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Medigap Coverage in Massachusetts, Minnesota and Wisconsin

 

In Massachusetts, Minnesota and Wisconsin, Medigap policies are standardized in a different way.

Massachusetts Medicare Supplement Insurance Plans:

All Medigap policies offered by traditional insurance companies provide the following benefits:

Basic Benefits

 

  • Inpatient Hospital Care: Covers the Medicare Part A coinsurance plus coverage for 365 additional days after Medicare coverage ends
  • Medical Costs: Covers the Medicare Part B coinsurance (generally 20% of the Medicare-approved amount)
  • Blood: Covers the first 3 pints of blood each year
  • Part A Hospice coinsurance or co-payment
Comparison of Plans
Core Plan
Supplemental 1 Plan
Basic Benefits
x
x
Medicare Part A: Inpatient Hospital Deductible
 
x
Medicare Part A: Skilled Nursing Facility Coinsurance
 
x
Medicare Part B: Deductible
 
x
Foreign Travel Emergency
 
x
Inpatient Days in Mental Health Hospitals
60 days per calendar years
120 days per benefit year
State-Mandated Benefits (Annual Pap tests and mammogram. Check your plan for other state-mandated benefits.)
x
x

 

Minnesota Medicare Supplement Insurance Plans:

All Medigap policies offered by traditional insurance companies provide the following benefits:

Basic Benefits

 

  • Inpatient Hospital Care: Covers the Medicare Part A coinsurance
  • Medical Costs: Covers the Medicare Part B coinsurance (generally 20% of the Medicare-approved amount)
  • Blood: Covers the first 3 pints of blood each year
  • Part A Hospice and respite cost sharing
  • Parts A and B home health services and supplies cost sharing
Medigap Benefits
Basic Plan
Extended Basic Plan
Basic Benefits
x
x
Medicare Part A: Inpatient Hospital Deductible
 
x
Medicare Part A: Skilled Nursing Facility Coinsurance

(Provides 100 days of SNF care)

(Provides 120 days of SNF care)
Medicare Part B: Deductible
 
x
Foreign Travel Emergency
80%
80%*
Outpatient Mental Health
50%
50%
Usual and Customary Fees
 
80%*
Medicare-covered Preventive Care
x
x
Physical Therapy
20%
20%
Coverage while in a Foreign Country
 
80%*
State-mandated Benefits (Diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations)
x
x

* Pays 100% after you spend $1,000 in out-of-pocket costs for a calendar year.

Mandatory Riders - Insurance Companies can offer four additional riders that can be added to a Basic Plan. You may choose any one or all of the riders to design a Medigap policy that meets your needs.

  • Medicare Part A: Inpatient Hospital Deductible
  • Medicare Part B: Deductible
  • Usual and Customary Fees
  • Non-Medicare Preventive Care

 

Wisconsin Medicare Supplement Insurance Plans:

All Medigap policies offered by traditional insurance companies provide the following benefits:

Basic Benefits

  • Co-payment for 61st to 90th day of hospitalization ($283 a day)
  • Co-payment for 91st to 150th day of hospitalization ($566 a day) - full coverage after Medicare days are exhausted
  • Co-payment for 21st to 100th day of skilled nursing care in a skilled nursing facility ($144.50 a day)
  • 175 days per lifetime of inpatient psychiatric care in addition to Medicare’s 190 days per lifetime
  • First 3 pints of blood
  • 40 home health care visits in addition to Medicare
  • 20% of Medicare’s Part B services with no lifetime maximum or, in case of hospital outpatient department services under a prospective payment system, applicable co-payments
  • Coverage for full usual and customary cost of non-Medicare covered chiropractic care, non-Medicare hospital and ambulatory surgery center charges and anesthetics for dental care and non-Medicare breast reconstruction
  • Coverage for 30 days non-Medicare skilled nursing facility care - no prior hospitalization required, but must meet medical necessity requirements

Note: Policies may also include preventive health care services, such as routine physical examinations, immunizations, health screenings, and private duty nursing services.

 

Optional Benefits

Insurance companies may offer the following optional benefits as a separate benefit for an additional premium.

