Non-Standard Medigap Plans in Minnesota, Wisconsin, and Massachusetts

Non-Standard Medigap Plans in Minnesota, Wisconsin, and Massachusetts

While Medicare Supplement (Medigap) plans are standardized in most states, there are three states—Minnesota, Wisconsin, and Massachusetts—that offer non-standardized Medigap plans. These states follow their own guidelines for Medigap coverage, differing from the lettered plans (A, B, C, etc.) available elsewhere in the U.S. Although these plans still serve the same purpose—covering the gaps in Original Medicare—their structure and benefits vary.

In this article, we’ll explore the unique Medigap offerings in Minnesota, Wisconsin, and Massachusetts, helping you understand how they work, what they cover, and how they compare to standardized Medigap plans in other states.

Medigap Plans in Minnesota

Minnesota offers a different approach to Medigap plans, using a basic and extended coverage model instead of the standard lettered plans.

Basic Plan

Minnesota’s Basic Plan covers many of the essential services provided by Medigap plans in other states. It includes:

• Part A Coinsurance: Covers coinsurance for hospital stays.
• Part B Coinsurance: Covers 20% of the Medicare-approved amount for medical services.
• Blood: Covers the first three pints of blood each year.
• Hospice Care Coinsurance: Covers coinsurance for hospice care.
• Skilled Nursing Facility (SNF) Coinsurance: Coverage for care in a skilled nursing facility.
• Foreign Travel Emergency: 80% coverage of medically necessary emergency care received outside the U.S., after a deductible.

Extended Basic Plan

The Extended Basic Plan offers all the benefits of the Basic Plan plus additional coverage, making it more comprehensive. It includes:

• Part A Deductible: Coverage of the Medicare Part A hospital deductible.
• Part B Deductible: Coverage of the Medicare Part B deductible.
• Part B Excess Charges: Covers charges above what Medicare approves, up to a certain limit.
• Additional Skilled Nursing Care: Enhanced coverage for skilled nursing facilities.
• More Foreign Travel Emergency: Expanded foreign emergency medical coverage.

In Minnesota, insurance companies can also offer optional riders that provide further coverage, such as non-Medicare covered preventive services and at-home recovery care.

Medigap Plans in Wisconsin

Like Minnesota, Wisconsin does not follow the traditional Medigap lettered plan system. Instead, Wisconsin offers a Basic Plan with the option to add riders to customize coverage.

Basic Plan

The Wisconsin Basic Plan includes the following essential benefits:

• Part A Coinsurance: Covers hospital coinsurance.
• Part B Coinsurance: Covers 20% of Medicare-approved costs for outpatient services.
• Blood: Covers the first three pints of blood each year.
• Hospice Care Coinsurance: Covers Medicare Part A coinsurance for hospice care.

Wisconsin’s Basic Plan is straightforward and covers the fundamental gaps left by Original Medicare. However, policyholders can add optional riders to expand their coverage, making the plan highly customizable.

Optional Riders

Some of the common riders available in Wisconsin include:

• Part A Deductible Rider: Covers the hospital deductible under Medicare Part A.
• Part B Deductible Rider: Covers the Part B deductible (only available to those eligible for Medicare before January 1, 2020).
• Part B Excess Charges Rider: Covers excess charges that providers may bill above what Medicare approves.
• Foreign Travel Emergency Rider: Provides coverage for emergency medical care while traveling outside the U.S.
• Additional Home Health Care Rider: Expands coverage for home health care beyond what Medicare offers.

By offering a wide range of riders, Wisconsin allows beneficiaries to build a Medigap plan that suits their unique medical and financial needs.

Medigap Plans in Massachusetts

Massachusetts takes a simplified approach to Medigap coverage, offering just three types of plans: Core Plan, Supplement 1, and Supplement 1A.

Core Plan

The Core Plan is the most basic Medigap option in Massachusetts. It includes:

• Part A Coinsurance: Covers hospital coinsurance costs.
• Part B Coinsurance: Covers 20% of Medicare-approved outpatient costs.
• Blood: Covers the first three pints of blood each year.
• Hospice Care Coinsurance: Covers coinsurance for hospice care.
• Additional Benefits: Some preventive services that aren’t covered by Medicare are also included in the Core Plan.

Supplement 1

The Supplement 1 Plan in Massachusetts provides more comprehensive coverage, similar to Medigap Plan F in other states (but without the name). It includes:

• Part A Deductible: Full coverage for the Part A deductible.
• Part B Deductible: Full coverage for the Part B deductible (only available to those eligible for Medicare before January 1, 2020).
• Part B Excess Charges: Full coverage for any excess charges above the Medicare-approved amount.
• Skilled Nursing Facility Care: Full coverage for coinsurance in a skilled nursing facility.
• Foreign Travel Emergency: Emergency medical coverage while abroad.

Supplement 1A

The Supplement 1A Plan is similar to Supplement 1 but without coverage for the Part B deductible. This plan is an attractive option for beneficiaries who want comprehensive coverage but are ineligible for the Part B deductible coverage due to the new Medicare regulations.

Key Differences and Considerations

1. Customization:

• In Minnesota and Wisconsin, Medigap plans are highly customizable with optional riders. This allows beneficiaries to tailor their coverage to meet specific needs, unlike in most other states where plans come pre-defined.

2. Comprehensive Coverage:

• Massachusetts offers three straightforward plans, with Supplement 1 offering comprehensive coverage similar to Plan F, which is no longer available to new enrollees in most other states.

3. Riders and Flexibility:

• Wisconsin offers a Basic Plan and allows policyholders to add specific riders for greater coverage. This level of flexibility is not available in standardized states.
• Minnesota follows a similar approach with its Extended Basic Plan and customizable riders.

4. Foreign Travel Emergency:

• All three states offer Medigap plans with foreign travel emergency coverage, which is particularly useful for beneficiaries who travel abroad frequently.

How to Compare Non-Standard Medigap Plans

When comparing non-standard Medigap plans in Minnesota, Wisconsin, and Massachusetts, consider the following:

1. Your Medical Needs: Assess your current and anticipated healthcare needs. If you frequently use specific services like skilled nursing care, consider a more comprehensive plan or adding riders.
2. Budget: Determine how much you can afford in premiums and out-of-pocket costs. While the more comprehensive plans (like Supplement 1 in Massachusetts) offer extensive coverage, they often come with higher premiums.
3. Customizability: In Minnesota and Wisconsin, consider adding optional riders to meet your healthcare needs. In Massachusetts, if you prefer simplicity, the Core Plan might suffice; if you want more coverage, explore Supplement 1 and 1A.

Conclusion

Medigap plans in Minnesota, Wisconsin, and Massachusetts offer unique structures and more flexibility compared to the standardized lettered plans in most states. By understanding the options available in your state, you can choose a plan that suits your medical needs and financial situation. Whether you prefer a basic plan with customizable riders or a comprehensive plan with all-inclusive coverage, there are plenty of options in these non-standard states.

If you need assistance choosing the right Medigap plan or understanding your options, feel free to contact our licensed Medicare brokers at 616-600-8444. We’re happy to provide no-cost guidance to help you make the best decision for your healthcare needs.

Source of information www.medicare.gov

More information:

Comparison of Medicare Advantage Plans
Medicare Advantage plans, how to get it and how much cost
Medicare Advantage Plans: questions and answer