On Wisconsin! Go BadgerCare!

BadgerCare is Wisconsin’s healthcare plan for low-income residents—and as state healthcare programs go, it’s one of the best. Wisconsin now ranks second in the country in percentage of people with access to health care. Massachusetts, with its mandatory health insurance program, is first.

Many states have health care options for low-income families with children, as does Wisconsin. But the Wisconsin legislature saw a need for a health care plan for adults without dependent children, and created the BadgerCare Plus Core Plan.  Here are the requirements for applying. You are eligible if you:

  • Are a Wisconsin resident;
  • Are a U.S. citizen or legal immigrant;
  • Are age 19 through 64;
  • Do not have children or do not have dependent children, under age 19 living with you;
  • Are not pregnant;
  • Have family income at or below 200% of the federal poverty level guidelines ($1,805 for a single person and $2,428.33 for a married couple*);
  • Do not have private health insurance coverage when you request Core Plan coverage or in the 12 months before that date;
  • Do not currently have access to insurance from an employer;
  • Cannot sign up for insurance from an employer during month of application or next three months;
  • Did not have access to insurance from an employer in the 12 months before you request Core Plan coverage; and
  • Are not getting BadgerCare Plus, Medicaid or Medicare.

Once an applicant is accepted to BadgerCare Plus Core Plan, the healthcare is free with the exception of $3 co-pays for doctor visits and some prescriptions, and $100 for a hospital stay. The covered benefits are remarkably comprehensive.

As of June 15, 2009, the Wisconsin Department of Health Services began accepting applications for the BadgerCare Plus Core Plan with the earliest enrollment date July 15, 2009. Unfortunately, by October 2009, the application process for the plan was suspended because the total number of applications was greater than the 60,000 slots available. A Core Plan wait list was created, and people on the wait list will be able to enroll in the Core Plan as space becomes available.

But a wait list was not good enough for Wisconsin Governor Jim Doyle. On June 1, 2010, he announced that individuals who are currently waiting for health care coverage under the BadgerCare Plus Core Plan now have the option to enroll in the BadgerCare Plus Basic plan. The Basic plan is an entirely self-funded health care plan created for more than 50,000 adults without dependent children who are on the BadgerCare Plus Core Plan waiting list. Benefits will start for some enrollees July 1, 2010. Premiums will be $130 per month.

“This will not be a Cadillac health plan,” Governor Doyle said. “In fact, it will be just what the name suggests – it will be basic.  But basic coverage can be the difference between a treatable condition and a trip to the emergency room.  And basic coverage can be the difference between having protection while you try and get your feet back on the ground and going bankrupt trying to pay for medical care.”

Members will have access to catastrophic coverage plus:

•Up to 10 physician visits each year;

•Limited hospitalization;

◦Coverage for first inpatient hospital stay and five outpatient hospital visits;

◦Subsequent stays after $7,500 deductible;

•Up to five emergency room visits each year;

•Some generic medications; and

•Badger Rx Gold discount drug membership.

The Basic plan is not designed to be a long-term health coverage plan, but is instead a temporary plan to help people take care of their health care needs while they wait for coverage on the BadgerCare Plus Core Plan. BadgerCare Plus Basic builds on Governor Doyle’s work over the last seven years to make Wisconsin a health care leader.