BadgerCare Plus Basic Plan — Other Coverage and Programs
Health Insurance Risk-Sharing Plan (HIRSP) and Health Insurance Risk-Sharing Plan Federal Plan Coverage
Before enrolling in the BadgerCare Plus Basic Plan, you should consider two other insurance options available to some Wisconsin residents. The Health Insurance Risk-Sharing Plan (HIRSP) currently offers several plan options that may meet your health insurance needs. You may qualify for the standard HIRSP plan or if you have been uninsured for six months you may qualify for a HIRSP Federal plan.
You may qualify for HIRSP if:
You may qualify for the HIRSP Federal Plan if:
HIRSP and HIRSP Federal offer comprehensive medical and pharmacy benefits including coverage of brand name drugs. Coverage of preventive services will be available at no cost to members beginning January 1, 2011.
If you qualify for HIRSP because you have been denied coverage in the private market, HIRSP will not cover medical services for a preexisting condition for the first six months of your HIRSP coverage. The HIRSP preexisting condition waiting period does not apply to drug coverage. If you qualify for the HIRSP Federal Plan, there is no preexisting condition waiting period.
In most cases, the HIRSP Federal premium will be lower than the HIRSP premium.
However, if your annual household income is below $34,000, you may be entitled to a HIRSP premium and deductible subsidy. For example, a 25 year old man with an annual income of less than $10,000 would receive a 43% premium discount and pay only $89 per month for a $2,500 deductible insurance plan. There is no low-income subsidy on the HIIRSP Federal Plan.
If you qualify for both HIRSP and HIRSP Federal, and your household income is below $34,000, please compare the subsidized HIRSP premium with the HIRSP Federal Plan premium before choosing which plan best meets your needs.
For more information about HIRSP or the HIRSP Federal Plan please contact HIRSP Customer Service at 1-800-828-4777 or visit www.hirsp.org. (exit DHS).
Some Basic Plan members may be able to enroll in other programs. Those programs are the following:
COBRA: The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost of the plan.
Tax credits and premium subsidies are available for some individuals choosing to enroll in COBRA. The COBRA Premium Reduction is available for individuals who became eligible for COBRA between September 1, 2008 and May 31, 2010 due to a covered employee's involuntary termination of employment. The COBRA Premium Reduction allows an individual to pay 35% of his or her COBRA premium. For more details, visit http://www.dol.gov/ebsa/cobra.html (exit DHS).
Health Coverage Tax Credit (HCTC): This program is available for individuals eligible for the Trade Adjustment Assistance (TAA), Alternative TAA, and Reemployment TAA benefit who also receive a Trade Adjustment Allowance or Unemployment Insurance. For more details, visit http://www.irs.gov/individuals/article/0,,id=187948,00.html (exit DHS).
Wisconsin Well Woman Program: Women between the ages of 45-64 who are enrolled in the Basic Plan may also be able to enroll in the Wisconsin Well Woman Program (WWWP). The WWWP pays for mammograms and pap tests. For more details on this program, please call (608) 266-8311 or visit dhs.wisconsin.gov/womenshealth/wwwp.
Wisconsin Chronic Disease Program: Wisconsin Chronic Disease Program (WCDP) provides payment to health care providers for disease-related services for individuals with chronic renal disease, adult cystic fibrosis and hemophilia. Members may participate in both WCDP and the Basic Plan while paying a cost-share for both programs. For more information, call 1-800-362-3002 or go to http://www.dhs.wisconsin.gov/.
Wisconsin AIDS/HIV Drug Assistance Program (ADAP): ADAP is a program to provide Wisconsin residents access to HIV-related antiretroviral drugs and prophylactic medications as well as certain vaccines for hepatitis. For more information, go to dhs.wisconsin.gov/aids-hiv or call 800-991-5532.
Last Revised: April 19, 2013