Wisconsin Medicare Supplement Riders
Wisconsin Medicare Supplement Plans
47 states offer the same style of Medicare supplement/Medigap plans. 3 states opted out of that style including Wisconsin. We chose to offer plans unlike every other state.
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Base Plan + Riders
In general, we have a base plan and riders to customize your coverage. The good news is the base plan and the riders are identical from company to company.
Riders sound scary but all they do is make your coverage more comprehensive. As it gets more comprehensive, the monthly premium gets more expensive because it covers more.
I’ll give you details on the specific riders below but many people want to know what the most popular ones other people choose are so I’ll start there.
Two most popular Wisconsin Medicare Supplement Options
Most people who buy a Medicare supplement in Wisconsin in 2020 or later buy one of two combinations. I included a comparison of pricing I did for a client recently.
Pricing varies by the company you choose as well as several factors including age, home zip code, tobacco use, and gender. Below is an example of pricing but your numbers may vary.
Option 1 – More comprehensive (similar to plan G in other states)
Includes riders 1. Part A Deductible 2. Part B Excess Charges 3. Foreign Travel 4. Additional Home Health Care
You pay:
- Medicare Part B Deductible ($203 in 2021)
$99.78 – Company A
$125.45 – Company B
$141.64 – Company C
$146.19 – Company D
$221.62 – Company E
Company E is more than double the price of company A. For the exact, same coverage.
I’ll all for paying more if I actually get more. But it makes zero sense to pay more to get the same thing…
Option 2 – Copay style (similar to Plan N in other states + it covers Part B excess charges)
Includes riders 1. Part A Deductible 2. Part B Excess Charges 3. Foreign Travel 4. Additional Home Health Care 5. Part B Copayment/coinsurance rider
You pay:
- Medicare Part B annual deductible ($203 in 2021)
- After deductible, $20 copay for Office Visits
- After deductible, $50 copay for emergency room
$67.68 – Company A
$101.99 – Company B
$100.64 – Company C
$131.58 – Company D
$210.40 – Company E
These riders, like the Basic plan, often vary quite a bit in cost from different companies. If you’d like to compare your options and tailor a plan specifically for you then please contact me. You can call me at 855-712-7316 or email mike@askmedicaremike.com
Wisconsin Medicare Supplements are standardized
It’s important to understand that Medicare supplements in Wisconsin are still standardized. This means that the plan with one company will be identical to any other company offering that same plan. The key is to make sure you have the same riders.
Therefore the ONLY difference in plans are the riders you select. And the price you pay for that plan. This is where there can be BIG differences for you.
Some insurance companies have rates that are much higher than others. I have seen rates more than double for the exact same coverage. And fortunately for you, this is one of those situations where you do not get more benefits by spending more money.
If you are curious where I get this information it is from experience being licensed in Wisconsin since 2009, Medicare and You, and the Wisconsin Guide to Health Insurance for People with Medicare.
Page 29 from “The Wisconsin Guide to Health Insurance for People with Medicare”
Medicare supplement insurance companies can only sell standardized Medicare supplement policies. Each standardized Medicare supplement policy must offer the same basic benefits, no matter which insurance company sells it.
Wisconsin Medicare Supplement Options
Wisconsin Basic Plan
In Wisconsin, the primary Medicare Supplement plan is called the Wisconsin Basic Plan. This plan offers the following benefits:
- Inpatient hospital care
- Medicare Part B coinsurance costs after you meet your deductible
- Blood, up to the first 3 pints
- Skilled nursing facility coinsurance
- Home health care – 40 visits in addition to those paid by Medicare
- Inpatient mental health care – 175 days per lifetime in addition to Medicare
- Outpatient mental health
This does a nice job of adding some coverage. But like the name implies, it is still fairly basic coverage. Many seniors prefer to have more comprehensive coverage.
Wisconsin Basic plans can be expanded to provide additional coverage in specific areas by adding optional riders. There are 7 riders available to increase the coverage of the Basic Plan.
Part A Deductible Rider
The Part A rider pays for your Part A deductible of $1,484 per benefit period (for the year 2021). A Medicare hospital benefit period is 60 days, and there can be up to four benefit periods in a year.
