Find answers to FAQs about supplemental medical insurance plans in Madison, WI.

Frequently Asked Questions About Supplemental Medical Insurance Plans in Wisconsin (WI)


Supplemental medical insurance plans may help cover costs that your primary insurance doesn’t cover. Below are some frequently asked questions about supplemental insurance in Wisconsin.


  1. Are supplemental medical insurance plans only meant for people with Medicare?

    No. Many kinds of medical insurance supplements are available in WI.

    • One type is offered just for people with Medicare. These types of plans are called “Medigap policies.” They can only be sold to people who have Medicare A and B coverage.
    • Another type is known as “fixed benefit” insurance. Fixed Benefit insurance plans are available for people without Medicare as well. These supplemental policies offer coverage for very specific things, such as –
      • Dental or vision
      • Coverage for specific types of accidents or illnesses
      • Hospital stays
      • Long-term care are

  2. How is supplemental medical insurance different than regular medical insurance? Most supplemental plans do not comply with the Affordable Care Act (ACA). The ACA directs ACA-compliant plans to cover ten essential health benefits. Supplemental plans are not meant to meet ACA requirements and often do not cover all ten of these essential health benefits. They are designed to cover costs not paid by a primary health insurance plan. If you only have supplemental insurance, it is likely that it is not an ACA-compliant plan. This means that you may have to pay a fee for being uninsured.

  3. How do insurance supplements work? Most supplemental plans are built to work with your primary medical insurance plan. When you have two plans, one plan must be named as the primary plan for Coordination of Benefits (COB). Your ACA-compliant plan should be listed as primary and your supplemental plan should be listed as secondary. That way, the primary plan covers medical costs first and the secondary may pay part of what is left.

  4. Who in Wisconsin might want to consider buying a medical insurance supplement? The answer to this question depends on each person. ACA-compliant plans are not meant to cover all expenses that result from an illness or accident. That’s where supplemental medical insurance comes in. Depending on the plan, supplemental insurance may pay expenses that your primary insurance doesn’t pay. Examples of such expenses are deductibles, travel and child care.

  5. Is supplemental medical insurance worth the cost? The answer to this question depends on each person and the supplemental insurance plan that is purchased. Most supplemental medical insurance policies have caps on how much the plan will pay out in any given situation. You should know what the fine print means before you buy such a plan. You’ll want to think about what expenses you may need to cover if you’re ever out of work due to a health issue, then compare that to what the policy offers. It may take time to shop around to find the supplemental medical plan that has the benefits you want.

  6. How do I know if a supplemental medical insurance plan is from a reliable company? You may check with the Wisconsin Office of the Commissioner of Insurance (OCI) to make sure the company is licensed to sell in Wisconsin. Or, email a question to OCI at ociquestions@wisconsin.gov. Another thing to do is contact a licensed agent who may help you find a plan that meets your needs.

Have more questions about supplemental medical insurance plans in Wisconsin or need a quote for an ACA-compliant plan that provides essential health benefits?  Get a quote or give us a call at 608.644.3430.


 



  1. https://www.healthcare.gov/quick-guide/one-page-guide-to-the-marketplace
  2. https://www.healthcare.gov/lower-costs/qualifying-for-lower-costs