Medicare Resources · Wisconsin
Wisconsin Medicare Supplement: Basic Plan & Riders Explained (2026)
TL;DR — Key takeaways
- Wisconsin does not use the national Plan A–N Medicare Supplement letter system
- Wisconsin uses a Basic Plan + optional riders system standardized by the Wisconsin Office of the Commissioner of Insurance (OCI)
- Basic Plan + Part A Deductible Rider + Part B Excess Charges Rider = functionally equivalent to national Plan G
- Your Medigap Open Enrollment Period (6 months from Part B effective date) is your guaranteed-acceptance window — timing matters
- Premiums for identical rider combinations vary up to 50% between carriers — always compare
- Minnesota (Winona clients) also has its own system — not the national letter plans
Why Wisconsin Medicare Supplement is different from other states
If you live in Wisconsin and search for "Medicare Supplement Plan G" or "Plan N," you'll find a flood of information that doesn't apply to you. The nationally-standardized Medicare Supplement letter plans (Plan A through Plan N) are used in 47 states. Wisconsin is not one of them.
Wisconsin, Massachusetts, and Minnesota have each been granted authority to create their own Medicare Supplement standardization systems under federal law. Wisconsin's system is administered by the Wisconsin Office of the Commissioner of Insurance (OCI) and has been in place since before the federal standardization was established nationally in 1992.
The practical implication: if a national call center, an out-of-state website, or an agent unfamiliar with Wisconsin tries to sell you "Plan G," they're either using that as shorthand for the Wisconsin equivalent — or they genuinely don't know Wisconsin's rules. Either way, you need to understand the correct Wisconsin framework before you buy.
What Wisconsin's system looks like
Instead of choosing from pre-packaged letter plans, Wisconsin residents build their Medigap coverage in two layers:
- The Basic Plan — mandatory in every Wisconsin Medicare Supplement policy. Every carrier in Wisconsin must offer this as the coverage foundation. You cannot buy a Wisconsin Medigap policy without it.
- Optional riders — additional benefits you can add to the Basic Plan for an extra premium. Each rider covers a specific gap that the Basic Plan doesn't address.
This system gives Wisconsin residents more flexibility to tailor coverage. But it also means more decisions — which riders to add, from which carrier, at what price. That's exactly where a Wisconsin-licensed local advisor adds value.
The Wisconsin Basic Plan — your mandatory foundation
Every Wisconsin Medicare Supplement policy must include the Basic Plan. This is the floor — it covers the most fundamental Original Medicare gaps that apply to nearly every Medicare beneficiary.
What the Basic Plan covers
Medicare Part B coinsurance
Original Medicare pays 80% of Medicare-approved costs for doctors, specialists, outpatient services, and procedures. The Basic Plan covers the remaining 20% coinsurance. For most people, this is the highest-frequency coverage — used on every doctor visit and procedure throughout the year.
Part A hospital coinsurance (days 61–150)
Medicare stops covering 100% of hospital costs after day 60. Days 61–90 have a daily coinsurance of $434 per day (2026). Lifetime reserve days 91–150 cost $868 per day (2026). The Basic Plan covers these amounts.
365 additional lifetime hospital days
After Medicare's hospital benefits are completely exhausted (including lifetime reserve days), the Basic Plan covers 365 additional hospital days for life at Medicare-allowed amounts. This protects against catastrophic, extended hospitalizations.
First 3 pints of blood per year
Original Medicare requires you to pay for the first 3 pints of blood used in a covered procedure each year. The Basic Plan covers this blood deductible.
Hospice care coinsurance
Medicare Part A hospice care includes some coinsurance and copayments for drugs and inpatient respite care. The Basic Plan covers these hospice cost-sharing amounts.
