FAQs About BadgerCare Plus Program Changes

Here are some commonly asked questions about the emergency room copay, monthly premiums, treatment needs question, and health survey. Don’t see your question listed below? You can email us your question. Please note that we may not be able to reply to every email.

 

 Emergency Room Copay

Print-friendly information about the emergency room copay

What is a copay?

It’s a set amount of money you pay for a medical service.

What is the emergency room copay?

It’s an $8 charge for going to the emergency room when it’s not an emergency.

Who has to pay an emergency room copay?

You may need to pay an emergency room copay if you:

  • Are age 19–64.
  • Aren’t pregnant.
  • Don’t have children under age 19 who are living with you.

Even if those apply to you, you still may not have to pay an emergency room copay. You don’t have to pay an emergency room copay if you:

  • Are a tribal member.
  • Are a child or grandchild of a tribal member.
  • Qualify for Indian Health Services.

What is considered an emergency?

It’s a medical condition that puts your life in danger or could seriously damage your body if you don’t get help right away.

Some examples of an emergency are:

  • You’re having seizures.
  • You can’t breathe or are severely short of breath.
  • You’re bleeding a lot, and it won’t stop.

For an emergency, call 911 or go to the emergency room right away. You won’t need to pay a copay in emergency situations.

What is not considered an emergency?

It’s a medical condition that can usually be taken care of at a doctor’s office or clinic.

Some examples of this are:

  • You have a cough, fever, or sore throat.
  • You sprained your ankle.
  • You burned yourself but not severely.

If you go to the emergency room in situations like these, you may need to pay a copay and probably also wait a long time to get treatment. Your doctor will decide whether or not your visit was an emergency.

What can I do instead of going to the emergency room?

Keep in mind that if it really is an emergency you should call 911 or go to the emergency room right away.

If you don’t think it’s an emergency, you can:

  • Call your doctor’s office. You can usually get an appointment the same day depending on your medical condition.
  • Go to an urgent care clinic. You will be treated the same day, and it will take less time than going to the emergency room.
  • Call your doctor or nurse helpline. You can ask what to do for treatment or where to go for care.

Do I have to pay a copay for going to the emergency room for an emergency?

No.

How does the copay work?

The doctor will decide whether or not your visit was an emergency. If it wasn’t an emergency and you choose to still get care in the emergency room, the hospital will send you a bill for $8.

Does the doctor or hospital need to provide care even if I can't pay the copay?

Yes.

When did this start?

The policy started February 1, 2020. However, because we were making changes to our copay system, you didn't need to start paying copays until July 1, 2020.

 

 Monthly Premiums

What is a premium?

A premium is a set amount of money you pay each month to get BadgerCare Plus benefits.

What is the difference between a copay and a premium?

A copay is money you pay for a medical service, like getting care in the emergency room. A premium is money you pay each month to get benefits or health care coverage from BadgerCare Plus. You pay a premium even if you don’t get medical care during that month.

Who has to pay a monthly premium to get BadgerCare Plus benefits?

You may have to pay a monthly premium for your BadgerCare Plus benefits if you:

  • Are age 19–64.
  • Aren’t pregnant.
  • Don’t have children under age 19 who are living with you.
  • Make a certain amount of money each month. This amount is different based on whether you’re single or married. If you’re single, it’s more than $531.67 per month. If you’re married, it’s more than $718.34 per month.

Even if all those apply to you, you still may not have to pay a premium. You don’t have to pay a premium if you:

  • Are a tribal member.
  • Are a child or grandchild of a tribal member.
  • Qualify for Indian Health Services.
  • Are homeless right now or were homeless at any point in the last 12 months.
  • Have stayed or expect to stay in a medical institution (such as a hospital, nursing home, or rehabilitation center) for at least 30 days.
  • Have a disability.

How will I know if I have to pay a premium?

A letter titled “About Your Benefits” will tell you if you need to pay a premium.

How much will my premium be?

Your premium can be anywhere from $4 to $8 per month. You’ll start out at $8 per month, but you may be able to lower it by taking an optional health survey and showing you have healthy habits:

  • If you’re not married and have healthy habits, your premium would be $4 per month.
  • If you’re married and both you and your spouse have healthy habits, your premium would be $4 per month.
  • If you’re married but only one spouse has healthy habits, your premium would be $6 per month.

