Medigap in Wisconsin, Minnesota and Massachusetts: The 3 Waiver States Explained

Why These Three States Have Their Own Medigap Rules

When Congress standardized Medicare Supplement insurance in 1990 (effective 1992), it wrote a specific carve-out into federal law. The statute at 42 U.S.C. § 1395ss requires insurers everywhere to sell only the standardized federal letter plans, but it also acknowledged that Wisconsin, Minnesota, and Massachusetts had already built their own uniform Medigap systems years earlier. Rather than force those states to scrap policies that were working, Congress grandfathered them in.

That is why these three states are called "waiver states." Wisconsin's insurance regulator explicitly notes that the state received a waiver of the federal standardization requirements under the Omnibus Budget Reconciliation Act (OBRA) of 1990, allowing it to keep offering its own Basic Plan plus riders rather than the national A-N standardized plans.

The practical result: if you live in one of these states, you cannot buy a Plan G or Plan N by name. You buy your state's version, and it is your job to match it against what generic Medigap advice describes. That is also why our Medigap comparison chart and our state-by-state Medigap guide both call out these three states separately.

Wisconsin: One Base Plan Plus Optional Riders

Wisconsin uses a single Medigap chassis called the Basic Plan. Every carrier that sells Medigap in Wisconsin must offer it, and every Basic Plan must include the same state-mandated benefits. You then customize it by adding riders.

What the Wisconsin Basic Plan covers

The Basic Plan already includes:

• Part A hospital coinsurance plus 365 additional lifetime days after Medicare benefits end
• Skilled nursing facility coinsurance ($217/day for days 21-100 in 2026)
• Part B coinsurance (the 20% you would otherwise owe)
• First 3 pints of blood per year
• Hospice coinsurance and copayments
• 175 additional lifetime inpatient mental health days
• 40 additional home health visits per year
• 30 days of medically necessary skilled nursing care even when Medicare will not pay
• State-mandated chiropractic, non-Medicare hospital and ASC charges, dental anesthetic when medically necessary, and breast reconstruction after mastectomy

Riders you can add on top

To approximate Plan G or Plan N coverage, Wisconsin carriers offer these optional riders:

Cost-sharing and high-deductible versions

Beyond the standard Basic Plan, Wisconsin allows three lower-premium variants: a 50% cost-sharing plan with an $8,000 out-of-pocket max in 2026, a 25% cost-sharing plan with a $4,000 out-of-pocket max, and a high-deductible Basic Plan with an annual deductible of $2,950 in 2026 (matching the federal High-Deductible Plan G threshold confirmed by CMS). These work like federal Plans K, L, and High-Deductible Plan G do elsewhere.

2026 premiums and top Wisconsin carriers

For 2026, MedicareFAQ's Milwaukee sample rates (a common benchmark market) show Basic Plan monthly premiums ranging from about $102 to $136 across the major carriers: Physicians Mutual at $102, Wellabe at $113, Wisconsin Physicians Service (WPS) at $118, Anthem BCBS at $126, Mutual of Omaha at $129, Humana at $131, AARP/UnitedHealthcare at $134, and State Farm at $136. Once you add typical riders, Milwaukee Basic-plus-riders bundles land around $138 (WPS), $149 (Anthem), $152 (Mutual of Omaha), $155 (Humana), and $158 (AARP/UnitedHealthcare) per month. Statewide, TheBig65 pegs a Wisconsin Basic Plan at roughly $165 per month on average, and MoneyGeek's 2026 data highlights AFLAC at about $161 and MedMutual Protect at $145 as competitive alternatives outside the Milwaukee benchmark. For a deeper carrier breakdown, see our AARP Medicare Supplement review, Mutual of Omaha Medigap review, and best Medigap companies of 2026.

Minnesota: Basic vs Extended Basic (Now With a Post-2020 Version)

Minnesota uses two main state-standardized designs: the Basic Plan (a lean chassis you customize with riders) and the Extended Basic Plan (a bundled comprehensive plan). Minnesota also allows a small set of lettered plans (K, L, M, N, and Plan F for pre-2020 eligibles) to be sold in parallel. Because Minnesota uses community rating, a 65-year-old and an 85-year-old generally pay the same monthly premium for the same plan from the same carrier.

