Why is Wisconsin implementing BadgerCare Plus?
- To make sure that every child in Wisconsin has access to affordable health insurance.
- To expand health insurance coverage and provide enhanced benefits to more pregnant women,
- To provide health insurance to more parents and caretaker relatives.
- To make it easier to enroll in health insurance coverage.
- To ensure that 98 percent of Wisconsin residents have access to quality, affordable health care.
Who may be eligible?
- All children under age 19, regardless of income.
- Pregnant women with incomes up to 300% of the Federal Poverty Level
- Parents and relatives caring for a child up to 200% of the FPL.
- Young adults in foster care who turn 18 on or after January 1, 2008, will automatically be
able to get BadgerCare Plus until they turn 21, regardless of income.
- Farm families and other families who are self-employed may be eligible under BadgerCare Plus if their income is under 200% of the
FPL. BadgerCare Plus has a new way of counting depreciation which will help more families enroll.
- Parents whose child/children are in foster care and you have a reunification plan in
place may be eligible for BadgerCare Plus if their income is below 200% of the
federal poverty level.
Additional Enrollment Requirements
- You must live in Wisconsin.
- You must provide proof of citizenship and identity.
- If you are currently insured, you might still be eligible. In some cases, the
state may pay your monthly premium so you can keep your other insurance.
What do I do once I am enrolled?
- Once you are enrolled, you will need to pick a health plan. You will receive a packet in the mail that gives you information about plans in your county.
- The state pays a monthly fee to the health plan for your coverage.
If you move out of state, you need to let us know right away.
If you don’t let us know, and the state keeps paying the monthly fee for
you will be required to repay the state.
What are the benefits?
- Your benefits depend upon your income.
- If your family income is below 200% of the FPL,
you will be enrolled in the Standard Plan.
- The Standard Plan has the same benefits as the current family
- The Standard Plan has the same copay amounts as the current
- If you are a child or a pregnant woman and your family income is above 200% of the
FPL, or if you are self-employed, you
will be enrolled in the new Benchmark Plan.
- The Benchmark Plan covers doctor or clinic visits, hospital stays, and prescription drugs.
- Other services may be covered but in a more limited way than under the Standard Plan.
- The Benchmark Plan has higher copays than the Standard Plan.
What does it cost?
- The Standard Plan has minimal copays for services such as prescription drugs, doctor visits, going to the hospital or using the emergency room. There are no copays for well child check ups and other preventive services.
- The Benchmark Plan has higher copays than the Standard Plan for services such as prescription drugs, doctor visits or for going to the hospital or using the emergency room. There are no copays for well child check ups and other preventive services.
- You will need to pay your provider for your copays. If you don’t pay the copay under the Benchmark Plan, the provider may refuse to offer you services.
- Some people in the Standard Plan, and everyone in the
Benchmark Plan will have to pay monthly premiums. Premiums will
be based on income.
February 14, 2013