Standardized Medicare Supplement Plans for Wisconsin

​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.​

Optional Riders: Insurance companies are permitted to offer six additional riders that can be added to a Basic plan. You may choose any one of all of the riders to design a Medicare Supplement plan that meets your needs.

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