Wisconsin Medicare insurance is a federally funded program that offers health care coverage to seniors over 65 as well as to workers with specific disabilities. In Wisconsin, the state government also has programs that provide financial and educational assistance to its Medicare beneficiaries.
Beneficiaries start their Medicare coverage with Original Medicare. This is composed of Medicare Part A, and Part B. Part A is hospital insurance, covering services such as inpatient hospital care. Part B is medical insurance, which helps cover the costs of outpatient treatments and medical supplies.
Medicare is quite affordable, in comparison to Wisconsin’s average health insurance premium of $525 a month. Part A typically does not require premium payments, while beneficiaries who earn less than $85,000 a year only pay Part B premiums of $134 a month. Part A and Part B do require beneficiaries to cover the costs of deductibles, copays, and coinsurance.
Many Medicare beneficiaries may feel that Original Medicare coverage is lacking, and to compensate for these gaps they may purchase “Medigap” supplemental plans from Medicare-approved private health insurance carriers. These supplemental plans will require an additional premium in addition to the premiums of original Medicare.
These supplemental plans often offer coverage for Medicare prescription medication; this particular coverage is known as Medicare Part D. Some plans can also cover various healthcare services that Original Medicare doesn’t cover. Other plans may help pay for the costs of deductibles, copays, and coinsurance involved with Original Medicare.
Medicare beneficiaries can instead opt to obtain a Medicare Advantage Plan that combines the coverage of Original Medicare with the benefits that may be obtained from supplemental plans. These plans can, therefore, contain Part A, Part B, and Part D coverage, as well as coverage of more healthcare services not covered by Original Medicare.
Beneficiaries can purchase these Advantage Plans from Medicare-approved carriers. Each Advantage plan is different, with various sets of extra coverage and varying prices.
Wisconsin has a poverty rate of 13.2%, and many Medicare beneficiaries here cannot afford the costs of Medicare on their own. To provide financial assistance, Wisconsin offers Medicare Savings Programs (MSPs) that can pay for part of Medicare expenses.
The most generous of the MSPs is the program for Qualified Medicare Beneficiaries (QMB). This program pays for the premiums of Part A and Part B, as well as the various deductibles, copays, and coinsurance costs. An individual can qualify for this program, with a monthly income of less than $1,032. Married couples have a combined income limit of $1,392 per month.
The program for Specified Low-Income Medicare Beneficiaries (SLMB) pays only for the Part B premium. This is for an individual who earns less than $1,234 a month while married couples can qualify with a combined income of $1,666 a month.
The SLMB Plus program also pays just for the Part B premium, but the funding is more limited for this program. In addition, beneficiaries for SLMB Plus may not receive benefits from Wisconsin Medicaid. The income limit is $1,386 per month for individuals and $1,872 for married couples.
These programs also have an asset limit, which does not count the value of the home and car of the beneficiary. The asset limit is $7,560 for individuals and $11,340 for married couples.
Qualifying for any of these MSPs also qualifies the beneficiary for the Low-Income Subsidy (LIS or “Extra Help”). This LIS pays for Medicare Part D expenses.
Another MSP is for Qualified Disabled and Working Individuals, and this program pays for just the premiums for Part A. To qualify, an individual must have an income of less than $4,132 and assets worth less than $4,000. Married couples have limits of $5,572 for income and $6,000 for assets.
Many Medicare beneficiaries have questions regarding health insurance matters, and the Wisconsin Board on Aging and Long Term Care has a Medigap Hotline to answer questions at no extra cost. Medicare beneficiaries can ask questions and seek guidance by calling the Medigap Hotline at 800-242-1060. The hotline offers unbiased advice, as it is not associated with any private health insurance carrier.
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