Medicare Supplement

Medigap in Madison: why Wisconsin's plans don't use the A-through-N letters

If you live in Madison and are shopping for a Medicare Supplement policy, the first thing to know is that Wisconsin doesn't play by the same rulebook as most of the country. Instead of the familiar Plan A, Plan G or Plan N you may have read about, Wisconsin has its own set of standardized Medigap policies — and knowing the names is the key to comparing what's for sale in Dane County.

Medicare SupplementMadison, WI

Why Wisconsin looks different

In most states, private insurers sell Medigap policies labeled Plan A through Plan N. Each letter means the same set of benefits no matter who sells it. Wisconsin was one of three states that already had its own standardized system when the federal rules were written, and it was allowed to keep it. Massachusetts and Minnesota did the same.

So when a friend in another state tells you about "Plan G," that plan isn't sold here. In Wisconsin, you'll be comparing policies by different names — but the idea is the same: the state defines what each policy has to cover, and insurers compete on price and service.

The Wisconsin plans, in plain English

Madison is in Dane County, and every insurer that sells Medigap here has to offer these standardized options:

• The Basic Plan. This is Wisconsin's core Medigap policy. It picks up certain gaps in Original Medicare, such as Part A and Part B coinsurance.
• Optional riders. You can add riders to the Basic Plan to cover more — for example, the Part A deductible, additional home health care, or Part B excess charges. You choose which riders to add.
• The 50% cost-sharing plan. You pay half of certain covered costs until you hit an out-of-pocket limit; the plan then pays the rest.
• The 25% cost-sharing plan. Same structure, but you pay 25% of those costs.
• The high-deductible plan. Premiums are typically lower, but you pay a set deductible before the policy starts paying.

None of these plans include prescription drug coverage. That's separate.

How Medigap pairs with Original Medicare and Part D

A Medigap policy only works alongside Original Medicare (Part A and Part B). Medicare pays first, and your Medigap picks up some of what's left — the coinsurance, copays or deductibles the plan is designed to cover.

Because Medigap doesn't include drug coverage, most people in Madison who choose this route also enroll in a stand-alone Part D prescription drug plan. A few figures worth remembering for 2026:

• Part D has a new $2,100 out-of-pocket cap on covered drugs.
• The maximum Part D deductible is $615.
• The old coverage gap ("donut hole") is gone as of 2025 — Part D now has three phases.
• If your drug costs are uneven month to month, the Medicare Prescription Payment Plan lets you spread them across the calendar year.
• IRMAA surcharges on Part B and Part D start above $109,000 in income for a single filer in 2026.

Medigap and Medicare Advantage are different paths — you generally can't have both at the same time.

The state rules that shape your choice

Two rules matter most in Wisconsin:

Your open enrollment window. For six months starting when you're 65 or older and enrolled in Part B, you have a federal right to buy any Medigap policy sold in Wisconsin without medical underwriting. That means the insurer can't turn you down or charge more because of your health. Outside that window, insurers can generally ask health questions unless you qualify for a guaranteed-issue right.

How policies are priced. Wisconsin insurers can use different pricing methods — some base premiums on your age at purchase, some on your current age, and some charge the same regardless of age. Two policies with identical benefits can cost very different amounts over time, so it's worth asking how a premium is set before you sign.

For state-specific rights beyond federal law, and for the latest guidance, check with the Wisconsin Office of the Commissioner of Insurance (OCI) or the state SHIP (called the Wisconsin Medigap Helpline and Board on Aging & Long Term Care).

How to find the policies sold in Madison

There isn't a single public list of every Wisconsin Medigap insurer that stays up-to-date the way Medicare Advantage rosters do. The most reliable places to look:

• Medicare.gov's Medigap policy search. Enter your Madison ZIP code and you'll see the insurers licensed to sell in your area, along with the plan types they offer.
• The Wisconsin OCI Medigap rate guide. The state publishes a comparison of premiums by insurer and plan type. It's the single best snapshot of who charges what.
• Wisconsin SHIP counselors. They provide free, one-on-one help and don't sell insurance. Call 1-800-242-1060.

When you compare, focus on: the plan type (Basic with riders, 50%, 25%, or high-deductible), the riders included, the pricing method, and any premium history.