Basic Plan in Wisconsin
2024 Medicare Supplement Insurance Plan (Medigap)

Monthly Premium

$102-$1,174

Covered Benefits

Skilled nursing facility
Part A deductible
Part B deductible

Part B excess charges
Foreign travel emergency

*Monthly costs shown do not include the standard Part B premium. 2024 Medicare Part B premium is $174.70 per month.

Coverage Overview

Part A - Hospital - Deductible

$1,632

(what you pay)

Part B - Medical - Deductible

$240

(what you pay)

Part B - Medical - Coinsurance

$0

(what you pay)

Coverage Details

Part A Coinsurance

(what you pay)

Hospital stays

Days 1-60: $1,632 (Part A deductible)

Days 61-90: $0

Days 91-150: $0 while using your 60 lifetime reserve days

After 150 days: All costs

Skilled nursing facility (for Medicare-covered stays)

Day 1-20: $0

Days 21-100: $0

After 100 days: All costs

Blood (during a hospital stay)

First 3 pints: $0

After 3 pints: $0

Hospice care

$0

Mental health hospital stays

Days 1-60: $1,632 (Part A deductible)

Days 61-90: $0

Days 91-150: $0 while using your 60 lifetime reserve days

Additional 175 days: $0 for Medicare-eligible services

After the additional 175 days: All costs

Part B Coinsurance

(what you pay)

Covered Part B services

First: $240 (Part B deductible)

Then: $0

Preventive services (covered by Medicare)

$0 Generally for most preventive services Medicare covers

Preventive services (not covered by Medicare)

Contact the company for details

Part B excess charges

All costs

Blood (outside a hospital stay)

First 3 pints: $0

After 3 pints: $240 (Part B deductible), then $0

Tests for diagnostic services

$0

Home Healthcare - Part A & B Services

(what you pay)

Home health care (for Medicare-approved services)

Medicare covered visits: $0

Additional 40 visits: $0

After the additional 40 visits: All costs

Durable medical equipment (covered by Medicare)

First: $240 (Part B deductible)

Then: $0

Extra Benefits

(what you pay)

Foreign travel emergency

All costs

State-mandated benefits

Contact the company for details

Insurance Companies Offering This Plan

Guarantee Trust Life Insurance Company

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