What both plans share

Both Basic and Extended Basic cover Part A and B coinsurance, the first 3 pints of blood, hospice cost-sharing, some home health, at least 50% of outpatient mental health and 20% of physical therapy, and state-mandated benefits like diabetic supplies, cancer screenings, and reconstructive surgery.

Where they diverge in 2026

The 2020 update that changed everything

Federal MACRA rules banned any Medigap policy from covering the Part B deductible for people first Medicare-eligible on or after January 1, 2020. Minnesota responded by splitting Extended Basic into two versions:

• Legacy Extended Basic (for pre-2020 eligibles) still covers the Part B deductible
• Extended Basic-new (for post-2019 eligibles) does not cover the Part B deductible and typically runs less

Real 2026 Hennepin County quotes for a 65-year-old non-tobacco male show Basic Plan premiums ranging from about $200 to $325 per month and Extended Basic from about $303 to $490 per month across carriers. MoneyGeek's statewide 2026 data spans an even wider $78 to $376 range once cost-sharing variants are included, with Extended Basic averaging near $376. Healthline lists ranges of $255 to $711 per month for Extended Basic-new and $274 to $732 for the legacy version. This is Minnesota's version of the same rule that closed Plan F to new enrollees nationwide.

Mapping Minnesota to Plan G and Plan N

• Extended Basic-new is Minnesota's closest analog to a comprehensive Plan G. It bundles the Part A deductible, excess charges, and expanded benefits automatically.
• Basic Plan plus Part A deductible rider plus excess charges rider approximates Plan G at a possibly lower total cost.
• Basic Plan alone functions more like a stripped-down Plan N, but without Plan N's office and ER copays unless you add the Part B copay rider.

Top Minnesota Medigap carriers include Blue Cross Blue Shield of Minnesota, HealthPartners, UCare, Medica, AARP/UnitedHealthcare, and Mutual of Omaha. Starting August 1, 2026, Minnesota is implementing a major consumer-protection change under Minn. Stat. § 62A.31: residents ages 65 to 70 who missed their original Medigap window or were previously denied coverage will have a one-time guaranteed-issue right during the fall Annual Enrollment Period (October 15 to December 7), with no medical underwriting or pre-existing condition denials allowed. That right comes with a permanent premium surcharge of 15% in 2026, rising 5 percentage points per year up to a 35% maximum for 2029 and later. Our Medigap birthday rule guide and switching from Medicare Advantage to Medigap guide cover the timing details.

Massachusetts: Core, Supplement 1A, and Legacy Supplement 1

Massachusetts is the simplest of the three waiver states in terms of shelf. There are only two plans you can actually buy in 2026 as a new enrollee: Core and Supplement 1A. The third design, Supplement 1, is closed to anyone first Medicare-eligible on or after January 1, 2020, and a legacy plan called Medigap 2 was closed to new sales after December 31, 2005 (existing members can keep it).

Massachusetts also uses community rating by state law (Mass. Gen. Laws ch. 176K). Everyone in the same plan with the same carrier pays the same base premium regardless of age, gender, or health, which makes shopping there very different from most of the country. Even more unusual, all Massachusetts Medigap carriers currently offer year-round continuous enrollment with no medical underwriting, on top of the state-mandated annual open enrollment window under 211 CMR 71.10.

Basic benefits in all three plans

Every Massachusetts Medigap plan includes:

• Part A hospital coinsurance (days 61-90 and 91-150, plus 365 extra lifetime days)
• Part B coinsurance
• First 3 pints of blood
• Hospice coinsurance and copays
• State-mandated preventive benefits like yearly Pap tests and mammograms

What separates Core, Supplement 1A, and Supplement 1

Using 2026 CMS figures (Part A deductible $1,736, SNF coinsurance $217/day for days 21-100, Part B deductible $283):

Massachusetts equivalents to Plan G and Plan N

Supplement 1A is essentially the Massachusetts version of Plan G. Supplement 1 acts like the old Plan F for those still eligible. Core has no direct federal analog, but functionally exposes you to more out-of-pocket risk in exchange for the lowest premium.

2026 Massachusetts premiums and carriers

The official 2026 Massachusetts Medigap chart, published by the state's Executive Office of Aging and Independence and the Serving Health Insurance Needs of Everyone (SHINE) program, lists these monthly premiums by carrier for coverage effective January 1, 2026:

A few notes: Humana continues offering continuous open enrollment through March 31, 2026 for its existing Massachusetts Medigap products, but its footprint is shrinking. Medex Choice is no longer sold as a new-enrollee option, though existing members may remain. Because Massachusetts is a higher-cost Medigap state overall, see our Medicare Supplement cost guide for context on how the state compares nationally.

