Is Badgercare Medicaid Or Medicare

Community Health Benefits Enrollment

Improving quality of life means taking care of your health. The Social Development Commission wants to help the community get the benefits they need to live a healthy life.

SDCs benefits enrollment program provides one less thing for our community to worry about. We will help you apply for the benefits that are available to you.

Learn more about the different benefits enrollment programs that SDCs Navigators can help you with. Submit an inquiry form below.

• Prescription Medication Assistance

What Are Qmb Slmb And Slmb+medicare Savings Programs

SLMB

• Pays Medicare Part B premium
• Includes Low-Income Subsidy for prescription drug coverage
• Can be backdated up to 3 months

SLMB+/QI

• Pays Medicare Part B premium
• Includes Low-Income Subsidy for prescription drug coverage
• Can be backdated up to 3 months
• Cannot be combined with any other Medicaid program

Wisconsin Medicaid And Badgercare Plus Deductible

English, Spanish

The Wisconsin Medicaid /BadgerCare Plus Deductible plan is for those people who meet all the program rules, except the income limit rule and who have high medical bills.

You may be able to enroll in a Deductible plan, if you are a:

• Pregnant woman,
• Child under 19 years of age, or
• Elderly or disabled adult.

You can use the cost of unpaid and recently paid bills for medical or remedial expenses to meet your deductible. You will need to provide proof of the expenses to your agency. Once your deductible has been met, Medicaid/BadgerCare Plus will pay for covered services until the end of the six-month period.

Medical expenses are cost for services or goods that have been prescribed or provided by a professional medical practitioner. The expense is for diagnosis, cure, treatment, or prevention of disease or for treatment affecting any part of the body.

Examples of medical expenses include:

• Health insurance premiums, and
• The portion of medical bills you must pay for yourself, your spouse or your minor children after Medicare and private insurance has paid.

Remedial expenses are costs for services and/or goods that you get to relieve, remedy or reduce a medical or health condition. These are costs that you are expected to pay and cannot be paid by any other source, such as Medicaid or BadgerCare Plus, private insurance, or an employer.

Some examples of remedial expenses are:

• Case management

Remedial expenses do not include housing or room and board services.

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Healthy Pregnancy And Birth Information

MercyCare is committed to helping our members achieve a healthy birth outcome. See your health care provider if you know you are pregnant and follow their recommendations throughout your pregnancy.

• MercyCares Healthy Babies is offered to pregnant MercyCare Medicaid members who enroll before their 16th week of pregnancy. In the program, you work with your OB provider to ensure that you have the best possible pregnancy experience and a healthy baby. Please call or email to sign up for this program.

It is important to return to your doctor within six weeks after your childbirth for a postpartum checkup.

How Much Do Copays Cost

Most copays cost from $0.50 to $3.00. The cost depends on the service. If you get more than one service, you may have more than one copay. Table 2 below shows copay costs.

Learn more about the Emergency Room Copay. View BadgerCare Plus: Some Adults Need to Pay a Copay for Going to the Emergency Room When Its Not an Emergency, P-02580.

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Unitedhealthcare Connected General Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

Medicaid Member Annual Survey

Thank you for choosing MercyCare HMO as your health care partner. Please take a moment to fill out our Medicaid Member Satisfaction Survey. We make member service changes based on your feedback. If you would like a paper copy of this survey, please contact the Medicaid Advocate at between 8:30 am and 4:30 pm, Monday-Friday.

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Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

How To Apply For Medicaid And Badgercare Plus In Wisconsin

Before you start the application process, you should have the following information available:

• You and your spouses taxable income.
• Social Security numbers and birthdates of people in your home.
• Current or recent health insurance information.
• Identity and citizenship information, or alien registration information.
• Income information including employer name, address and phone number, of all household members who are employed.
• Amount of money received from other types of income.
• Expected date of delivery and number of babies of any pregnant household member.
• Current health insurance information for all household members with health insurance including company name, policy or group number, type of coverage, effective date, policy holders name, and ID.

