Wisconsin Medicare Supplements / SeniorCare Rx
Wisconsin Medicare Supplements (Medigap)
While most of the US states offer 10 standardized types of Medigap plans, those offered in Wisconsin are a bit different. Within Wisconsin, all Wisconsin Medicare Supplements (Medigap plans) of a particular type must be standardized, or, in other words, offer the same coverage and benefits.
All Medigap plan types in Wisconsin cover the following basic benefits:
- Medicare Part A coinsurance for inpatient hospital care.
- Medicare Part B coinsurance (typically 20% of the Medicare-approved amount).
- First three pints of blood used every year.
Wisconsin offers a Medigap Basic Plan that includes the following benefits:
- All basic benefits.
- Medicare Part A skilled nursing facility coinsurance.
- Medicare Part A inpatient mental health coverage (175 days per beneficiary’s lifetime in addition to the Medicare benefit of 190 lifetime days).
- Medicare Part A home health coverage (40 visits in addition to those covered by Medicare).
- State-mandated benefits such as preventive services.
Wisconsin Medicare beneficiaries can also add optional riders to the Medigap Basic Plan, for an additional cost, to cover the following:
- 100% or 50% of the Medicare Part A deductible.
- Medicare Part B deductible.
- Medicare Part B excess charges.
- Overseas emergency travel coverage.
- Home health care coverage (365 visits including those covered by Medicare).
SeniorCare Rx is a State Pharmaceutical Assistance Program (SPAP) for Wisconsin residents who are 65 years of age or older.
There are different levels that you may qualify for with SeniorCare Rx. Depending on what level you qualify for you may or may not have a deductible. No matter what level someone qualifies for, once the deductible is met (if there is one) then the cost of a generic refill is $5.00 and a name brand refill is $15.00.
Enrollment Requirements Include:
- Must be a Wisconsin resident.
- Must be 65 years of age or older.
- Your application will not be accepted if you apply earlier than the month before your 65th birthday.
- Annual enrollment fee of $30.00 per person.
- Only income is counted. Assets such as bank accounts, retirement accounts and home property are not counted.
There are multiple plans in my area…how do I know which one is best for me?
Yes that is correct, there are multiple plans that are generally offered in each zip code/county. The Extra Help Agency was set up as a brokerage agency so this means we can help you understand all of the plans available to you in your area. In addition to the volunteer work we do for the local communities for free, we also help people understand their Medicare options at no cost or obligation. If someone wants our help with structuring their Medicare and help them when they need help…we can become their local agent to help them with their insurance needs. The plan would commission us to be your local agent of record…this is one way we can afford to offer our services to our communities at no cost or obligation to you.