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BadgerCare Plus

Wisconsin’s Medicaid program for children, families, and pregnant women is BadgerCare Plus. BadgerCare Plus also administers the Children’s Health Insurance Program for children under 19 years old with any level of income. Parents and caretakers with income up to 200 percent of the Federal Poverty Level, and pregnant women who earn up to 300 percent FPL can also get coverage through BadgerCare Plus. BadgerCare Plus also provides limited family planning services to those with incomes over the limit for adults. Adults without children were at one point covered by BadgerCare, though that segment of the program has now closed its doors for enrollment.

Each eligibility group has different specifications to qualify, but once enrolled, everyone can enjoy a vast number of medical services for a small copay. Copays also vary based on the plan in which you are enrolled, though certain members are not required to pay a copay. BadgerCare Plus has two different comprehensive health insurance plans for a monthly premium, a free plan, one plan for temporary maternity coverage, and a plan for family planning only. Depending on your eligibility and income, you will be placed in the Standard Plan or Benchmark Plan as a regular BadgerCare Plus member.

 

BadgerCare Plus Eligibility

BadgerCare Plus covers children up to age 19 with any income level, pregnant women, and parents/caretakers. Young adults who are leaving foster care between ages 18 and 20 can also receive coverage regardless of their income. Parents and caretaker relatives, parents whose children are in foster care, farmers and other self-employed parents are also eligible. In order to qualify, you must be a U.S. citizen or legal immigrant, a resident of Wisconsin, and meet the income limits for your group, if applicable. Based on the current federal poverty level and your total household income based on your family size, you may be able to qualify for one of Wisconsin’s Medicaid programs.

 

Income Guidelines

 

Children Ages 0-19 No Limit

 

Pregnant Women 300%

Family of 2: $3,783 monthly

Family of 3: $4,773 monthly

Family of 4: $5,766 monthly

Family of 5: $6,753 monthly

Add $990 for each additional family member.

 

Parents & Caretakers 200%

Family of 1: $1,862 monthly

Family of 2: $2,522 monthly

Family of 3: $3,182 monthly

Family of 4: $3,842 monthly

Family of 5: $4,502 monthly

Add $660 for each additional family member.

 

Covered Benefits & Copays

The Wisconsin Medicaid program for children and families covers many services at no cost to certain members, and for a small copay to others. Each plan offers a slightly different set of covered services and payments, and benefits for pregnant women also vary from the traditional plans. Standard Plans have copays between $0.50 and $3.00, while adult members of the Benchmark Plan are likely subject to a small fee for their medical services.

 

Standard Plan Benefits

  • Case management
  • Chiropractic
  • Dental care
  • Diagnostic services
  • Family planning
  • HealthCheck (preventive care for members under age 21)
  • Home and community based services (limited)
  • Home health services
  • Hospice care
  • Inpatient hospital, skilled nursing facility, and intermediate care facility for patients in institutions for mental illness who are under 21, under 22 and receiving services when turned 21, or 65 years or older
  • Medical supplies
  • Mental health care
  • Nurse midwife services
  • Nursing services
  • Outpatient hospital care
  • Personal care
  • Physician services
  • Podiatry
  • Prenatal care coordination for high-risk pregnancies
  • Rural health clinics
  • Therapies
  • Transportation
  • Tuberculosis services

 

Benchmark Plan Benefits

  • Ambulance rides – $50
  • Ambulatory surgery centers – $15
  • Chiropractic – $15
  • Dental care – 50% coinsurance
  • Disposable Medical Supplies – $0.50
  • Prescription drugs – $5
  • Durable Medical Equipment – $5
  • Emergency room (outpatient) – $60
  • End-Stage Renal Disease – $0
  • EPSDT for children – $0-1
  • Eye exam – $15 (one per year)
  • Hearing services – $0-15
  • Home health care – $15
  • Hospice care – $0
  • Inpatient hospital – $100 per medical stay
  • Medical transportation – $0-1
  • Mental health care – $50 per inpatient stay, $10-15 outpatient
  • Nursing home services – $0
  • Office visits – $0-15
  • Outpatient hospital – $15
  • Physical, occupational, speech therapy – $15
  • Podiatry – $15
  • Prenatal and maternity – $0
  • Reproductive health – $0

Copayments through the Benchmark Plan do not apply to the following members of BadgerCare Plus:

  • Children under age 19 with income up to 100 percent of FPL, enrolled through Express Enrollment, living in an institution, or enrolled in a BadgerCare Plus Extension
  • Children under age 6 with family income between 100 and 150 percent of FPL with the exception of newborns
  • Children ages 1-5 who are Tribal members with income between 185 and 300 percent FPL
  • Children ages 6-18 who are Tribal members with income between 150 and 300 percent FPL
  • Pregnant women, except for those under age 19 with income over 300 percent FPL
  • Pregnant women enrolled through Express Enrollment, or in BadgerCare Plus Prenatal Services benefit

 

Maternity Benefits

  • Prenatal care
  • Doctor and clinic visits
  • Dental services
  • Labor and delivery
  • Prescription drugs, including prenatal vitamins

 

How to Apply

Use the online ACCESS portal to find out if you qualify for benefits through BadgerCare Plus, apply for benefits, and check on your application status. This is the most efficient way to apply and keep track of your application. Applicants will also receive a response much faster than sending a paper form. However, you can also apply by mail and provide any documentation necessary with your program application and send to:

If you live in Milwaukee County:

MDPU

PO Box 05676

Milwaukee, WI 53205

Fax: 888-409-1979

If you live outside of Milwaukee County:

CDPU

PO Box 5234

Janesville, WI 53547-5234

Fax: 855-293-1822

Download an application

 

Resources

BadgerCare Plus

ACCESS.wi.gov

Locate your local agency

800-362-3002

 

 

 

Sources:

 

1. Wisconsin Department of Human Services. “BadgerCare Plus.” http://www.badgercareplus.org/

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