Medicare Supplement (Medigap)

Medicare Supplement insurance — also called Medigap — is a secondary insurance policy sold by private companies that helps pay for the out-of-pocket costs that Original Medicare (Parts A and B) leaves behind, such as copays, coinsurance, and deductibles. Medigap always pays after Original Medicare pays its share first. It has no provider networks, no referrals required, and works with any doctor or hospital in the U.S. that accepts Medicare. You must be enrolled in both Medicare Part A and Part B to purchase a Medigap policy. Note: Medigap does not include prescription drug coverage — you'll need a separate Part D plan for that.

Wisconsin is one of only three states in the country — along with Massachusetts and Minnesota — that have a federal waiver to run their own Medigap standardization system. In most states, you choose from 10 standardized lettered plans (Plan A through Plan N). In Wisconsin, there is one Basic Plan with a core set of mandated benefits, and you customize it by adding optional riders to build the coverage you need. This "build your own" approach gives Wisconsin residents more flexibility but can also make comparison shopping more complex. Brad specializes in Wisconsin Medicare Supplement plans and can walk you through exactly which riders make sense for your situation.

The Wisconsin Basic Plan includes these core benefits as standard:

• Part A coinsurance — daily hospital copays for extended inpatient stays, SNF care, and hospice care
• Part B coinsurance — the 20% of Medicare-approved costs that Original Medicare does not pay
• 175 extra days of inpatient mental health care beyond Medicare's lifetime benefit
• 40 additional home health care visits per year beyond what Medicare covers
• Kidney disease coverage — at least $30,000 per calendar year for dialysis, transplants, and donor services
• Blood — the first three pints needed for Medicare-approved procedures

Additional coverage is available by adding riders for the Part A deductible, Part B deductible (if eligible), foreign travel emergencies, and more.

Wisconsin Medicare Supplement enrollees can choose from four plan structures:

• Basic Plan — the standard plan with core benefits; riders can be added to customize coverage. Average monthly cost is around $165/month for a 65-year-old woman.
• High-Deductible Plan — same benefits as the Basic Plan, but you pay the first $2,950 out-of-pocket in 2026 before coverage kicks in. Lower monthly premium.
• 50% Cost-Sharing Plan — you pay 50% of covered out-of-pocket costs, with an $8,000 annual out-of-pocket maximum in 2026. Similar to Plan K in other states.
• 25% Cost-Sharing Plan — you pay 25% of covered costs. Similar to Plan L in other states.

Brad can compare all four structures and help you select the right riders to match your health needs and budget.

The best time — and the most important window — is your Medigap Open Enrollment Period. This 6-month window starts the first month you are both enrolled in Medicare Part B and age 65 or older. During this period:

• No insurance company can deny you coverage
• No company can charge you more because of pre-existing health conditions
• You have access to every plan available in Wisconsin

This is a one-time window — it does not repeat. After it closes, insurers can use medical underwriting to deny your application or charge higher premiums. Enrolling on time is one of the most impactful Medicare decisions you can make. Brad can make sure you don't miss it.

Outside of your Open Enrollment Period, yes — insurance companies can use medical underwriting to review your health history and either deny your application or charge higher premiums based on pre-existing conditions. This is one of the most critical reasons to enroll during your Open Enrollment Period when guaranteed issue rights protect you. There are limited Special Enrollment Periods that trigger guaranteed issue rights — such as losing other coverage, moving out of a Medicare Advantage plan's service area, or if your plan goes bankrupt. Brad can help you determine if you qualify for guaranteed issue rights outside of the standard enrollment window.

Premiums can increase over time — but only on a class-wide basis. An insurance company cannot single you out and raise your rate based on your personal health or claims history. Rate increases apply to everyone in the same state with the same carrier and plan. As for cancellation — Medigap policies are guaranteed renewable, meaning your insurer cannot cancel your coverage as long as you pay your premiums and did not commit fraud on your application. This gives Wisconsin Medigap holders strong long-term protection.

Yes — if a doctor or provider accepts Original Medicare, they must also accept your Medicare Supplement plan. This is one of the biggest advantages of Medigap over Medicare Advantage: there are no network restrictions, no referrals required, and no need to check if your doctor is "in-network." You can see any Medicare-participating provider anywhere in the United States. This makes Medigap especially valuable if you travel frequently, have specialists outside your local area, or want the freedom to choose any doctor without restriction.

Yes, but switching outside your Open Enrollment Period generally requires passing medical underwriting. If you are in good health, you may be able to switch to a plan with lower premiums or different coverage — but if your health has changed, you could be denied or charged more. There is one notable Wisconsin advantage: if you left an employer plan to join a Medicare Advantage plan, you can drop the Advantage plan within 12 months and apply for a Medigap plan with guaranteed issue rights — no health questions. Brad can evaluate whether switching makes financial sense for your specific situation.

Even with a robust Wisconsin Medigap plan, there are services not covered:

• Prescription drugs — you need a standalone Part D plan
• Routine dental, vision, and hearing — not covered unless added via a separate plan
• Long-term custodial care — nursing home or in-home personal care
• Private-duty nursing
• Cosmetic procedures

Brad can help you pair your Wisconsin Medigap plan with the right Part D plan and point you toward supplemental dental/vision options to round out your coverage.