The Part A deductible is NOT an annual deductible. It is per benefit period. This means if you do not choose to add this rider, you could end up paying this deductible four times each year. If you have to pay this deductible 4 times then you would end up spending $5,936 (4 * 1,484 = 5,936)
That is a lot of extra risk that you can remove by simply adding this rider to your policy.
Medicare Part B Deductible
Another option is the Part B Deductible rider, which pays your Part B deductible of $203 for 2021.
If you do not have this rider then you will have to pay all costs medical costs for Part B until you meet your deductible. For 2021 that deductible is $203. The good news is this deductible is an annual deductible. So you would only have to pay it 1 time per year.
But if you add this rider then the insurance company will pay your deductible for you.
If you first became eligible for Medicare in 2020 or later, you most likely cannot purchase the Medicare Part B deductible rider due to MACRA.
Medicare Part B Co-payment/Coinsurance Rider
As an alternative to the rider above, you may select the Part B Co-payment or Coinsurance rider. Most of the riders can be added in any combination but this is an either or none combination with the Part B deductible.
With this coverage, you will have to pay the Medicare Part B deductible each year. After that deductible is met, the policy will pay for Part B services. But in addition to the deductible, you will pay up to a $20 co-pay for a doctor’s office visit or up to $50 for an emergency room visit.
You may be wondering why you would take this rider since it appears to add more costs to you. You are correct you have more responsibility so adding this rider often lowers your premium.
Wisconsin Medicare Part B Excess Charges
This rider has a long name and many people are confused by it. So what does it actually do for you? To get to that we have to back up a bit to how doctors bill Medicare and Medicare patients.
A doctor may accept Medicare, but might not accept Medicare assignment, the amount that Medicare will approve to pay. If a doctor doesn’t accept Medicare Assignment, he or she is allowed to charge up to 15% more than what Medicare will approve and pay, (The Medicare Limiting Amount). The Part B Excess Charges Rider will cover the difference between the excess charge and what Medicare approves to pay.
An example to help understand looks like this. A doctor does not accept Medicare assignment charges you $115 for a visit. Medicare only approves $100. Original Medicare will cover 80% of that so they pay $80. Your responsibility depends on your coverage.
- If you do not have a supplement then you are responsible for $45 (115-80 = 45)
- If you have a supplement that pays your Part B but NOT your Excess Charges you are responsible for $15 (115-100 = 15)
- If you have a supplement plan that pays your Part B and your Excess charges you are responsible for $0 (115-100 = 0)
The good news is that many doctors accept Medicare Assignment. The concern would be getting major treatment from a hospital or doctor group that does not accept Medicare Assignment.
Wisconsin Additional Home Health Care Rider
The basic plan includes 40 days of home health care visits per year. This rider extends that coverage from 40 to 365 home health care visits per year (including those paid by Medicare).
Many people question what Home Health Care is. Medicare.gov does a nice job offering more information about it. https://www.medicare.gov/what-medicare-covers/home-health-care/home-health-care-what-is-it-what-to-expect.html
40 visits could obviously go by very quickly, potentially just over a month. Adding 365 visits per year offers a lot of extra coverage to the Basic plan.
Wisconsin Foreign Travel Emergency Rider
Provides up to $50,000 of coverage for Medicare Approved medical expenses incurred outside the United States (this includes cruise ships outside of US boundary waters), after meeting a $250 deductible.
If you don’t plan on traveling outside of the United States then there would likely be no need to have this rider. But if you do travel or take a cruise then it could be beneficial to add.
50% Part A Deductible Rider
The Part A rider pays half of your Part A deductible of $1,484 per benefit period (for the year 2021). A Medicare hospital benefit period is 60 days, and there can be up to four benefit periods in a year.
The Part A deductible is NOT an annual deductible. It is per benefit period. You could potentially pay your half of the deductible multiple times per year still. But you are splitting the risk with your Medicare supplement insurance company.
Mike Lovell
Medicare supplements do not cover prescription medication. You will likely need a separate prescription drug plan for your Rx coverage.
Or some people prefer to look at other options like Medicare Advantage.