Medigap Plans are standardized differently in Massachusetts, Minnesota, and Wisconsin

If you live in Massachusetts, Minnesota, or Wisconsin, Medigap policies are standardized in a unique way.

Medigap in Massachusetts

If you live in Massachusetts, Medigap is guaranteed issue (meaning an insurer can’t deny you for any reason other than non-payment), and instead of having letter plans A – N you have two main choices, one of which can have riders added to it, and then .

  1. Medigap Core, which just covers the essentials but can have riders added to it (see below).
  2. Medigap Supplement 1 Plan, which covers extras like the Part A and Part B deductible.

You can compare the Medigap Core and Medigap Supplement 1 plans side-by-side below.

If a “yes” appears, the plan covers the described benefit 100%. If “no” appears, the policy doesn’t cover that benefit.

Medigap Benefits Medigap Plans
Core Plan Supplement 1
Basic benefits Yes Yes
Part A: inpatient hospital deductible No Yes
Part A: skilled nursing facility coinsurance No Yes
Part B: deductible No Yes
Foreign travel emergency No Yes
Inpatient days in mental health hospitals 60 days per calendar year 120 days per benefit year
State-mandated benefits
(yearly Pap tests and mammograms.Check your plan for other state-mandated benefits.)
No Yes

Learn more at Medicare.gov’s page on Medigap in Massachusetts.

Medigap in Minnesota

If you live in Minnesota, Medigap is guaranteed issue (meaning an insurer can’t deny you for any reason other than non-payment), and instead of having letter plans A – N you have two choices.

  1. Basic Plan, which just covers the essentials.
  2. Extended Plan, which covers extras like the Part A and Part B deductible.

You can compare the Basic Plan and Extended Plan side-by-side below.

If a “yes” appears, the plan covers the described benefit 100%. If a row lists a percentage, the policy covers that percentage of the described benefit. If a “no” appears, the policy doesn’t cover that benefit.

Medigap Benefits Medigap Plans
Basic Plan Extended Basic Plan
Basic benefits Yes Yes
Part A: inpatient hospital deductible No Yes
Part A: skilled nursing facility coinsurance Yes (Provides 100 days of SNF care) Yes (Provides 120 days of SNF care)
Part B: deductible No Yes
Foreign travel emergency 80% 80%*
Outpatient mental health 50% 50%
Usual and customary fees No 80%*
Medicare-cover preventative care Yes Yes
Physical therapy 20% 20%
Coverage while in a foreign country No 80%*
State-mandated benefits
(diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations)
Yes Yes

* The plan pays 100% after you spend $1,000 in out-of-pocket costs for a calendar year.

K, L, M, N, and high deductible F in Minnesota

Minnesota also offers versions of Medigap Plans K, L, M, N, and high deductible F.

In Minnesota insurers can offer 4 different riders that can be added to the Basic Plan. You may choose any or all of these riders listed below:

  • Part A: inpatient hospital deductible
  • Part B: deductible
  • Usual and customary fees
  • Non-Medicare preventive care

Learn more at Medicare.gov’s page on Medigap in Minnesota.

Medigap in Wisconsin

If you live in Wisconsin, Medigap is guaranteed issue (meaning an insurer can’t deny you for any reason other than non-payment), and instead of having letter plans A – N you have a basic plan and then you have plans known as “50% and 25% Cost-sharing Plans.” The 50% and 25% Cost-sharing Plans plans are similar to Plans K (50%) and L (25%) found in other markets. Meanwhile, a high-deductible plan ($2,000) is also available.

Further, in Wisconsin insurers are also allowed to offer the following riders:

  • Part A deductible
  • Additional home health care (365 visits including those paid by Medicare)
  • Part B deductible
  • Part B excess charges
  • Foreign travel emergency
  • 50% Part A deductible
  • Part B copayment or coinsurance

In other words, in Wisconsin you’ll pick your base Medigap plan (either the Basic or a reduced cost sharing plan), and then you can add riders if you like. The result is something similar to what is offered in other states, it is simply a little more flexible.

Learn more at Medicare.gov’s page on Medigap in Wisconsin.