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Medicare Supplement (Medigap) Plans

Medicare Supplement Insurance, also known as Medigap, is designed to help cover the "gaps" in Original Medicare (Part A and Part B) by paying for out-of-pocket expenses like copayments, coinsurance, and deductibles. Medigap plans are offered by private insurance companies and work alongside Original Medicare, providing greater financial protection and flexibility in healthcare coverage. Here’s everything you need to know about how Medigap works, how premiums are determined, the unique rules in Wisconsin, rider options, and how to sign up.

How Medigap Coverage Works

Medigap plans are standardized by the federal government, which means that each type of plan (e.g., Plan A, Plan F, Plan G) offers the same basic benefits, no matter which insurance company you purchase it from. Medigap plans help pay for costs that Original Medicare doesn't fully cover, such as:

• 🏥 Part A hospital coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted
• 💉 Part B coinsurance or copayments
• 🌼 Part A hospice care coinsurance or copayments
• 🏨 Skilled nursing facility care coinsurance
• 💵 Medicare Part A and B deductibles (depending on the plan)
• ✈️ Foreign travel emergency care (up to plan limits)

It’s important to note that Medigap plans do not include prescription drug coverage (Part D), so you will need a separate Part D plan if you want prescription drug benefits.

How Premiums are Determined for Medigap Plans

Premiums for Medigap plans are determined based on several factors:

• 🎂 Age: Some Medigap plans are age-rated, meaning your premium increases as you get older, while others may be community-rated, where the premium is the same for all enrollees regardless of age.
• 📍 Location: Premiums vary depending on where you live, as healthcare costs can differ significantly by region.
• 👩‍⚕️ Gender: In some cases, women may pay lower premiums than men, depending on the insurer's pricing model.
• 💊 Health status and medical history: If you’re applying for Medigap outside of your guaranteed issue period, your health status may affect your premium through medical underwriting.
• 📋 Plan type: Some Medigap plans offer more extensive coverage, and these plans tend to have higher premiums. For example, Plan F and Plan G are more comprehensive and, therefore, cost more than Plan A or Plan K.

How Wisconsin Is Different: Medigap Coverage in the State

Wisconsin is one of only three states that operates under its own set of rules for Medigap coverage. While most states follow the federal standardized Medigap plans (A, B, C, etc.), Wisconsin offers a basic Medigap plan with optional riders that allow you to customize your coverage.

Wisconsin’s basic Medigap plan automatically includes benefits such as:

• 🏥 Part A hospital coinsurance
• ⏳ 365 additional days of hospital care after Original Medicare coverage is used
• 💉 Part B coinsurance coverage (100% after the deductible)
• 🩸 3 pints of blood per year

In Wisconsin, you can add optional riders to increase your coverage, allowing more flexibility in tailoring your plan to your individual needs.

Rider Options in Wisconsin

In Wisconsin, instead of choosing a comprehensive plan, you can customize your Medigap plan with riders to increase your coverage. Common rider options include:

• 🏥 Part A deductible rider: Covers the hospital deductible for Medicare Part A
• 💉 Part B deductible rider: Covers the annual deductible for Medicare Part B (Note: This is no longer available for new beneficiaries as of 2020)
• ✈️ Additional foreign travel emergency coverage
• 🏨 Skilled nursing facility coinsurance rider
• 💵 Excess charges rider: Covers any charges that exceed the Medicare-approved amount for Part B services
• 🏡 Home health care rider: Provides additional coverage for home health care services

These riders give you the flexibility to only pay for the coverage you need, making Wisconsin’s Medigap plans more customizable than in other states.

When and How to Sign Up for Medigap

The best time to sign up for Medigap is during your Medigap Open Enrollment Period, which lasts for 6 months and begins the month you turn 65 and are enrolled in Medicare Part B. During this period, you have guaranteed issue rights, meaning you can buy any Medigap policy offered in your state without being denied coverage or charged higher premiums due to pre-existing conditions.

If you miss this open enrollment window, you can still apply for Medigap, but the insurance company may require medical underwriting, where they assess your health status to determine your eligibility and premiums. If you have health issues, this could result in higher premiums or being denied coverage.

Underwriting for Medigap Plans Outside of Guaranteed Issue

If you apply for Medigap outside of your guaranteed issue period, insurers may require medical underwriting, which involves reviewing your medical history and current health conditions. Here’s what you need to know about underwriting:

• 📄 During underwriting, the insurer may ask about past hospitalizations, surgeries, chronic conditions, or medications.
• 💰 Based on your health status, the insurer can charge a higher premium, limit coverage for certain pre-existing conditions, or deny your application entirely.
• 📆 In some special situations, such as losing employer-based coverage or moving out of your plan's service area, you may qualify for a special enrollment period with guaranteed issue rights, avoiding underwriting.

Contact us today to discuss your options.