Figuring out an optimal Medicare plan can be confusing and frustrating. Even when basic coverage is decided, navigating through supplementary and non-standard plans can be a difficult task. Medicare plans and coverage vary by state, some with more complicated offerings than others. Massachusetts, Minnesota, and Wisconsin are three states that offer non-standard plans with optional Medigap policies.
Medigap (officially called Medicare Insurance Supplement Plan) is designed to work alongside the Original Medicare (A and B). Essentially, Medigap acts as an extension for Original Medicare coverage, paying some health care costs that the original plan might not cover; they are health insurance plans offered through private companies.
Medicare Supplement Plans in Massachusetts (MA)
Medicare in Massachusetts still follows the basic enrollment requirements (like being at least 65 years of age) to be eligible for benefits and coverage. Original Medicare coverage refers to Parts A and B. Part A covers hospital care while Part B covers medical care (doctor’s visits, lab testing, etc.). MA Medicare beneficiaries have a few options for extra coverage (keep in mind that the two options aren’t necessarily mutually exclusive, either) through Medigap.
The basic benefits of Medigap in MA, according to the official government site, includes covering Part A coinsurance and part of Part B coinsurance (other basic benefits are also available). In addition to these and other basic benefits, Medigap in MA offers the following plans:
Medigap Core Plan in MA
This core plan covers state-mandated benefits as well as 60 days of inpatient mental hospital care.
Medigap Supplement 1 Plan in MA
This plan also covers basic Medigap benefits along with covering more deductibles, some costs for emergencies during foreign travel, and twice the number of inpatient days in a mental hospital as offered through the Core Plan (other benefits are also available through this plan).
Further information and details about Medicare/Medigap options and what certain plans cover in MA are available on the official Medicare government site.
Medicare Supplement Plans in Minnesota (MN)
In Minnesota, Original Medicare functions similarly to how it does in other states. The basic plan includes Parts A and B, which typically covers (among other things) hospital, nursing, and physician services. These plans also include some health and preventive services.
The basic benefits of Medigap in MN, according to the official government site, includes covering Part A coinsurance and part of Part B coinsurance (other basic benefits are also available). In addition to these and other basic benefits, Medigap in MN offers Basic and Extended Basic benefits plans. These plans become available after certain conditions are met, which can be checked on the official government site.
Medigap Basic Plan in MN
Basic Medigap offers basic benefits, such as preventive care. However, it doesn’t cover things that might be vital to certain individuals, such as inpatient hospital deductibles. Riders, offered through insurance companies, are also available for eligible, interested individuals to add to their Basic Plan.
Further information and details about Basic benefits, coverage, and cost in MN are available on the official Medicare government site.
Medigap Extended Basic Plan in MN
The Medigap Extended Basic Plan provides extra coverage beyond Basic. Some benefits of the Extended Basic Plan include, but are not limited to, inpatient hospital deductibles and 120 days of skilled nursing facility care. Naturally, the Extended Basic premium will cost more, but it does provide much more extensive coverage.
Further information and details about Extended Basic benefits, coverage, and cost in MN are available on the official Medicare government site.
Further Information about Plans in MN
Note that the official government site says that MN offers its own versions of Medigap K, L, M, N, and high deductible F Plans.
Medicare Supplement Plans in Wisconsin (WI)
Original Medicare (Part A and B) is offered to eligible individuals in Wisconsin. Those looking to provide extra coverage in WI have a few options. Medigap in WI offers a Basic Plan and the option to select a Cost-sharing Plan.
Medigap Basic Plan in WI
The Basic Plan covers some of the Part A and Part B coinsurance (regarding hospital care and medical care), according to the official site.
Eligible, interested individuals may also have an additional 175 days of inpatient mental health coverage, and an extra 40 days of home health care services, among other benefits.
Cost-sharing Plans in WI
Essentially, Cost-sharing Plans are similar to the standard K and L Plans; these two plans are called “50% and 25% Cost-sharing Plans,” according to the official government site. This state also offers a “high-deductible plan.”
WI also allows insurance companies to offer additional riders to Medigap. While these additional policies depend on someone’s insurance company, many companies offer Part A and Part B deductibles, together with Part B coinsurance or copayment.
Further information on Medigap and Cost-sharing Plans (what they cover, their benefits, and pricing) in WI are available on the official Medicare government site.
Beyond Medigap
Of course, Medigap is not the only way that interested individuals (not just in MA, MN, and WI) may gain extra coverage not initially covered by their Original Medicare (Parts A and B). Other options include Part D (Medicare Prescription Drug Benefit) and Part C (Managed Medicare by the Trustees).
Part D
Those who need extra assistance in paying for prescription drugs they take themselves (i.e., not administered by a licensed medical professional) may want to opt in to Medicare Part D. Common exclusions include (but are not limited to) drugs not approved by the FDA or those already covered by a different part of Medicare.
Part C
Part C of Medicare is optional for eligible individuals who want coverage that might not be extended under Parts A and/or B. This extra coverage might include, for instance, dental care.
Medicare Advantage
This insurance falls under Medicare Part C and puts a cap on how much patients spend out of pocket. There are a variety of plans through Part C that can help cover costs for, among other things, dental care and vision care. Patients must be enrolled in Parts A and B for potential enrollment into Medicare Advantage plans.
Navigating through the healthcare system is oftentimes tricky; however, finding the right benefits and coverage can make the time spent researching policies worth it.
Disclaimer: This article is not endorsed by Medicare. Note that someone cannot sell a Medigap policy to someone enrolled in a Medicare Advantage Plan (Part C), unless said individual is disenrolling out of a Medicare Advantage Plan and returning to Original Medicare.