When do I have to pay my premium?

We will charge you a premium each month. Your monthly statement and ACCESS account will say your premium is due the 10th of each month. However, you can pay your premium at any time as long as it is before your yearly renewal or before your BadgerCare Plus coverage ends.

What happens if I don’t pay my premium?

If you don’t pay all your owed premiums before your yearly renewal or before your BadgerCare Plus coverage ends, you won’t be able to get BadgerCare Plus benefits for six months.

To get benefits again, you’ll either need to wait until the six-month period is over or pay the full amount of what you owe. If you pay the full amount within one month of your benefits ending, you won’t need to reapply for benefits. If you pay the full amount more than one month after your benefits end, you’ll need to reapply for benefits.

How can I pay my premium?

The easiest and fastest way to pay is by credit card, debit card, checking account, or savings account through the MyACCESS mobile app or the ACCESS website. If you’re paying by credit or debit card, you can use Visa, MasterCard, American Express, or Discover.

You can also pay by check or money order. This will take us more time to process than an online payment. If you pay by check or money order:

  • Make the check or money order out to BadgerCare Plus Premium.
  • Write your case number on the check or money order.
  • Fill out and cut off the top section on the last page of your monthly statement, and include it with your check or money order. Including that section helps us process your payment more quickly.
  • Mail your check or money order to the following address:

State of Wisconsin
PO Box 93651
Milwaukee, WI 53293-3651

Can I pay with cash?

No.

Can other people help me pay my premium?

Yes.

Can I prepay my premium?

No.

Can I get help with paying my premium?

Yes. You can call 888-907-4455 to ask for help with paying your premium. You’ll need to provide the following information when you call:

  • Your full name.
  • Your Social Security number, case number, or ForwardHealth ID.
  • Your date of birth.

What is the State of Wisconsin e-Payment Services?

When you use the MyACCESS mobile app or the ACCESS website to make your payment, you will be taken to a U.S. Bank app or website to make your payment. The app and website are secure, and U.S. Bank will only use the information you provide for your premium payment.

Why is the e-Payment Services website and app only available in English?

This is a U.S. Bank website and app. We are working with them to make the website and app available in Spanish. There isn’t a date for this yet.

If you need language assistance when using the e-Payment Services website or app, please call ForwardHealth Member Services at 800-362-3002, Monday through Friday, from 8 a.m. to 6 p.m.

Can I set up autopay?

No.

Are there instructions on how to make a payment using the MyACCESS mobile app or the ACCESS website?

Who can I contact if I need help when paying online?

You can call ForwardHealth Member Services at 800-362-3002, Monday through Friday, from 8 a.m. to 6 p.m.

When does this start?

  • If you’re applying for BadgerCare Plus benefits, it starts February 1, 2020.
  • If you’re already getting BadgerCare Plus benefits, it starts with your next renewal due on or after March 31, 2020.

For example, your renewal is due June 30. You renew your benefits on June 23. Based on the information you provide, you now have to pay a monthly premium. You would first be charged a premium on July 10.

The start date is different for everyone, so make sure you’re reading the letters you get. They will tell you if you owe a premium and when it is due.

 

 Treatment Needs Question

What is a treatment needs question?

It’s one question that asks, “During the last 12 months, have you used drugs in ways that cause problems for you or those around you, and are you open to getting help?”

What is considered a drug?

  • Cannabis (for example, marijuana or hashish)
  • Narcotics or opioids (for example, oxycodone or heroin)
  • Stimulants (for example, cocaine or methamphetamine)
  • Hallucinogens (for example, LSD)
  • Solvents (for example, paint thinner)
  • Tranquilizers/benzodiazepines (for example, valium)
  • Barbiturates
  • Any prescribed or over-the-counter drugs taken in ways or amounts not directed

In this case, drugs do not include alcohol or tobacco or using prescription drugs as directed.

Who has to answer the treatment needs question?

You may have to answer a treatment needs question if you:

  • Are age 19–64.
  • Aren’t pregnant.
  • Don’t have children under age 19 who are living with you.

Even if all those apply to you, you still may not have to answer the treatment needs question. You don’t have to answer the treatment needs question if you:

  • Are a tribal member.
  • Are a child or grandchild of a tribal member.
  • Qualify for Indian Health Services.
  • Have stayed or expect to stay in a medical institution (such as a hospital, nursing home, or rehabilitation center) for at least 30 days.
  • Have a disability.

