must include coverage for up to thirty thousand dollars for kidney disease care in any calendar year. Another state-mandated benefit includes diabetic treatment. Plans must include coverage for diabetic supplies, including self-management training and Insulin infusion pumps. State-mandated benefits also, include Chiropractic Care. Medigap policies cover the usual and customary expense for services provided by a chiropractor under the scope of chiropractors license. This benefit in Wisconsin is available even if Medicare does not cover the claim. The care must also meet the insurance company standards as medically necessary. Some additional state-mandated benefits include breast reconstruction surgery, colorectal cancer screening, and coverage of certain health care costs in cancer clinical trials. Please note that Medicare Advantage plans are not required to include coverage for the above-listed state-mandated benefits. In addition to the basic plan benefits, there are 7 additional riders that you can add on. These riders are available a la carte and allow you to customize your own plan. If you just go with the basic plan benefits, it's very similar to Medigap Plan A. Insurance companies in Wisconsin are allowed to include the following Riders. Coverage for the Part A deductible, in addition to a rider that covers only 50% of the Part A deductible, additional Home Health Care, coverage for the Part B deductible as well as Part B excess charges, additional coverage for foreign travel emergency, and coverage for any co-payments or coinsurance under Part B. You can add these riders to make your coverage equivalent to the most popular standardized Medigap plans. For example, to obtain coverage similar to Plan G, you would start with a basic plan and add on the following riders. The Part A deductible rider, the rider for Part B excess charges, the rider for additional home health care benefits, and the rider for foreign travel emergency. Now, there is a rider for the Part B deductible. However, due to To some recent changes, you're only eligible to add on the Part B deductible rider if you are eligible for Medicare prior to 2020. If you prefer a cost-sharing plan that comes with a lower monthly premium. There is an optional plan that includes 25% and 50% cost-sharing. It's very similar to Plan K and Plan L. A high deductible plan is also available that's very similar to the High Deductible Plan G. I hope you found this video helpful, and if you did, don't forget to subscribe to our YouTube channel, make sure notifications turned on so you're notified each time we upload a new video. We also have a great Medicare committee on Facebook, well include a link in the description below so you can join. Until next time. Bye.