Guaranteed Issue, Birthday Rules, and Switching

None of these three states use a traditional California-style birthday rule. Instead, they lean on strong initial and event-triggered guaranteed-issue protections. Here is what actually applies in 2026:

Wisconsin

• Standard 6-month federal Medigap Open Enrollment when you enroll in Part B
• 63-day guaranteed-issue window when you lose group coverage, a Medicare Advantage plan, a Medicare Cost plan, prior Medigap, or Medicaid
• No active state birthday rule

Minnesota

• Standard Open Enrollment plus event-triggered guaranteed issue
• New effective August 1, 2026: a one-time guaranteed-issue right for ages 65 to 70 usable during the fall Annual Enrollment Period (October 15 to December 7). No underwriting, no denial based on pre-existing conditions, but a permanent premium surcharge applies (15% in 2026, +5 points per year, capped at 35%)
• No traditional birthday rule

Massachusetts

• Standard Open Enrollment plus event-triggered guaranteed issue
• Community rating on all plans (age and health cannot change your premium)
• State-mandated annual open enrollment from February 1 through March 31 under 211 CMR 71.10, during which any eligible person can enroll in any Medigap the carrier offers with guaranteed issue and coverage effective no later than June 1
• All Massachusetts Medigap carriers currently offer continuous year-round enrollment with no medical underwriting, so you can typically apply any month for a first-of-next-month effective date

If you want the full national comparison, our Medigap birthday rule guide shows how these three states stack up against the 15 birthday-rule states now on the books for 2026.

Frequently Asked Questions

Why can't I buy Plan G in Wisconsin, Minnesota, or Massachusetts?

Because federal law grandfathered these three states' pre-1992 Medigap systems, insurers there sell state-designed plans instead of the federal letter plans. You can still build coverage equivalent to Plan G by choosing the right state-specific plan (Wisconsin Basic plus riders, Minnesota Extended Basic-new, or Massachusetts Supplement 1A). The benefits are nearly identical, only the plan name and packaging differ.

Which Minnesota plan is closest to Plan G?

Extended Basic-new is Minnesota's closest analog to Plan G for anyone first Medicare-eligible on or after January 1, 2020. It automatically includes the Part A deductible ($1,736 in 2026), Part B excess charges, 120 days of SNF coverage, and 80% of usual and customary fees on non-Medicare services. If you prefer to pay less upfront, a Basic Plan with the Part A deductible and excess charges riders can approximate the same coverage at a potentially lower total premium.

How does the Massachusetts February to March window work?

Under 211 CMR 71.10, each year from February 1 through March 31, any eligible Medicare beneficiary in Massachusetts can enroll in or switch Medigap plans with guaranteed-issue rights, and coverage bought during that window is effective by June 1 at the latest. Insurers cannot deny coverage, impose waiting periods, or charge higher premiums based on health. Because Massachusetts carriers also offer year-round continuous enrollment with community-rated pricing, this window functions more as a formal state-mandated open enrollment than a rare access point.

Are Wisconsin Medigap premiums cheaper than the national average?

Yes, in most cases. Milwaukee-market Basic Plan premiums from the major Wisconsin carriers in 2026 range from about $102 to $136 per month per MedicareFAQ, with a statewide average near $165. That sits well below the roughly $166 to $220 national average for Plan G at typical enrollment ages. Even a Wisconsin Basic Plan with common riders (roughly $138 to $158 in Milwaukee) usually costs less than a comparable Plan G in high-premium states like New York, Connecticut, or Massachusetts.

If I move out of Wisconsin, Minnesota, or Massachusetts, what happens to my Medigap?

Your waiver-state Medigap policy generally cannot travel with you as-is. When you move to a state that uses federal letter plans, you typically need to enroll in a new Medigap policy there, and you may qualify for a guaranteed-issue right if you apply within 63 days of losing your prior coverage. Our Medigap underwriting when leaving Medicare Advantage guide explains the guaranteed-issue mechanics in detail, and the same 63-day rules generally apply when you relocate out of a waiver state.