How will I know if I have to answer the treatment needs question?

We’ll ask you the question based on the information you give us when you apply for or renew your benefits.

If you apply or renew using the ACCESS website or by calling your agency, we’ll ask right then. If you don’t answer then or you apply or renew by paper, we’ll send you a letter asking you to answer the question.

What happens if I don’t answer the treatment needs question?

You won’t be able to get BadgerCare Plus benefits.

Does my answer affect my benefits?

No. Your answer just helps us get to know your health care needs better.

What will you do with my answer?

We’ll share it with your health plan. This will help them get to know your health care needs better.

Your health plan is also called your HMO or MCO. This is a group of doctors, clinics, and hospitals you can get health care services from.

How can I answer the treatment needs question?

You can answer through any of the following:

Can someone else answer the treatment needs question for me?

Yes. The following can answer the treatment needs question on your behalf:

  • An authorized representative
  • A financial power of attorney
  • A legal guardian over your estate
  • Someone you say can answer the treatment needs question for you

When does this start?

  • If you’re applying for BadgerCare Plus benefits, it starts February 1, 2020.
  • If you’re already getting BadgerCare Plus benefits, it starts with your next renewal due on or after March 31, 2020.

 

 BadgerCare Plus Health Survey

What is the BadgerCare Plus Health Survey?

It’s a list of questions about your health, such as whether you exercise or smoke.

Who can take the survey?

You can take the survey if you:

• Have applied for or are enrolled in BadgerCare Plus.
• Are age 19–64.
• Aren’t pregnant.
• Don’t have children under age 19 who are living with you.

The survey is completely optional. You don’t have to take it.

Will my survey answers be shared?

Your survey answers will be shared with your health plan. This will let them know what your health care needs are so they can help you manage your care.

Your health plan is also called your HMO or MCO. This is a group of doctors, clinics, and hospitals you can get health care services from.

Why should I take the survey?

  • It will help us get to know your health care needs better.
  • If you pay a premium, you could lower it by showing you have healthy habits, have a health condition that keeps you from participating in healthy habits, or are managing your health risks. We usually just shorten this to say you “have a healthy habit.”

What do you mean by “a healthy habit”?

This is something you do that shows you are trying to be healthy or safe. An example is exercising or wearing your seatbelt.

What do you mean by “a health condition that keeps me from participating in healthy habits”?

This is a medical condition, such as an injury or illness, that keeps you from being healthy. An example is having a disability that keeps you from exercising.

What do you mean by “managing a health risk”?

This means you are trying not to do something that is bad for your health. An example is trying to quit smoking.

How can I take the survey?

You can take the survey any of the following ways:

I pay a monthly premium. How much can I lower it by taking this survey?

Your premium will start at $8 per month.

  • If you’re not married and have healthy habits, your premium would be $4 per month.
  • If you’re married and both you and your spouse have healthy habits, your premium would be $4 per month.
  • If you’re married but only one spouse has healthy habits, your premium would be $6 per month.

I pay a monthly premium. How will I find out if I lowered my premium based on my survey answers?

You’ll get a letter titled “About Your Benefits” that will tell you what your premium amount is.

How often can I take the survey?

You can take it as often as you’d like. If you pay a premium, keep in mind that your answers may affect how much you pay.

Can someone else take the health survey for me?

Yes. The following can take the health survey on your behalf:

  • An authorized representative
  • A financial power of attorney
  • A legal guardian over your estate
  • Someone you say can take the survey for you

Do I have to answer all of the survey questions?

No, but you do need to answer at least one. If you pay a premium, keep in mind that your answers may affect how much you pay. You have a better chance of lowering your premium if you answer more questions.

If I’ve already taken the survey, how can I see my answers?

Log into your ACCESS account through the MyACCESS mobile app or the ACCESS website, and choose the survey option from the menu. You’ll be able to see your answers on the screen and also download a PDF of your answers.

When can I take the survey for the first time?

  • If you’re applying for BadgerCare Plus benefits, the earliest you could take it is February 1, 2020 (and only after you apply).
  • If you’re already getting BadgerCare Plus benefits, the earliest you could take it is with your next renewal due on or after March 31, 2020.
Last Revised: June 9, 2021