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Alternatives to BadgerCare Plus Plan

Before enrolling in the BadgerCare Plus Basic Plan, you should consider two other insurance options available to some Wisconsin residents. Enrolling in BadgerCare Plus Basic will make you ineligible for coverage under the Federal Pool option described below.

Health Insurance Risk-Sharing Plan (HIRSP)

You may qualify for HIRSP if:

1. You recently lost your employer-sponsored insurance coverage; or 

2. You have been rejected for coverage in the private insurance market; or 

3. You have HIV/AIDS; or 

4. You have Medicare because of a disability. 

HIRSP offers comprehensive medical and pharmacy benefits including coverage of brand name drugs and first dollar coverage of select routine/preventive services. HIRSP will not cover medical services for a preexisting condition for the first six months of coverage. The preexisting condition waiting period does not apply to drug coverage. The medical services preexisting condition waiting period does not apply if you qualify for HIRSP because you have recently lost your employer-sponsored coverage, lost Medicaid, Medicare or BadgerCare Standard Plan coverage, or dropped BadgerCare Plus Basic, Core or Benchmark coverage.

If your annual household income is below $34,000, you may be entitled to a premium and deductible subsidy. For example, a 25 year old man with an annual income of less than $10,000 would pay $89 per month for a $2,500 deductible insurance plan. For more information about HIRSP please contact HIRSP Customer Service at 1-800-828-4777 or visit the HIRSP website at http://www.hirsp.org/.

HIRSP members can also be enrolled in the BadgerCare Plus Basic or Core Plan.

The HIRSP Federal Temporary Plan

You may qualify for the new HIRSP Federal Temporary Plan if:

1. You are a citizen or national of the United States, or are lawfully present; 

2. You have a preexisting medical condition; and 

You have been uninsured for at least 6 months before applying for coverage.

The Federal Plan offers the same medical and drug benefits as HIRSP. There is no preexisting condition waiting period under the Federal Plan. In most cases, the Federal Plan premium will be lower than the HIRSP premium. For more information about the HIRSP Federal Plan, please contact HIRSP Federal Plan Customer Service at 1-888-253-2698 or go to http://www.hirsp.org/plans/federal-eligibility.shtml.

Consolidated Omnibus Budget Reconciliation Act (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.

Health Coverage Tax Credit (HCTC) 

The Health Coverage Tax Credit (HCTC) 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

Last Revised:  February 19, 2013