Wisconsin Department of Health Services

Common questions

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.

All children under age 19, regardless of income.
Pregnant women with incomes up to 300% of the Federal Poverty Level (FPL).
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.

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.

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.

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 Medicaid/BadgerCare Program.
The Standard Plan has the same co-payment amounts as the current Medicaid/BadgerCare Program.

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 co-payments than the Standard Plan.

The Standard Plan has minimal co-payments for services such as prescription drugs, doctor visits, going to the hospital or using the emergency room. There are no co-payments for well child check ups (Health Check) and other preventive services.
The Benchmark Plan has higher co-payments 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 co-payments for well child check ups (Health Check) and other preventive services.
You will need to pay your provider for your co-payments. If you don’t pay the co-payment 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. See the special messages below for exceptions to these payments.

Last Revised: July 18, 2011