BadgerCare Plus Program



 

BadgerCare Plus

Coverage for Low-Income Pregnant Women, Children and Families

Administered by the state-funded ForwardHealth organization, the BadgerCare Plus program provides medical coverage to a significant population in Wisconsin: infants, children, pregnant women and parents. Childless adults were also covered by BadgerCare Plus until 2014. The program offers comprehensive medical coverage for various services including prescriptions, maternity care, doctor’s office visits, and emergency care.

Beginning in the 2014 enrollment year, adults eligible for or enrolled in BadgerCare Plus’ Core Plan are referred to the Wisconsin Health Insurance Exchange for subsidized coverage. The exchange provides tax credits to low-income adults who wish to purchase an affordable health plan that covers a wide range of benefits. If you were waitlisted for the Core Plan, you will also be able to apply for coverage on the marketplace.

 

BadgerCare Plus

Eligibility for BadgerCare Plus

Depending on your income and eligibility group, you may be able to enroll in ForwardHealth insurance benefits if you’re already a U.S. citizen or legal resident who lives in the state of Wisconsin. Pregnant women can enroll in BadgerCare Plus for the duration of their pregnancy, and immediately enroll their newborn child after birth. Children of all incomes have access to full insurance benefits until their 19th birthday, and parents can also receive coverage if their income is low-to-moderate and their children live at home. Income criteria varies for each group, and changes slightly each year with the federal poverty line.

2013 Federal Poverty Level

Eligible Groups and Income Limits

  • Children: No income limit
  • Pregnant Women: 300% FPL
  • Parents and Caretakers: 200% FPL
  • Parents with Children in Foster Care: 200% FPL
  • Farm Families
  • Self-Employed Families

 

Plans and Coverage

ForwardHealth BadgerCare Plus provides services ranging in cost depending on the plan in which you are enrolled. There are four main plans (not including the Core Plan for childless adults, which is no longer available); two for full coverage through the Standard and Benchmark plans, and two partial coverage programs for prenatal services and family planning. Services may be free or covered at a copayment.

 

Standard Plan

Standard plans cover lower-income individuals and include a variety of medical benefits at a minimal cost. Copays range from $0/50 to $3 depending on the type of care received, and you may be asked to pay multiple copays at once for obtaining more than one type of care.

 

Service Cost Copay
Up to $10 $0.50
$10 to $25 $1
$25.01 to $50 $2
Over $50 $3

 

Covered Services Under Standard Plan

  • Dental
  • Vision (exams and eye glasses)
  • Family Planning
  • Laboratory and X-ray
  • HealthCheck, or Early and Periodic Screening, Diagnosis and Treatment for members under age 21
  • Case management services
  • Select home and community-based services
  • Hospice care
  • Chiropractic
  • Inpatient hospital care
  • Inpatient mental health care for members under age 21 or age 65 or older
  • Nurse midwife services
  • Mental health and medical day treatment
  • Intermediate care facility services
  • Outpatient hospital care
  • Nursing care, including services obtained from a nurse practitioner
  • Medical supplies and equipment
  • Psychosocial rehabilitative and mental health services
  • Tuberculosis (TB) treatment
  • Substance abuse treatment
  • Personal care
  • Physical and occupational therapy
  • Community health clinic services
  • Respiratory care for ventilator-dependent members
  • Podiatry
  • Over-the-counter and prescription medications
  • Tobacco cessation
  • Prenatal care for high-risk women
  • Medical transportation
  • Speech, hearing and language disorder treatment
  • Skilled nursing home care

 

Benchmark Plan

Benchmark plan members have access to coverage at a higher cost than Standard plan members as this is designed for those who earn slightly more. Services may have certain limitations and cost more depending on the type of care. For instance, the copay for an outpatient hospital visit is $15, an outpatient ER visit is $60, and prescription drugs are $5. Some services are free, including prenatal and maternity care, end-stage renal disease treatment, and family planning services.

Certain members do not have to pay a copay for services, including:

  • Children under age 19 with household income up to 100% FPL
  • Children under age 6 with household income between 100 and 150% FPL, excluding newborns
  • Children ages 1-5 who belong to a federally recognized tribe with income between 185 and 300% FPL
  • Children ages 6-18 who are Tribal members with income between 150 and 300% FPL
  • Institutionalized children under age 19
  • BadgerCare Plus Extension enrollees under age 19
  • Pregnant women, excluding those under age 19 with family income over 300% FPL
  • Pregnant women enrolled through Express Enrollment
  • BadgerCare Plus Prenatal Services members

 

Covered Services Under Benchmark Plan

  • Ambulatory surgery
  • Dental care
  • Chiropractic
  • Disposable Medical Supplies
  • Hospice
  • End-Stage Renal Disease
  • Prescription Drugs
  • Prenatal and Maternity Care
  • Hearing services
  • Pediatric HealthCheck screenings (for children under 21 years old)
  • Home Care
  • Hospitalization
  • Mental health and substance abuse treatment
  • Physician services
  • Outpatient hospital care
  • Emergency care
  • Nursing home services
  • Family Planning
  • Podiatry
  • Medical Transportation
  • Eye exam

 

Individual Health Insurance Quotes

Adults Without Children

If you were formerly a BadgerCare Core plan member, or are an adult without dependent children living with you in Wisconsin, you may qualify for affordable coverage on the health insurance marketplace. The marketplace is separate from BadgerCare, and is operated by the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) in Washington. Plans are available through a number of Wisconsin health insurers so that you can find a network that suits your needs. The government issues subsidies to reduce premiums and cost sharing for those who earn from 100 to 250% of poverty, and premium tax credits for incomes from 100-400% FPL.

Research your options on the exchange and find out if you qualify for a subsidy by calling a licensed East Coast Health Insurance agent at 888.803.5917.

 

How to Apply

You can apply online, over the phone, by mail, or in person at your local health department. To obtain an application, you can contact the state Human Services Department at 800-362-3002, or visit the DHS Customer Help page. Apply online at ACCESS.wi.gov.

Paper applications can be sent or faxed to:

Milwaukee County residents only

Milwaukee Document Processing Unit
P.O. Box 05676
Milwaukee, WI 53205
Fax: 888-409-1979
Non-Milwaukee County Residents
Central Document Processing Unit
P.O. Box 7190
Madison, WI 53707-7190
Fax: 855-293-1822

Resources

ForwardHealth Enrollment Information and Benefits (PDF)

Medicaid