Applicants can apply online, by phone, by mail or in person at their local Wisconsin Department of Health Services agency.

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What Does Badgercare Plus Cover

BadgerCare Plus covers services like those in the list below. To find out about coverage for a specific service, call ForwardHealth Member Services at 800-362-3002.

BadgerCare Plus covers:

• Care with a nurse or nurse practitioner.
• HealthCheck, which gives health care to kids and young adults .
• Lab work and X-rays.
• Prescription drugs and over-the-counter drugs.

Using Your Forwardhealth Card

After you get BadgerCare Plus, well send you a ForwardHealth card in the mail. If you had Family Planning Only Services, BadgerCare Plus, or Medicaid in the past, you wont get a new card. You can use the same card you used before.

Need a card? Go to your ACCESS account or call ForwardHealth Member Services at 800-362-3002.

Your ForwardHealth card includes your name. It also has a 10-digit number and magnetic stripe. There is a place for you to sign your name as soon as you get it. If you need help, the Member Services phone number is on the card.

You must show your card when you go to the doctor. You also need it when you pick up medicine at the pharmacy.

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Unitedhealthcare Senior Care Options Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Medicaid And Badgercare Eligibility In Wisconsin

To be eligible for Wisconsin Medicaid, you must meet certain requirements before submitting your application. In general, the following eligibility standards apply:

• You must be a resident of Wisconsin
• Be a U.S. citizen or legal immigrant
• Meet financial income and resources limitations standards

Wisconsin Medicaid offers several programs that will have more specific eligibility requirements and will depend on the type of care you need. You will need to review specific program details to determine if you are eligible or call Wisconsin Medicaid to discuss your particular situation.

BadgerCare provides healthcare coverage programs for low-income Wisconsin residents who are not elderly, blind or disabled but still need healthcare coverage. It does not have an open enrollment period, and people can apply at any time.

Eligible groups include:

• All children under age 19, regardless of income.
• Pregnant women with incomes up to 300% of the Federal Poverty Level .
• Parents and relatives caring for a child up to 200% of the FPL.
• Young adults in foster care who turn 18 on or after January 1, 2008, will automatically be able to get BadgerCare until they turn 21, regardless of income.
• Farm families and other families who are self-employed may be eligible under BadgerCare if their income is under 200% of the FPL.
• Parents whose child/children are in foster care and who have a reunification plan in place may be eligible for BadgerCare if their income is below 200% of the federal poverty level.

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Limited Coverage Health Care Plans

BadgerCare Plus also has several limited coverage health care plans. These include:

• Family Planning Only Services. People of childbearing or reproductive age may be eligible for limited benefits under the Family Planning Only Services Program.
• BadgerCare Plus Prenatal Program. Documented and undocumented immigrants who are pregnant and ineligible for BadgerCare Plus solely due to their immigration status may be eligible for the BadgerCare Plus Prenatal Program.
• BadgerCare Plus Emergency Services. Documented and undocumented immigrants who are children, pregnant women, parents, or caretakers and who are ineligible for BadgerCare Plus solely due to their immigration status may be eligible for coverage for BadgerCare Plus Emergency Services.
• Tuberculosis -Related Medicaid. People infected with TB who are not eligible for any other category of full-benefit BadgerCare Plus or Medicaid may be eligible for limited benefits for the treatment of TB.

Enrollment Issues And Badgercare+ Basic

The extremely high number of applications for the BadgerCare+ Core plan put undue stress on the program’s budget, and Doyle suspended enrollments for that program in October 2009 with 21,000 individuals still on the waiting list. To assuage the thousands of Wisconsinites still seeking coverage, Doyle proposed an additional plan named BadgerCare+ Basic, targeted at childless adults. The income stipulations for BadgerCare+ Basic were $21,660 a year for a single childless individual and $29,140 for a childless couple. In contrast to Badgercare+ Core, coverage would be funded by a $130 premium to be paid by the policyholder, rather than taxpayers, and would cover up to 10 doctor visits, one inpatient hospital visit, five outpatient visits, and up to five emergency room visits in addition to some generic medications and discounts on other drugs. Signing the BadgerCare+ Basic bill into law in May 2010 was one of Doyle’s last major acts as governor, as he did not seek re-election in the 2010 Wisconsin gubernatorial election.