  • Part A deductible ($1,156)
  • Additional home health care (up to 365 visits per year)
  • Part B deductible ($140)
  • Part B excess charges up to the actual charge or the limiting charge, whichever is less
  • Foreign Travel Emergency: May have a deductible of up to $250. Must pay at least 80% of billed charges for Medicare-eligible expenses for medically necessary emergency care received outside the U.S. Emergency care must begin during the first 60 days of a trip outside the U.S. Benefit limit must be at least $50,000 per lifetime.
  • Effective June 1, 2010, Medicare 50% Part A deductible
  • Effective June 1, 2010, Part B co-payment or coinsurance rider

 

Cost-Sharing 50% AND 25% Plans

All Medigap Cost-Sharing policies offered by traditional insurance companies provide the following benefits:

Basic Benefits

  • Co-payment for 61st to 90th day of hospitalization ($289 a day)
  • Co-payment for 91st to 150th day of hospitalization ($578 a day) - full coverage after Medicare days are exhausted
  • Co-payment for 21st to 100th day of skilled nursing care in a skilled nursing facility ($144.50 a day) (50% or 75%)
  • 175 days per lifetime of inpatient psychiatric care in addition to Medicare’s 190 days per lifetime
  • First 3 pints of blood (50% or 75%)
  • 40 home health care visits in addition to Medicare
  • 20% of Medicare’s Part B services with no lifetime maximum or, in case of hospital outpatient department services under a prospective payment system, applicable co-payments
  • Coverage for full usual and customary cost of non-Medicare covered chiropractic care, non-Medicare hospital and ambulatory surgery center charges and anesthetics for dental care, and non-Medicare breast reconstruction
  • Coverage for 30 days non-Medicare skilled nursing facility care - no prior hospitalization required, but must meet medical necessity requirements

Note: Policies may also include preventive health care services, such as routine physical examinations, immunizations, health screenings, and private duty nursing services

Optional Benefits

Insurance companies may offer the following optional benefits as a separate benefit for an additional premium.

  • Part A deductible ($1,156) (50% or 75%)
  • Additional home health care (up to 365 visits per year)
  • Part B deductible ($140) (50% or 75%)
  • Part B excess charges up to the actual charge or the limiting charge, whichever is less
  • Foreign Travel Emergency: May have a deductible of up to $250. Must pay at least
    80% of billed charges for Medicare-eligible expenses for medically necessary
    emergency care received outside the U.S. Emergency care must begin during the first
    60 days of a trip outside the U.S. Benefit limit must be at least $50,000 per lifetime.

 

Medicare Select

All Medicare Select policies provide the following benefits:

  • Part A deductible ($1,156)
  • Co-payment for 61st to 90th day of hospitalization ($289 a day)
  • Co-payment for 91st to 150th day of hospitalization ($578 a day) - full coverage after Medicare days are exhausted
  • Co-payment for 21st to 100th day of skilled nursing care in a skilled nursing facility ($144.50 a day)
  • 175 days per lifetime of inpatient psychiatric care in addition to Medicare’s 190 days per lifetime
  • First 3 pints of blood
  • Part B deductible ($140)
  • 20% of Medicare’s Part B services with no lifetime maximum and actual charges for authorized referral services
  • 365 home health care visits including those paid by Medicare
  • Foreign Travel Emergency: May have a deductible of up to $250. Must pay at least 80% of billed charges for Medicare-eligible expenses for medically necessary emergency care received outside the U.S. Emergency care must begin during the first 60 days of a trip outside the U.S. Benefit limit must be at least $50,000 per lifetime.
  • Coverage for full usual and customary cost of non-Medicare covered chiropractic care, non-Medicare hospital and ambulatory surgery center charges and anesthetics for dental care, and non-Medicare breast reconstruction
  • Coverage for 30 days non-Medicare skilled nursing facility care - no prior hospitalization required, but must meet medical necessity requirements
  • Effective June 1, 2010, Medicare 50% Part A deductible

 

Medicare Select Cost-Sharing 50% and 25%

All Medicare Select Cost-Sharing policies provide the following benefits:

  • Part A deductible ($1,156) (50% or 75%)
  • Co-payment for 61st to 90th day of hospitalization ($289 a day)
  • Co-payment for 91st to 150th day of hospitalization ($578 a day) - full coverage after Medicare days are exhausted
  • Co-payment for 21st to 100th day of skilled nursing care in a skilled nursing facility ($144.50 a day) (50% or 75%)
  • 175 days per lifetime of inpatient psychiatric care in addition to Medicare’s 190 days per lifetime
  • First 3 pints of blood (50% or 75%)
  • Part B deductible ($140) (50% or 75%)
  • 20% of Medicare’s Part B services with no lifetime maximum and actual charges for authorized referral services
  • 365 home health care visits including those paid by Medicare
  • Foreign Travel Emergency: May have a deductible of up to $250. Must pay at least 80% of billed charges for Medicare-eligible expenses for medically necessary emergency care received outside the U.S. Emergency care must begin during the first 60 days of a trip outside the U.S. Benefit limit must be at least $50,000 per lifetime.
  • Coverage for full usual and customary cost of non-Medicare covered chiropractic care, non-Medicare hospital and ambulatory surgery center charges and anesthetics for dental care, and non-Medicare breast reconstruction
  • Coverage for 30 days non-Medicare skilled nursing facility care - no prior hospitalization required, but must meet medical necessity requirements

