Know Your Health Insurance Options

Imagery for open enrollment, woman and child.

There are many paths to quality health insurance. Some people find affordable coverage through an employer. If you are 65 and older, or have a qualifying disability, you may be eligible for Medicare or Supplemental Security Income-Related Medicaid. If these options aren’t right for you, there is a state or federal health insurance program that can help. 

HealthCare.gov

HealthCare.gov plans

The federal Health Insurance Marketplace, HealthCare.gov, helps individuals and families shop for and enroll in affordable health plans. 

When can I apply?

You can apply for coverage during the open enrollment period, November 1 through December 15, 2020, for 2021 health care coverage. If you need health coverage for 2020 see if you are eligible for a special enrollment period on HealthCare.gov.

Can I qualify for financial assistance?

When you apply for coverage on HealthCare.gov, you’ll find out if you qualify for help to make your coverage more affordable.

What do I need to apply?

You’ll need to answer a few questions about your household to apply for coverage. The process is quicker and easier when you have this information on hand. Here’s what you’ll need:

  • Social Security number(s)
  • Date(s) of birth
  • Home address
  • U.S. citizenship or immigration status
  • Employment information
  • Estimated household income
  • Other income and benefits, like child support, Social Security, or unemployment
  • Housing and utility expenses
  • Previous HealthCare.gov account information (for returning consumers)
How to compare health plans

Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler. Learn more about comparing HealthCare.gov plans.

Understand your insurance costs
  • Copay: A payment you make for a health care service.
  • Deductible: The amount you pay for covered health care services before your insurance begins to pay. For example, if you have a $200 deductible each year, you pay the first $200 of covered services yourself. Once you pay the deductible, you will only have to pay a copay for services.
  • Coinsurance: The amount you pay to share the cost of covered services after your deductible has been paid. The coinsurance rate is usually a percentage. For example, if the insurance company pays 90% of the service costs, you will pay 10%.
  • Premium: A set amount of money your household pays each month to have health care coverage.
  • Out-of-pocked maximum: This is the most you will have to pay each year for health care coverage. It includes your deductible and copays. Your insurance will cover all of the costs of your health care once you have paid this amount. This amount does not include any premiums you may have to pay.
Ready to apply?

Apply now at HealthCare.gov. If you're not sure what plan is right for you and need help, you can get help from an expert. Find a local health insurance expert to help you make the right choice today.

BadgerCare Plus (Medicaid)

BadgerCare Plus (Medicaid)

BadgerCare Plus is a joint federal and state program that provides high-quality health care coverage for people who are ages 0-64. Low income adults, pregnant women, and children may qualify for BadgerCare Plus.

BadgerCare Plus is one of the largest health insurance programs in the state, providing around 900,000 Wisconsinites low or no-cost, high-quality health care.

What does BadgerCare Plus cover?

BadgerCare Plus coverage is no different than any other health insurance coverage. It provides a wide variety of services and supports, including but not limited to: 

  • Case management services
  • Chiropractic services
  • Dental services
  • Family planning services and supplies
  • HealthCheck: Preventive health care for children and young adults through age 20 (Early and Periodic Screening, Diagnosis and Treatment benefit)
  • Some home and community-based services
  • Home health services or nursing services if a home health agency is unavailable
  • Hospice care
  • Inpatient hospital services other than services in an institution for mental disease
  • Inpatient hospital, skilled nursing facility, and intermediate care facility services for patients in institutions for mental disease who are:
    • Under 21 years of age
    • Under 22 years of age and were getting services when they turned 21 years of age
    • 65 years of age or older
  • Intermediate care facility services, other than services at an institution for mental disease
  • Laboratory and X-ray services
  • Medical supplies and equipment
  • Mental health and medical day treatment
  • Mental health and psychosocial rehabilitative services, including case management services, provided by staff of a certified community support program
  • Nurse midwife services
  • Nursing services, including services performed by a nurse practitioner
  • Optometric/optical services, including eye glasses
  • Outpatient hospital services
  • Personal care services
  • Physical and occupational therapy
  • Physician services
  • Podiatry services
  • Prenatal care coordination for women with high-risk pregnancies
  • Prescription drugs and over-the-counter drugs
  • Respiratory care services for ventilator-dependent individuals
  • Rural health clinic services
  • Skilled nursing home services other than in an institution for mental disease
  • Smoking cessation treatment
  • Speech, hearing, and language disorder services
  • Substance abuse (alcohol and other drug abuse) services
  • Transportation to obtain medical care 
  • Tuberculosis (TB) services
    When can I apply?

    You can check to see if you are eligible and apply at any time during the year. 

    Am I eligible?
    • The only way to know if you are eligible is to apply. If you would like to see if may be eligible before you apply, go to our online application and choose “See if you qualify.” You will be asked questions to see if you might be eligible.​
    • BadgerCare Plus has a monthly income limit that is based on things like the number of people in your household and how much money your household makes every month.
    What do I need to apply?

    When you apply for BadgerCare Plus, you may be asked to provide some or all of the following information for each person applying. Having this information available when you apply will make applying easier and faster.

    • Social Security number(s)
    • Date(s) of birth
    • Home address
    • U.S. citizenship or immigration status
    • Employment information
    • Estimated household income
    • Other income and benefits, like child support, Social Security, or unemployment
    • Housing and utility expenses
    Ready to apply?

    You can apply for BadgerCare Plus and other benefits and programs online, by phone, by mail, or in person at your agency. If you read or write in a language other than English or Spanish, you will need to apply by calling your agency or submitting a paper application.

     

    Protect yourself from scams

    The federal government and the Wisconsin Department of Health Services will not call you seeking personal or financial information. 

    The Federal Trade Commission (FTC), the nation's consumer protection agency, advises consumers not to give out personal or financial information to people you do not know through phone calls, text messages, emails, or knocks on your door. Scam artists want your information to commit identity theft, charge your existing credit cards, debit your checking account, open a new credit card, checking, or savings account, write fraudulent checks, or take out loans in your name.

    To file a complaint with the FTC, go to their website, or call 877-FTC-HELP. If you think your identity has been stolen, report it on the FTC’s website, or call 877-ID-THEFT.

    Last Revised: October 23, 2020