Wisconsin optional riders — what each one covers
Riders are add-ons to the Basic Plan. Each rider has its own premium, and you choose which ones to include. Here is every available Wisconsin Medigap rider as of 2026:
Part A Deductible Rider Most popular
Covers the Medicare Part A inpatient hospital deductible — $1,736 per benefit period in 2026 (updated annually by CMS). This deductible applies every time you start a new benefit period, which can happen multiple times in the same year if you're hospitalized more than once.
Who needs it: Almost everyone. A single hospital stay without this rider costs $1,736 out of pocket before Medicare begins paying. The rider typically adds only $20–$50/month to your premium — far less than a single deductible hit.
50% Part A Deductible Rider
Covers half of the Part A hospital deductible ($868 in 2026) instead of the full amount. Some carriers offer this as a lower-cost alternative to the full Part A Deductible Rider.
Who uses it: People seeking a middle ground between the full deductible exposure and the higher premium of the complete rider. Less common than the full rider.
Part B Excess Charges Rider Recommended
Covers the extra amount — up to 15% above Medicare's approved rate — that providers who don't accept Medicare assignment can charge. This is called an "excess charge." Without this rider, you owe that 15% on every visit to a non-participating provider.
Who needs it: People who see specialists at independent practices, who travel and may use providers outside their area, or who want the highest level of protection. The major health systems in the La Crosse area (Gundersen, Mayo Clinic Health System) generally accept Medicare assignment — but not all independent specialists do.
Note: Adding this rider, combined with the Part A Deductible Rider, brings your Wisconsin coverage to a functional equivalent of national Plan G.
Part B Deductible Rider
Covers the annual Medicare Part B deductible — $283 per year in 2026. This rider was eliminated for new national Medigap enrollees after January 1, 2020 (federal legislation removed Plan C and Plan F from new sales), but Wisconsin has maintained it as an available rider under its own standardization.
Who uses it: People who want to cover every possible Medicare cost-sharing amount. However, the small Part B deductible ($283/year) often costs more to insure via the rider premium than to simply pay out of pocket. We run the math for you.
Foreign Travel Emergency Rider
Covers emergency medical care received outside the United States. After a $250 deductible, the rider pays 80% of covered foreign emergency expenses up to the plan's lifetime maximum (typically $50,000). Coverage begins during the first 60 days of a trip.
Who needs it: People who travel internationally — winter trips to Mexico or Central America, cruises, European travel. Original Medicare does not cover care outside the U.S. (with very limited exceptions).
Home Health Care Rider (365 additional days)
Extends coverage for Medicare-approved skilled nursing care and home health care beyond what Original Medicare covers. Medicare's home health benefit has limitations; this rider provides an additional 365 days of coverage.
Who uses it: People with chronic conditions requiring ongoing home health care, or those with family history of post-surgical or post-hospital recovery care needs.
Preventive Care Rider
Covers certain preventive care services that Medicare doesn't otherwise cover — primarily services recommended by the U.S. Preventive Services Task Force but not yet covered by Medicare.
Short-Term At-Home Nursing Care Rider
Covers the cost of skilled nursing care received at home instead of in a skilled nursing facility. Provides an alternative to institutional care for people recovering from surgery or illness.
Building your coverage: the most common Wisconsin rider combinations
While you can mix and match riders, most Wisconsin Medicare Supplement buyers choose one of four standard combinations. Here's how each compares to the national letter plan framework you may have seen advertised:
| Coverage level | Wisconsin combination | National equivalent | What you still pay | Approx. monthly premium (age 65) |
|---|---|---|---|---|
| Most comprehensive (new) | Basic + Part A Deductible + Part B Excess Charges | ≈ Plan G | Part B deductible ($257/yr) only | $80–$180 |
| Budget-friendly | Basic + Part A Deductible (no excess rider) | ≈ Plan N | Part B deductible + possible excess charges | $60–$140 |
| Grandfathered maximum | Basic + Part A Ded. + Part B Ded. + Part B Excess | ≈ Plan F | Near $0 (available to pre-2020 enrollees) | $100–$220 |
| Minimum coverage | Basic Plan only | ≈ Plan A | Part A deductible + all excess charges | $40–$90 |
Premium ranges are estimates for La Crosse County, WI as of 2025. Actual premiums vary by carrier, age, and gender. Source: Wisconsin Medigap carrier rate filings. We provide exact current quotes at no charge.
