Medicare in Wisconsin

Medicare in Wisconsin, just like Medicare in Massachusetts and Minnesota, has some particularities when compared with the rest of the U.S. Although the benefits of Medicare are the same in all the states, in Wisconsin some plans may vary. In case you live in Wisconsin and are interested in knowing your options or you are just curious about it, we will explain you the differences and similarities between this state and the rest of the country.

What are the similarities between Medicare in Wisconsin and the rest of the U.S?

     The main services offered by Medicare in the U.S are also available in Wisconsin. The following Medicare benefits are available in Wisconsin:

  • Original Medicare Part A (hospital insurance) and Part B (medical insurance) are available for Wisconsin’s residents. They have the same coverage and benefits as in any other state. If you want to join it you must apply during the Initial Enrollment Period when you are turning 65 or apply manually if you suffer from End-Stage Renal Disease. You are automatically enrolled if you suffer from amyotrophic lateral sclerosis or if you are receiving Social Security Services disability benefits. Remember that in the previous cases you receive Part A for free but you must pay a monthly premium for Part B in case you want it.
  • Original Medicare Part C or Medicare Advantage Plans are also available. This must cover the same as Original Medicare and includes more benefits that will depend on the plan you choose, like dental or hearing care. Remember that you join Part C through private insurance companies and the prices vary depending on the one you choose.
  • Medicare Part D or Medicare Prescription Drug Coverage is also available. This is very helpful if you don’t have a Medicare Advantage Plan that has prescription coverage or if you have Original Medicare and you want to save some dollars.

      What are the differences between Medicare in Wisconsin and the rest of the U.S?  

Unlike other states in the U.S, Medicare in Wisconsin does not have such a wide variety of Medicare Supplement Plans. In this state they offer a Basic plan with some riders that you can add to it and a couple more plans that are similar to other plans offered in the rest of the country.

     What does the Basic Plan cover in Wisconsin?

     The Basic plan covers the following services:

  • Medicare Part A coinsurance for inpatient hospital care.
  • Medicare Part B coinsurance (generally 20% of the Medicare-approved amount).
  • The first three pints of blood each year.
  • Medicare Part A hospice coinsurance or copayment.
  • Medicare Part A skilled nursing facility (SNF) coinsurance.
  • 175 days per lifetime in addition to Medicare’s benefit of inpatient mental health coverage. Medicare has coverage of 190 lifetime days of inpatient days in a mental health hospital.
  • 40 home health care visits in addition to those paid for by Medicare.
  • State mandated benefits.

Other Medigap policies available in Wisconsin

There are also two Medicare Supplemental plans offered by Medicare in Wisconsin through private companies called “50% Cost-sharing Plan” and “25% Cost-sharing Plan”. They are similar to standardized Plans L (50%) and L (25%) available in the rest of the country, There is also a high deductible plan of $2000 available.

Riders offered to Medicare Supplement Plans

     Some private insurance companies also offer a list of riders that you can add to the Medigap policy of your preference. The prices and premiums will depend on the company that you choose. Those riders are:

  • Medicare Part A deductible.
  • Additional home health care (365 visits including those paid by Medicare).
  • Medicare Part B deductible.
  • Medicare Part B excess charges.
  • Foreign travel emergency.
  • 50% Part A deductible.
  • Medicare Part B copayment or coinsurance.