Medicare Select (Medigap)

Medicare Select Plan (Rock, Green & Jefferson Counties)

*Applications and 2 months premium  must be received by MercyCare Sales Department by the 25th of each month for the upcoming month.



2021 Premiums

2021 Outline of Coverage

2021 Policy

2021 Provider Directory 

The Senior Supplement Provider Directory (hard copy) is updated annually. For an up to date list of providers, please use our “Find a Doctor” search tool, which is updated monthly: Click here


2020 Premiums

2020 Outline of Coverage

2020 Policy

2020 Provider Directory


Forms & documents:


Voluntary Discontinuation of Coverage FILLABLE VERSION

Stay Healthy Form

Auto withdrawal form- FILLABLE VERSION

Agent statement FILLABLE VERSION (to be completed by agent if assisting in process)

Guide to Health Insurance for People with Medicare in Wisconsin


UPDATED: 02-02-21