Which combination is most common in the La Crosse area?
The Basic Plan + Part A Deductible + Part B Excess Charges combination (Plan G equivalent) is the most commonly chosen combination for new Wisconsin Medicare Supplement enrollees. It provides near-complete Original Medicare gap coverage, with only the Part B deductible ($257/year) remaining as your out-of-pocket exposure.
For people with tight budgets, the Basic Plan + Part A Deductible only (Plan N equivalent) is also popular. You save on premiums but retain some exposure to Part B excess charges and the Part B deductible. For most La Crosse area residents seeing Gundersen or Mayo Clinic Health System providers who accept assignment, excess charges are rarely triggered.
What Wisconsin Medicare Supplement costs in the La Crosse area (2025)
Premium pricing for Wisconsin Medicare Supplement policies is community-rated or age-rated depending on the carrier — but unlike some states, Wisconsin insurers cannot refuse to issue a policy or charge higher rates based on your health history during your Open Enrollment Period (more on that below).
Typical premium ranges for a 65-year-old in La Crosse County
- Basic Plan + Part A Deductible + Part B Excess Charges: $80–$180/month. The spread reflects different carrier pricing for identical coverage.
- Basic Plan + Part A Deductible only: $60–$140/month.
- Adding the Part B Deductible Rider: typically adds $10–$25/month.
- Adding the Foreign Travel Emergency Rider: typically adds $5–$15/month.
Beyond the premium: Part D adds to your total cost
Wisconsin Medicare Supplement policies don't include drug coverage. You'll add a standalone Medicare Part D plan for prescriptions — typically $15–$60/month for standard coverage in La Crosse County, depending on your medications. The right Part D plan depends on your specific drug list and formulary matching; we run your prescriptions against every available plan before you enroll.
How Wisconsin Medigap compares to Medicare Advantage total cost
The apparent premium difference between Medigap ($80–$180/month) and Medicare Advantage ($0–$50/month) can be misleading. Medicare Advantage plans have copays and cost-sharing on every service — a plan that charges $0 premium but $250/night for hospital stays can easily cost more over a year than a Medigap policy that covers most of those costs automatically.
We model your expected total annual cost under both paths — based on your actual health usage — before recommending either one.
Wisconsin Medigap vs. Medicare Advantage: which is right for you?
This is the most consequential decision most people make when turning 65. Here's the honest comparison:
Wisconsin Medicare Supplement (Medigap)
Best for: People who heavily use healthcare, travel frequently, want provider freedom, or have conditions requiring specialist care
- No provider networks — see any Medicare provider in the U.S.
- No referrals needed for specialists at Gundersen, Mayo, or anywhere
- Predictable costs — with the right riders, near-zero out-of-pocket for most services
- Coverage works the same in Wisconsin, Minnesota, Florida, or any other state
- Once enrolled, can only be canceled by you (not the insurer)
- Higher monthly premium ($80–$180+ depending on riders)
- No drug coverage — must add Part D separately
- No extra benefits like dental, vision, or gym membership
Medicare Advantage (Part C)
Best for: Relatively healthy people who stay local, want extra benefits, and are comfortable with a managed care network
- Lower or $0 monthly premium beyond Part B
- Often bundles drug, dental, vision, hearing, and OTC benefits
- Annual out-of-pocket maximum caps yearly exposure
- Some plans include fitness benefits (SilverSneakers, etc.)