 

Cost Insurance - Basic and Enhanced

Basic Plan

  • Co-payment for 61st to 90th day of hospitalization ($289 a day)
  • Co-payment for 91st to 150th day of hospitalization ($578 a day) - full coverage after Medicare days are exhausted
  • Co-payment for 21st to 100th day of skilled nursing care in a skilled nursing facility ($144.50 a day)
  • First 3 pints of blood
  • 40 home health care visits in addition to Medicare
  • 20% of Medicare’s Part B services with no lifetime maximum or, in case of hospital outpatient department services under a prospective payment system, applicable co-payments

Note: Policies may also include preventive health care services, such as routine physical examinations, immunizations, health screenings, and private duty nursing services.

Enhanced Plan

Insurance companies may offer additional benefits for an additional premium:

  • Part A deductible ($1,156)
  • Additional home health care (up to 365 visits per year)
  • Part B deductible ($140)
  • Part B excess charges up to the actual charge or the limiting charge, whichever is less
  • 175 days per lifetime of inpatient psychiatric care in addition to Medicare’s 190 days per lifetime
  • Foreign Travel Emergency: May have a deductible of up to $250. Must pay at least 80% of billed charges for Medicare-eligible expenses for medically necessary emergency care received outside the U.S. Emergency care must begin during the first 60 days of a trip outside the U.S. Benefit limit must be at least $50,000 per lifetime.
  • Coverage for full usual and customary cost of non-Medicare covered chiropractic care, non-Medicare hospital and ambulatory surgery center charges and anesthetics for dental care, and non-Medicare breast reconstruction
  • Coverage for 30 days non-Medicare skilled nursing facility care - no prior hospitalization required, but must meet medical necessity requirements

High-Deductible Plan

Effective June 1, 2010, a high-deductible Medicare supplement plan will be available. This high-deductible plan offers benefits after you have paid a calendar year deductible of $2,070. This deductible consists of expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B but does not include the separate foreign
travel emergency deductible of $250.

Benefits

  • Part A deductible included
  • Co-payment for 61st to 90th day of hospitalization ($289 a day)
  • Co-payment for 91st to 150th day of hospitalization ($578 a day) - full coverage after Medicare days are exhausted
  • Co-payment for 21st to 100th day of skilled nursing care in a skilled nursing facility ($144.50 a day)
  • 175 days per lifetime of inpatient psychiatric care in addition to Medicare’s 190 days per lifetime
  • First 3 pints of blood
  • Part B deductible included
  • Part B excess charges up to the actual charge or the limiting charge, whichever is less, included
  • 20% of Medicare’s Part B services with no lifetime maximum and actual charges for authorized referral services
  • 365 home health care visits including those paid by Medicare
  • Foreign Travel Emergency: May have a deductible of up to $250. Must pay at least 80% of billed charges for Medicare-eligible expenses for medically necessary emergency care received outside the U.S. Emergency care must begin during the first 60 days of a trip outside the U.S. Benefit limit must be at least $50,000 per lifetime.
  • Coverage for full usual and customary cost of non-Medicare covered chiropractic care, non-Medicare hospital and ambulatory surgery center charges and anesthetics for dental care, and non-Medicare breast reconstruction
  • Coverage for 30 days non-Medicare skilled nursing facility care - no prior hospitalization required, but must meet medical necessity requirements

 

The Facts

The Insurers

Medicare Supplement Insurers
 

The States

Click on your state to view the insurance companies we're contracted with in your area.

Medicare Supplement Plans by State
Alabama Delaware Indiana Massachusetts Nevada Oklahoma Texas
Alaska D.C. Iowa Michigan New Hampshire Oregon Utah
Arizona Florida Kansas Minnesota New Jersey Pennsylvania Vermont
Arkansas Georgia Kentucky Mississippi New York Rhode Island Virginia
California Hawaii Louisiana Missouri North Carolina South Carolina Washington
Colorado Idaho Maine Montana North Dakota South Dakota Wisconsin
Connecticut Illinois Maryland Nebraska Ohio Tennessee Wyoming

 

 

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