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  Frequently Asked Questions

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Medigap

What's the difference between a Medigap/Medicare Supplement and an Advantage Plan (Part C)?

Original Medicare has out of pocket expenses: deductibles, co-payments and co-insurance amounts.

A Medicare Supplement policy is paying those Medicare out of pocket expenses.  Changing to a Medicare Advantage plan will change how you receive your Medicare benefits and services.  You will still have Medicare out of pocket expenses: deductibles, co-payments and co-insurance amounts.  You must pay these expenses yourself.

The Medicare Supplement policy is governed by the State of Wisconsin.  There are consumer protections in place and enforced by the Office of the Commissioner of Insurance.  The plans are guaranteed renewable which means as long as you pay the premium the policy will stay in force and the company cannot terminate the insurance.  Your premium will increase and the benefits will keep up with Medicare out of pocket expenses.  If it is a traditional medicare supplement, it will allow you to see any doctor that accepts Medicare and it follows you if you move out of state or are a "snowbird".  It allows the most feedon and flexiblity.  You can move at any time to another medicare supplement however, you WILL be subject to udnerwriting (health questions asked).  If you successfully  move from one medicare supplement to another you cannot be asked to serve a pre-existing condition waiting period.

With an Advantage plan (Part C), this becomes your Medicare plan.  It may have low or no premium but there are copays for most services.  The cost sharing amount and the benefit structure can chagne from year to year.  The Advantage plan is not guaranteed renewable.  The plan can leave your area or the company can choose to close the plan entirely.  There are some consumer protections in place if this happens.  Advantage plans are governed by the federal government.  The state has no jurisdiction.

You can apply for an Advantage Plan during the Annual Election Period which begins October 15th and ends December 5th of each year.  Anyone can qualify as long as you are not on active dialysis.


 

 

 

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Board on Aging & Long Term Care
1402 Pankratz Street, Suite 111
Madison, Wisconsin  53704-4001
FAX:  608 246 7001
BOALTC@Wisconsin.Gov