Alyssa Lane
If you're looking to apply for Medicare in Wisconsin, there are a few things you should know. Medicare is the largest health insurance program in the US, providing coverage for people aged 65 and older, as well as some individuals with disabilities. In Wisconsin, there is only one Medigap plan available, with optional policy riders that can be purchased for additional coverage. Before choosing a plan, it is important to understand the costs and what each plan covers. Wisconsin Medigap insurers are required to offer coverage to disabled enrollees under 65, with a six-month open enrollment period. Additionally, beneficiaries who require prescription drug coverage may need to enrol in Medicare Part D. For more information on Medicare application and eligibility in Wisconsin, the Wisconsin Department of Health Services offers a range of resources.
| Characteristics | Values |
|---|---|
| Medicare in Wisconsin | Largest health insurance program in the U.S. |
| Who is eligible | People 65 or older, people with a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease) |
| How to apply | Via the ACCESS website, by calling your local county or Tribal agency during their office hours, or by filling out and mailing a paper application |
| Supplemental insurance | Known as "Medigap"; only 1 Medigap plan available in Wisconsin, with optional policy riders that can be purchased for additional coverage |
| Medicare Advantage | Managed care plan option for Medicare beneficiaries; disabled beneficiaries can enroll in a Medicare Advantage plan instead of Original Medicare |
| Prescription drug coverage | Medicare Part D prescription drug plan can be purchased as a stand-alone plan or obtained as part of a Medicare Advantage plan; 16 stand-alone Medicare Part D plans are available in Wisconsin |
| Appeals process | Request for Fair Hearing form can be used to appeal a decision about program eligibility |
| Additional resources | Wisconsin Department of Health Services website, Medicare Rights Center website, Guide to Applying for Wisconsin's Health, Nutrition, and Other Programs |
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What You'll Learn
Medigap plans and riders
If you have Original Medicare and live in Wisconsin, you have the option to enhance your coverage by purchasing a Medigap policy, also known as Medicare Supplement Insurance. Medigap plans are offered by private insurance companies and are designed to fill in the gaps in coverage left by Medicare Parts A and B. These gaps can include deductibles, coinsurance, and copayments.
In Wisconsin, as in most other states, there are standardized Medigap plans identified by the letters A, B, D, G, K, L, M, N, and high-deductible G. Each plan offers a different combination of benefits, but the same lettered plan will have the same basic benefits regardless of the insurance company selling it. This makes it easier to compare plans and find the one that best suits your needs.
Medigap policies in Wisconsin are guaranteed renewable, which means that as long as you pay your premiums, your coverage cannot be canceled due to age or health status. However, it's important to note that Medigap policies do not cover everything. They generally don't cover services that Medicare doesn't cover, such as long-term care, dental care, hearing aids, and private nursing.
When purchasing a Medigap policy in Wisconsin, you have a guaranteed issue right to buy a Medigap policy during a special enrollment period. This means insurance companies are required to sell you a Medigap policy, cover all your pre-existing health conditions, and generally can't charge you more because of past or present health problems. This special enrollment period is a six-month window that starts the first month that you're 65 or older and enrolled in Medicare Part B.
Now, let's focus on Medigap riders. A Medigap rider is an optional add-on to a Medigap policy that provides additional benefits. In Wisconsin, there are two main types of Medigap riders: the Medicare Select Rider and the At-Home Recovery Care Rider. The Medicare Select Rider limits your Medicare coverage to a specific network of healthcare providers, but it typically offers a lower premium than a standard Medigap policy. The At-Home Recovery Care Rider provides coverage for services that aid in your recovery from an illness or injury at home, such as skilled nursing care and therapy services. Not all insurance companies offer these riders, so be sure to check with your chosen company.
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Prescription drug coverage
In Wisconsin, Medicare Part D provides prescription drug coverage. This can be purchased as a standalone plan to complement Original Medicare or Medicare Supplement coverage. Alternatively, you can opt for a Medicare Advantage (Part C) plan that includes prescription drug coverage (Part D), as well as hospital, medical, dental, vision, and hearing benefits.
Medicare Part D plans in Wisconsin offer a range of features, including low copays, extensive drug coverage, and access to pharmacies across the United States. Some plans have different pricing tiers for drugs, with generic drugs typically being the most affordable. It's important to review the formulary, or the list of drugs covered by the plan, to ensure your medications are included.
If you have high out-of-pocket prescription drug costs, you may be interested in the Medicare Prescription Payment Plan. This optional program allows you to make monthly payments instead of paying the full amount upfront. Additionally, if you manage multiple medications for complex medical needs, you may be eligible for the Medication Therapy Management program, which helps you and your doctor optimize your medication outcomes.