- Must use in-network providers — must verify Gundersen and Mayo are covered
- Copays apply at every service point — costs add up with frequent use
- Plan and network can change annually
- Switching back to Medigap later may require underwriting
The specific question for La Crosse area residents: Gundersen vs. Mayo in your plan
Western Wisconsin residents often use both Gundersen Health System and Mayo Clinic Health System. Not all Medicare Advantage plans include both in-network. Before enrolling in any Advantage plan, we verify that your specific providers — your primary care doctor, your cardiologist, your orthopedist — are in-network. With Wisconsin Medigap, this is never an issue: both systems accept Medicare, and you have access to both without restriction.
When to buy: the Wisconsin Medigap Open Enrollment Period
Timing your Medigap purchase correctly is the single most important decision in this process. Miss the window, and you may face underwriting.
Your guaranteed-acceptance window
Federal law gives you a 6-month Medigap Open Enrollment Period that begins on the first day of the month you are both age 65 or older and enrolled in Medicare Part B. During this window:
- Wisconsin carriers must sell you a policy regardless of your health history
- Carriers cannot charge higher premiums based on pre-existing conditions
- Carriers cannot impose waiting periods for pre-existing conditions (with limited exceptions)
This window closes exactly 6 months after your Part B effective date. After it closes, you typically need to go through health underwriting — and carriers may decline coverage or charge more.
What happens if you miss the Open Enrollment Period?
After the 6-month window, Wisconsin carriers can:
- Charge higher premiums based on your health conditions
- Apply pre-existing condition waiting periods
- Decline your application entirely
There are some federal guaranteed-issue situations (moving out of a plan's service area, losing employer coverage, plan insolvency) that can reopen your guaranteed-acceptance rights — but these are specific situations, not general opportunities. Don't count on them.
Working past 65 with employer coverage
If you are still working at 65 with active employer-sponsored health coverage, you may delay Part B enrollment penalty-free while your employer coverage is active. When employer coverage ends, you get a Special Enrollment Period for Part B — and your 6-month Medigap Open Enrollment Period begins at that point. We track this sequence carefully for clients who are still working at 65, because the rules differ based on whether your employer has 20 or more employees.
Minnesota Medigap: what Winona-area clients need to know
Our Winona, Minnesota office serves clients who fall under Minnesota's own standardized Medicare Supplement system — which is different from Wisconsin and from the national letter plans.
Minnesota's Medigap structure
Minnesota offers:
- Basic Plan — mandatory foundation (similar coverage philosophy to Wisconsin's Basic Plan)
- Extended Basic Plan — broader coverage with additional benefits built in
- Optional riders that can be added to either plan: Part A deductible, foreign travel emergency, nursing facility coverage, and others
Like Wisconsin, Minnesota residents cannot simply purchase a national "Plan G" from a carrier — they must purchase under Minnesota's standardized framework. An advisor who doesn't know Minnesota's rules may try to sell you a product designed for the other 47 states.
Cross-border considerations
Many Winona clients access care at facilities in both Minnesota and Wisconsin — including Mayo Clinic Health System facilities in Winona and La Crosse. Both Wisconsin Medigap and Minnesota Medigap provide nationwide coverage (any Medicare provider anywhere in the U.S.), so cross-border care is not an issue with either state's supplement plan. The difference is in the benefit structure, rider options, and carrier availability by state.
We are licensed in both states and compare your options correctly based on where you live and which state's rules apply to your coverage.
Frequently asked questions
Does Wisconsin have Plan G or Plan N Medicare Supplement?
No. Wisconsin is one of three states that does not use the federal A–N Medigap letter system. Instead, Wisconsin has a state-standardized Basic Plan with optional riders. A Basic Plan + Part A Deductible + Part B Excess Charges Rider provides functionally equivalent coverage to national Plan G. We use Wisconsin-correct terminology and identify the right rider combination for your situation.
What does the Wisconsin Basic Plan cover?
The Basic Plan is the mandatory foundation of every Wisconsin Medicare Supplement policy. It covers: Medicare Part B 20% coinsurance, Part A hospital coinsurance for days 61–150, 365 additional lifetime hospital days after Medicare benefits are exhausted, the first 3 pints of blood per year, and hospice care coinsurance/copayments.
