I'm covering retirement health insurance in four parts:- Original Medicare,
- Medigap, a private Medicare supplement,
- Medicare Advantage, and
- Typical Medicare insurance bundles.
See the Expanded Medicare Glossary for help with any unfamiliar terms.
Medigap is extra health insurance that you buy from a private company to pay health care costs not covered by Original Medicare, such as coinsurance and copayments, deductibles, and travel outside the U.S. Standardized Medigap plans are offered in all states but Massachusetts, Minnesota, and, you guessed it, Wisconsin. Medicare.gov has a familiar comparison table of the standardized plans, but I won't be talking about whether the popular Plan F is really the best. I'll be talking about Wisconsin Medigap1:
Basic Plan
The Wisconsin Basic Medigap Plan Covers- Inpatient hospital care: covers the Part A coinsurance
- Medical costs: covers the Part B coinsurance (generally 20% of the Medicare-approved amount)
- Blood: covers the first 3 pints of blood each year
- Part A hospice coinsurance or copayment
- Part A skilled nursing facility coinsurance
- An additional 175 days per lifetime for inpatient mental health care
- An additional 40 home health care visits
- Wisconsin-mandated benefits, page 20. These benefits are required by Wisconsin insurance law for Medigap policies. They are available even when Medicare does not cover these
expenses. Medicare Advantage plans are NOT required to provide these benefits. - an additional 30 days of skilled nursing care
- an additional 40 home care visits per year
- expenses for dialysis, transplantation, or donor-related services of kidney disease of $30,000 in any calendar year
- insulin pump or other equipment or non-prescription supplies for the treatment of diabetes
- chiropractor services
- hospital and ambulatory surgery charges and anesthetics for dental care
- breast reconstruction incident to a mastectomy
- colorectal cancer examinations and laboratory tests
- expenses for cancer clinical trials
- catastrophic prescription drugs
Cost-sharing Plans
Wisconsin Cost-sharing Plans at 50% and 25% are also available. These plans are similar to standardized Plans K (50%) and L (25%), and pay only 50% or 75% of the other plan benefits for a lower premium. A high-deductible plan is also available, where you must pay for Medicare-covered costs up to a $2,000 deductible before your Medigap plan pays anything.Additional Riders
Finally, insurance companies are allowed to offer the following Additional Riders or options:- Part A deductible
- Additional home health care (365 visits including those paid by Medicare)
- Part B deductible
- Part B excess charges
- Foreign travel emergency
- 50% Part A deductible
- Part B copayment or coinsurance
Medigap Open Enrollment
The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems, for the same price as people in good health. This one-time period automatically starts the month you're 65 and enrolled in Medicare Part B. After the initial enrollment period, Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. You may not be able to buy a policy, or it may cost more.Prescription Drug Plans
Original Medicare does not cover prescription drug costs, but you can get private supplemental plans managed by Medicare from a Part D Prescription Drug Plan. You can compare costs for specific Part D plans in your zip code. It is recommended that you do this annually during the enrollment period from October 15 through December 7, because plan costs and coverage can change dramatically, and inertia is not your friend. You can save and update a list of your prescription drugs on the Medicare site.Next: Medicare Advantage
Expanded Medicare Glossary
Resources
References
1 Wisconsin Medigap, Medicare.gov, retrieved November 28, 2017
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