When considering prescription drug coverage in Wisconsin, it's important to evaluate your specific needs and preferences. You can use tools to look up your prescriptions and their costs under different plans, ensuring you find the most suitable and cost-effective option.
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Supplemental insurance
If you have Medicare in Wisconsin, you may still have to pay for some healthcare costs. Supplemental insurance, also known as Medigap, can help cover these extra expenses. Medigap is extra insurance that you can buy from a private company. Wisconsin law states that all Medigap plans must offer certain basic benefits.
There is only one Medigap plan available if you live in Wisconsin. However, there are also 50% and 25% Cost-sharing Plans available, which are similar to standardized Plans K (50%) and L (25%). A high-deductible plan is also an option. Insurance companies can add more coverage to the Medigap policy, and you may choose any or all of these options to design a Medigap policy that meets your specific needs.
Before purchasing a Medigap policy, it is important to shop around for the right plan. You can contact your State Insurance Department for more information on these policies and to find out which plan would be best for you. Additionally, you can refer to the 2022 Guide to Health Insurance for People with Medicare in Wisconsin for more information on supplemental insurance plans. This guide provides an overview of the different Medicare options, including supplemental insurance, and can help you understand the pros and cons of each plan.
Medigap policies can help cover expenses that Medicare doesn't pay for, ensuring that you have comprehensive health insurance coverage. By purchasing a Medigap plan, you can have peace of mind knowing that your financial burden in the event of medical issues will be reduced.
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Managed care plans
In 13 counties in eastern and central Wisconsin, the Centers for Medicare & Medicaid Services (CMS) has approved Network Health Insurance Corp. Inc. to offer managed care coverage to Medicare beneficiaries. These counties include Brown, Calumet, Dodge, Fond du Lac, Green Lake, Manitowoc, Marquette, Outagamie, Portage, Sheboygan, Waupaca, Waushara, and Winnebago. The company's new PPO plan, Network PlatinumPlus, offers another healthcare option to beneficiaries in these counties.
Other Medicare Advantage plans operating in these 13 counties include Security Health Plan (HMO), United Healthcare of Wisconsin, and three private fee-for-service plans: Humana Insurance Co., Unicare Life and Health Insurance Co. Medicare Advantage HMOs, PPOs, and fee-for-service plans are available where private companies choose to offer them.
Wisconsin law mandates that all Medigap plans, which include managed care plans, offer certain basic benefits. However, many plans provide additional benefits as well. It is important to note that the premium, or the cost of the Medigap plan, can vary significantly across different options. Therefore, it is advisable to research and choose a plan that best suits your needs and budget.
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Financial assistance
Wisconsin Medicare beneficiaries can access financial assistance through various programs and services. Firstly, Medicare Savings Programs (MSPs) are available to help with the cost of Medicare coverage. Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) are two such programs with different income limits for singles and married couples. QMB covers Part A and B cost-sharing and premiums, while SLMB has higher income thresholds.
Medicare beneficiaries in Wisconsin can also receive assistance with prescription drug costs through the state's SeniorCare program. This program assists those aged 65 and over with prescription drug costs. Additionally, Wisconsin's Medicaid program offers coverage for dental services, ophthalmologic exams, and eyeglasses. The income and asset limits for Medicaid eligibility are provided, and applicants with higher incomes may still qualify through the Medicaid spend-down pathway.
Medigap, or supplemental insurance, can also help cover expenses that Medicare does not, such as the Medicare Part A deductible, additional home healthcare, and foreign travel emergencies. Wisconsin Medigap insurers offer optional policy riders for purchase, allowing customization of coverage. The state also provides the Medigap Helpline, a free counseling service for Medicare, Medigap, and long-term care insurance options.
Wisconsin's Medicare beneficiaries can also access the Medicare Part D and Prescription Drug Helpline for counseling on prescription drug coverage options. The Disability Drug Benefits Helpline assists disabled beneficiaries facing challenges with prescription drug costs. These helplines are valuable resources for understanding the range of options available and making informed choices about Medicare and supplemental coverage in Wisconsin.
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Frequently asked questions
Medicare is a health insurance program for people aged 65 and above and for some people with disabilities.
Medigap is supplemental insurance that can help cover expenses that Medicare doesn't pay for.
You can find resources and guides to applying for Medicare in Wisconsin on the website for the Wisconsin Department of Health Services.
There is only one Medigap plan available in Wisconsin, but insurers can offer up to three optional policy riders that beneficiaries can purchase. These include coverage for the Medicare Part A deductible, additional home health care, and foreign travel coverage for emergencies abroad.
Before buying a Medigap policy in Wisconsin, it is recommended that you shop around for the right plan and consider the costs and what the plan covers.
