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Children's Health Insurance Program (Wisconsin)

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Wisconsin BadgerCare Plus

Wisconsin BadgerCare Plus provides health insurance to Wisconsin children under the age of 19, whose families meet the income requirements.

Eligibility Requirements

To be eligible for BadgerCare Plus, your child must live in Wisconsin and must be either a U.S. citizen or a legal immigrant. Your income must be within the guideline limits i.e. up to 200% of the federal poverty level. Your child must not be covered by other health insurance.

Waiting Periods
There is a 12 month waiting period for those individuals with current health care coverage to be eligible for BadgerCare Plus benefits. The exception to this rule would be if coverage was lost due to a "good cause" reason. Examples of good cause reasons include loss of job (unless you voluntarily quit), loss of job because you were unable to work due to an illness or injury, change to a new job that does not offer group benefits, termination of COBRA, group benefits lost due to reduction in hours or employer terminated group health plan for all employees.

Covered Services and Benefits
BadgerCare Plus of Wisconsin provides comprehensive coverage for all of the medical needs listed below:

  • Doctor visits
  • Vaccinations
  • Prenatal Care
  • Hospitalization
  • Prescription drugs
  • Vision care
  • Hearing services
  • Family planning assistance
  • Mental health services
  • Medical equipment
  • Speech, physical and occupational therapy
  • Lab and x-ray
  • Health check
  • Home health services
  • Hospice care
  • Substance abuse services

Health Plan Choices
The majority of families with children receiving health care through Wisconsin's BadgerCare Plus Program are enrolled in HMO's. The exception to this would be if there is only one HMO available to you in your area. If such is the case, you may receive your health care from any provider who accepts the BadgerCare Plus Forward card.

Premium Payments, Co-Payments and Coinsurance
Whether or not a monthly premium is required depends upon your family income. If the family income is below 200% of the FPL, your child will be enrolled in the Standard plan where you will pay no premium. If it's above 200%, you will pay a monthly premium that is no more than 5% of your family income under the Benchmark plan. Co-payments for health care services range from $.50 to $3.00 for families with lower incomes. Families with higher incomes will be required to co-payments for certain health care services such as $5.00 for prescription drugs and $100.00 for a hospital stay. Under both plans, there are no co-payments for well child checkups and other preventive services.

Program Length, Enrollment and Renewal
Coverage under BadgerCare Plus is available for as long as you meet the original enrollment guidelines. A review of your eligibility will be conducted annually. Program requirements are subject to change from one year to the next.

Contact
Applications for BadgerCare Plus must be submitted in the location designated for your county. For more information, contact BadgerCare Plus at: 1-800-362-3002

Wisconsin BadgerCare Plus Website

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