What is the Wisconsin Part A Deductible Rider?
The Part A Deductible Rider covers the Medicare Part A hospital deductible — $1,736 per benefit period in 2026. Without this rider, you owe the full deductible out of pocket before Medicare begins paying for an inpatient hospital stay. Most Wisconsin Medicare Supplement buyers add this rider because a single hospital stay can trigger the full deductible.
What is the Part B Excess Charges Rider?
Certain providers who don't accept Medicare assignment can charge up to 15% above Medicare's approved amount — called excess charges. The Part B Excess Charges Rider covers that extra amount. Without it, you'd pay that 15% yourself on every visit to a non-participating provider. Most providers at Gundersen and Mayo Clinic Health System accept assignment, but independent specialists may not.
Can I switch to a Wisconsin Medicare Supplement after enrolling in Medicare Advantage?
Possibly — but it's not guaranteed. You have a 6-month Medigap Open Enrollment Period when you first enroll in Part B at age 65, during which Wisconsin carriers must accept you regardless of health history. After that period expires, switching typically requires health underwriting and carriers can decline coverage or charge higher premiums based on your health. This is why starting in the right plan matters.
How much does a Wisconsin Medicare Supplement cost in the La Crosse area?
For a 65-year-old in La Crosse County, a Basic Plan + Part A Deductible + Part B Excess Charges combination typically runs $80–$180 per month depending on the carrier. Premiums for identical rider combinations can vary by 30–50% between carriers — comparison shopping is essential. We compare every carrier in your county at no cost.
Does Wisconsin Medigap cover prescriptions?
No. Wisconsin Medicare Supplement plans do not include drug coverage. You add a standalone Medicare Part D plan alongside your Medigap policy to cover prescriptions. We set both up together so your coverage is complete from the first day.
What about Winona, MN — does Minnesota have the same system?
Minnesota also has its own state-standardized Medigap system — different from Wisconsin and from the federal letter plans. Minnesota offers a Basic Plan and Extended Basic Plan plus optional riders. We are licensed in both Wisconsin and Minnesota and compare each state's options correctly based on where you live.
How do I know which Wisconsin Medigap rider combination is right for me?
The right combination depends on your health conditions, how often you use specialist care, whether your providers accept Medicare assignment, and your budget. People with chronic conditions who frequently see specialists often benefit most from the Part B Excess Charges Rider. Those with high hospital risk prioritize the Part A Deductible Rider. We review your situation and recommend the right combination — at no cost.
Is a Wisconsin Medicare Supplement plan better than Medicare Advantage?
It depends on your situation. Medigap gives you no provider networks and lower out-of-pocket costs when you use care heavily — better for people with chronic conditions or who travel. Medicare Advantage typically has lower monthly premiums and often includes dental, vision, and drug coverage — better for relatively healthy people who stay local. We model both paths before recommending either.
Sources
- Centers for Medicare & Medicaid Services (CMS). Medicare Costs at a Glance, 2025. cms.gov
- Centers for Medicare & Medicaid Services (CMS). Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. Medicare.gov
- Wisconsin Office of the Commissioner of Insurance (OCI). Medicare Supplement Insurance Guide (Wisconsin). oci.wi.gov
- Social Security Administration. Medicare — Enrolling in Part B. ssa.gov
- KFF (Kaiser Family Foundation). Medicare Supplement (Medigap) Insurance: A Primer, 2024. kff.org
Compliance disclosures: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. Not affiliated with or endorsed by the U.S. government or the federal Medicare program. This article is for general information only and is not medical, insurance, tax, or legal advice. Eligibility, costs, plan availability, and Wisconsin Medigap rules may change; confirm current details at oci.wi.gov or Medicare.gov. Consult a licensed agent. Hougom Insurance Agency is a licensed independent insurance agency (NPN 20742808). Plan year 2025 figures used throughout.
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