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Wisconsin Standardized Medicare Supplement Plans

Basic Benefits - Included in all plans:

Inpatient Hospital Care: Covers the Part A coinsurance.

For medicare supplement plans, Medical Costs: Covers the Part B coinsurance (generally 20% of Medicare-approved payment amount) or copayment amount which may vary according to the service. For hospital outpatient services, the copayment amount will be paid under a prospective payment system. If this system is not used, then 20% of eligible expenses will be paid.

Blood: Covers the first 3 pints of blood each year.

Basic Plan Covers
Basic Benefits
Part A: Skilled-Nursing Facility Coinsurance
Inpatient Mental Health Coverage 175 days per lifetime in addition to Medicare
Home Health Care 40 visits in addition to those paid by Medicare
Part B Coinsurance
Outpatient Mental Health
Prescription Drugs

Optional Riders:

Insurance companies are permitted to offer additional riders to a Medicare Supplement plan.

Optional Riders Covers
Medicare Part A Deductible Rider
Additional Home Health Care Rider
365 visits including those paid by Medicare
Medicare Part B Deductible Rider
Medicare Part B Excess Charges Rider
Outpatient Prescription Drug Rider
Foreign Travel Rider

Mandated State Benefits under Medicare Supplement Basic Plan:

  • Usual and customary expenses for chiropractic services

  • Usual and customary expenses for diabetic supplies and equipment

  • 30 day skilled nursing home confinement

  • Kidney disease treatment for dialysis, transplantation and donor-related services with a $30,000 maximum

  • Usual and customary expenses for breast reconstruction following a masectomy

  • Usual and customary expenses for hospital and ambulatory surgery center charges and anesthetics for dental care

  • Nervous and mental disorder and alcoholism and other drug abuse coverage

  • Coverage for at least 80% of the charges for outpatient prescription drugs after a drug deductible of no more than $6,250 per calendar year

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