Medicare Supplement

Medigap in Wausau: a separate policy from Medicare

WAUSAU, Wis. — If you've been reading about Medicare and keep bumping into the word "Medigap," you're not alone. Medicare Supplement insurance — the formal name for Medigap — is one of the most misunderstood pieces of the Medicare puzzle. It doesn't replace Medicare, and it isn't the same as Medicare Advantage. It's a separate policy that helps pay some of the out-of-pocket costs Original Medicare leaves behind.

Here's a plain-English guide to what Medigap does, how the standardized letter plans work, and how to think through whether it fits your situation.

What Medigap actually is

Medigap is private insurance you can buy to go alongside Original Medicare (Part A and Part B). After Medicare pays its share of a covered service, your Medigap policy picks up some or all of what's left — things like coinsurance, copayments, and deductibles.

A few key ground rules from Medicare:

• You must have both Part A and Part B to buy a Medigap policy.
• Medigap only works with Original Medicare. You generally can't use it with a Medicare Advantage plan.
• Medigap policies are sold by private insurance companies, but the benefits inside each lettered plan are set by federal and state law.
• Most Medigap plans do not include prescription drug coverage. For drugs, people typically add a stand-alone Part D plan.

How the standardized letters work

In most states, including Wisconsin — well, almost. Wisconsin is actually one of three states (along with Massachusetts and Minnesota) that standardize Medigap differently from the rest of the country. Instead of the familiar lettered plans (A, B, C, D, F, G, K, L, M, N) used elsewhere, Wisconsin uses a base Medigap policy with optional riders you can add on.

The base plan covers a core set of benefits required by state law. From there, you choose add-ons — riders that cover extra things like the Part A deductible, additional home health care, or Part B excess charges. Different insurance companies can sell the same base plan and the same riders, but their prices can vary.

Two important national rules still apply here:

• Plans sold to people newly eligible for Medicare on or after January 1, 2020 cannot cover the Part B deductible. That's why the older "first-dollar coverage" plans (like Plan F in other states) aren't available to newer enrollees.
• The benefits inside a given plan or rider are the same from company to company. What changes is the price, the customer service, and how the company raises rates over time.

You can compare Wisconsin Medigap options directly on Medicare.gov's plan finder or through the Wisconsin Office of the Commissioner of Insurance.

When you can buy Medigap — and why timing matters

This is the part that catches people off guard.

Your Medigap Open Enrollment Period is a one-time, six-month window that starts the month you're 65 or older and enrolled in Part B. During that window:

• Insurers must sell you any Medigap policy they offer.
• They can't charge you more because of health problems.
• They can't turn you down.

Outside that window, in most cases, insurers can use medical underwriting. That means they can ask about your health, charge more, or decline to sell you a policy — with some exceptions called "guaranteed issue rights."

If you're approaching 65 in the Wausau area, this is the timing detail worth circling on the calendar.

Medigap vs. Medicare Advantage — they're not the same road

A quick side-by-side, because this is where confusion runs highest:

• Medigap works with Original Medicare. You keep Parts A and B, add a Medigap policy, and usually add a separate Part D drug plan. You can generally see any provider in the U.S. that accepts Medicare.
• Medicare Advantage (Part C) replaces the way you get your Original Medicare benefits. These are all-in-one plans from private insurers, often with networks, and drug coverage is frequently built in.

You can't use both at the same time. Choosing between them is a personal decision based on your doctors, your travel habits, your budget, and how you feel about networks versus flexibility.

Wausau is in Marathon County, where a range of Medicare Advantage and Part D plans are offered each year. If you want to see exact counts and options for your ZIP code, Medicare.gov's plan finder is the official source.

What's changing in 2026 that Medigap shoppers should know

Medigap itself isn't getting an overhaul in 2026, but a few Medicare-wide changes are worth understanding since they affect the full picture:

• Part D out-of-pocket cap: $2,100 for 2026. Once you hit that limit on covered drugs, you pay $0 for the rest of the year.
• Part D maximum deductible: $615.
• The coverage gap ("donut hole") is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: an optional program that lets you spread your drug costs across the year in monthly payments instead of paying big bills at the pharmacy counter.
• IRMAA surcharges — the extra amount higher-income beneficiaries pay for Part B and Part D — begin above $109,000 in income for a single filer in 2026.
• Enrollment windows to remember: Annual Enrollment runs Oct. 15 – Dec. 7. Medicare Advantage Open Enrollment runs Jan. 1 – March 31. (Medigap has its own timing rules, described above.)

How to think it through

A few questions that tend to clarify the Medigap decision:

1. How important is provider choice? If seeing any doctor who accepts Medicare — including specialists out of state — matters, Medigap plus Original Medicare tends to feel roomier. 2. How do you feel about predictable vs. variable costs? Medigap usually means a higher monthly premium in exchange for fewer surprises when you use care. 3. Are you inside your one-time Open Enrollment window? If yes, your options are widest and health questions are off the table. 4. Do you need drug coverage? If you go the Medigap route, plan on adding a stand-alone Part D policy.