How do WPS Medigap plans work?
The not-for-profit health insurer Wisconsin Physicians Service (WPS) provides several supplement insurance options. People can choose from base plans and purchase additional riders depending on their coverage needs.
Most people enrolled in Original Medicare pay 20% toward the costs of their covered Part B services, deductibles, and the Part B monthly premium. Medicare supplement insurance plans, also known as Medigap, help reduce out-of-pocket costs.
Most states have 10 Medigap plans, each identifiable by a letter. All Medigap plans within the same letter category offer the same benefits, irrespective of the provider or location.
However, Wisconsin does not offer these standard Medigap plans. Instead, it offers a choice of base plans and optional riders that allow people to customize their insurance.
This article looks at the WPS supplement insurance plans, coverage, costs, and enrollment.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What is WPS?
This article originally appeared on Medical News Today
Based in Madison, Wisconsin, WPS Health Insurance is a not-for-profit corporation that offers health insurance for groups and individuals.
WPS was founded in 1946 to help civilians and soldiers who were returning from World War 2 and had difficulty paying for healthcare.
WPS offers several healthcare plans, including Medicare supplement or Medigap plans, as well as individual, family, short-term, and group health plans, including Administrative Services Only (ASO).
Are WPS plans location-specific?
WPS plans are available to people who live in these states:
Wisconsin
Florida
Illinois
Ohio
What are the WPS Medigap plans?
In 2025, WPS will offer two different base plans. Once a person has chosen a base plan, they can add on riders, each at an additional cost.
Base plans
Base plans include:
a base plan only, which is the highest coverage option
a base plan with Medicare Part B copayment or coinsurance rider
The following sections outline the optional add-on riders.
Rider 1
Medicare Part A deductible: WPS pays either 100% or 50% of the Part A deductible during the first 60 days of hospitalization. A person can choose the 100% or 50% option.
Rider 2
Medicare Part B deductible: WPS pays the Part B deductible each year. This rider is only available to people who have chosen the highest coverage base plan and were eligible for Medicare before January 1, 2020.
Rider 3
Medicare Part B excess charges: If a person’s healthcare provider does not accept Medicare assignment, WPS pays the difference between the provider’s charges and the amount Medicare approves for their services.
Rider 4
Additional home healthcare: WPS pays for an additional 325 home healthcare visits each calendar year. The total number of visits, including those paid for by Original Medicare, cannot exceed 365.
Rider 5
Foreign travel emergency: WPS pays 80% of the billed expenses for medically necessary emergency care outside the United States that begins in the first 60 days of a trip. A person must pay a deductible of $250 before WPS pays. The maximum amount they will pay during a person’s lifetime is $100,000.
What else do WPS Medigap plans cover?
A person who chooses a Medigap plan from WPS will also have Original Medicare (parts A and B), which covers hospitalization and medical services. The base plan and riders a person chooses will determine which other factors are covered.
WPS Medigap plans also cover access to the following programs:
Hearing Care Solutions program: This includes a free hearing exam, hearing aid evaluation and fitting, and savings on hearing aids. The program is included in WPS Medigap plans at no extra cost.
EyeMed Vision Care program: This program offers savings on eyeglasses, contact lenses, eye exams, and laser vision correction. There is no extra cost for this program.
Optional Delta Dental coverage: For an extra monthly cost of $55.31, a person can access various dental services. There is an annual maximum benefit of $1,200 per person.
How much do WPS supplement plans cost?
The cost of WPS Medigap plans depends on a person’s age, location, and coverage level. This section outlines costs in Wisconsin.
There is separate information available for Florida, Illinois, and Ohio.
WPS divides Wisconsin into these areas
Area 1: Milwaukee area and southeastern Wisconsin
Area 2: Central and Western Wisconsin
Area 3: All other Wisconsin areas
Area 3 covers most of Wisconsin. The chart below shows area 3 costs for three age groups, effective from January 1, 2025.
Age at enrollment | 65 | 75 | 85+ |
|---|---|---|---|
Base plan only | $138.25 | $215.22 | $279.84 |
Base plan with copay | $120.14 | $187.02 | $243.19 |
Rider 1: Part A deductible 100% | $28.11 | $46.09 | $64.11 |
Rider 1: Part A deductible 50% | $13.78 | $22.59 | $31.39 |
Rider 2: Part B deductible | $21.83 | $21.83 | $21.83 |
Rider 3: Part B excess charge | $6.48 | $9.12 | $11.77 |
Rider 4: Additional home healthcare | $2.04 | $2.04 | $2.04 |
Rider 5: Foreign travel emergency | $1.53 | $1.53 | $1.53 |
If a person pays their premiums with automatic bank withdrawal, WPS provides a 2% discount. The company also gives a 7% discount when two or more people in the same household take out a policy.
A person can use the online Medigap plan finder to check the prices of Medigap policies in their area.
When can I enroll in a WPS Medigap plan?
A person enrolled in Original Medicare can apply for a Medigap plan throughout the year, although they may pay more if they enroll outside the Medigap Open Enrollment Period (OEP). The OEP lasts 6 months and begins on the first day of the month a person turns 65 and is enrolled in Medicare Part B.
During the OEP, insurance companies cannot refuse a Medigap policy or ask for information about preexisting medical conditions. Once the OEP ends, the insurer can ask for medical underwriting, which means a person would have to take a physical examination or provide information about their health. An insurance provider has the right to refuse to provide a policy based on a person’s health.
Read more about Medicare enrollment.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Summary
Wisconsin Physicians Service (WPS) provides supplement insurance plans in Wisconsin, Florida, Illinois, and Ohio to people enrolled in Original Medicare.
The plans comprise a choice of base plans and optional add-on riders. The costs of these plans vary depending on a person’s age at enrollment, their location, and the coverage they choose.
People can enroll in a Medigap plan at any time, but doing so after the 6-month Open Enrollment Period (OEP) may be more difficult and may cost more.
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