3.2 Wisconsin Medicare Supplement Regulations

Wisconsin's Unique Medigap System

Medicare Supplement Insurance (Medigap) pays the gaps Original Medicare leaves — deductibles, coinsurance, and copayments. Most states use the federally standardized lettered plans (A through N). Wisconsin does NOT. Under a federal waiver, Wisconsin is one of only three states — along with Massachusetts and Minnesota — that designs its own Medigap policies. This is the single most-tested fact in the section: if an answer choice says Wisconsin uses Plans A–N, it is wrong.

How Wisconsin coverage is built

Wisconsin starts from a single mandated Basic Plan and lets the consumer add optional riders à la carte, plus choose cost-sharing or high-deductible versions to lower the premium.

Exam tip: The older study materials say "$2,700" — the High Deductible amount is indexed annually and is $2,950 in 2026. Use the current figure.

Building "Plan G"-equivalent coverage

Because the Basic Plan alone resembles Plan A, a Wisconsin buyer recreates richer federal plans by stacking riders. Adding the Part A deductible, Part B excess charges, additional home health care, and foreign travel emergency riders to the Basic Plan produces coverage roughly equal to federal Plan G. Expect a scenario asking which riders convert the Basic Plan into broader protection.

The 6-Month Open Enrollment Period

Wisconsin gives every new Medicare beneficiary a 6-month Medigap open enrollment period with the strongest possible consumer protections. The clock starts on the first day of the month in which the person is both (1) age 65 or older AND (2) enrolled in Medicare Part B. Both conditions must be met; missing either delays the start.

Protections during open enrollment

• Guaranteed issue — the insurer must accept the applicant regardless of health.
• No pre-existing condition exclusions may be imposed.
• No health-based rate-up — the insured cannot be charged more because of medical history.
• Free choice — any Wisconsin Medigap policy or rider combination is available.

Worked example: Maria turns 65 on March 12, 2026 and her Part B coverage begins March 1, 2026. Her 6-month open enrollment runs March 1 through August 31, 2026. If she applies September 5, she has missed the window and an insurer may use medical underwriting unless a separate guaranteed-issue right (such as loss of employer coverage) applies.

Mandated Basic Plan Benefits

The Basic Plan must cover, at minimum, the following — these are the core, non-optional benefits:

• Part A hospital coinsurance for days 61–150
• Part B coinsurance or copayment
• The first 3 pints of blood each year
• Part A hospice cost sharing
• Skilled nursing facility coinsurance (days 21–100)
• Inpatient mental health coverage beyond Medicare's limits
• Certain home health care services

Common traps

Replacement of an existing Medigap policy triggers OCI replacement disclosure rules and a new free-look period, so producers must document the comparison and the reason for replacing.

Guaranteed-Issue Rights Outside Open Enrollment

The 6-month window at 65 is not the only guaranteed-issue right. Federal guaranteed-issue (GI) protections also apply, and Wisconsin honors them, when a beneficiary loses other coverage through no fault of their own. Common triggers:

• A Medicare Advantage plan leaves the service area or the beneficiary moves out of it.
• Employer or union retiree coverage ends.
• A Medigap insurer becomes insolvent or the policy is terminated through no fault of the insured.
• The beneficiary tries Medicare Advantage for the first time and disenrolls within 12 months (the "trial right").

During a GI period the same protections apply — no underwriting, no pre-existing exclusion, and no health-based rate-up — though the choice of plans may be narrower than during the initial 6-month window.

Outline of Coverage and Free Look

Wisconsin Medigap rules require an insurer to deliver a standardized Outline of Coverage at the time of application so the buyer can compare the Basic Plan and rider options side by side. Every Medigap policy carries a 30-day free-look period, longer than the 10-day free look on ordinary individual accident-and-sickness policies; if the buyer returns the policy within 30 days, all premium is refunded. Producers must also avoid selling a beneficiary a duplicate Medigap policy, which is prohibited, and must use the OCI replacement notice when switching an existing supplement.