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Badgercare Plus: Covered Services And Copays

BadgerCare Plus covers health care services. Some members get all services at no cost. Some members get some services at no cost and may have a copay for others. A copay is money you pay each time you get a health service. Here, we explain more about services BadgerCare Plus covers and copays.

Badgercare Plus Coverage Groups

Populations eligible for BadgerCare Plus include:

• Children younger than 19 years old
• Parents and caretakers of children younger than 18 years old and dependent 18-year-olds
• Parents and caretaker relatives whose children have been removed from the home and placed in out-of-home care
• Former Foster Care Youth younger than 26 years old who were in out-of-home care when they turned 18
• Adults ages 1964 who are not receiving Medicare and do not have dependent children

For information on income limits, see Section 16.1 Income and Section 50.1 Federal Poverty Level Table.

All BadgerCare Plus members receive coverage under the Standard Plan. See Chapter 38 Covered Services for information on covered services.

BadgerCare Plus is funded by Medicaid and CHIPChildren’s Health Insurance Program. CHIP, which is also known as State Children’s Health Insurance Program or Title 21, is primarily a program covering low-income childrens health care needs. In Wisconsin, these low-income children include children with incomes above the Medicaid income limits up to 306% of the Federal Poverty Level . Children eligible for CHIP are covered under BadgerCare Plus. CHIP also covers pregnant women who are enrolled in the BadgerCare Plus Prenatal Program.

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No Aca Medicaid Expansion But No Coverage Gap Either

Although Wisconsin has not expanded Medicaid under the guidelines laid out in the Affordable Care Act , the states Medicaid program does cover all legally present residents with incomes under the poverty level. Wisconsin is the only non-Medicaid-expansion state that does not have a coverage gap all low-income residents either have access to Medicaid or subsidies to help them purchase private coverage in the exchange.

Premium subsidies in the marketplace are only available if a persons income is at least the poverty level. In most states, subsidy eligibility actually starts above 138% of the poverty level, as Medicaid expansion covers adults with income up to that level. But there are 12 states that have not expanded Medicaid under the ACA. Wisconsin is one of them, but Wisconsin does make Medicaid available to adults with income up to the poverty level. So theres a seamless transition from Medicaid eligibility to premium subsidy eligibility in Wisconsin.

Thats not the case in the other 11 states that have not expanded Medicaid. Instead, Medicaid for adults under 65 is not available at all in those states unless a person is disabled, pregnant, or caring for a minor child. And the income limits for parents tend to be quite low well below the poverty level.

Federal poverty level calculator

• $1.6 billion Federal money Wisconsin is leaving on the table in 2021-2022 by not expanding Medicaid

The Basics Of Badgercare Plus And Medicaid Ssi

BadgerCare Plus is the state of Wisconsin’s health insurance program. It covers children, adults and families that are in need of additional assistance with health care costs. When you sign up for BadgerCare Plus, you choose your HMO plan. If you don’t choose one, the state will assign one for you.

Medicaid SSI health care coverage is for individuals age 65 or older or who are blind or disabled. Visit the State of Wisconsin webpage for more information.

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Walker And Evers Administrations

In 2013, Governor Scott Walker rejected federal money, and 92,000 people were told that their health insurance through BadgerCare Plus would end and that they would be required to buy potentially more costly commercial health coverage under the Affordable Care Act.

In 2019, Governor Tony Evers wants to expand BadgerCare Plus by about 76,000 participants, which Republican opponents argue will “shift costs to the private sector.”

How Does Medicaid Provide Financial Help To Medicare Beneficiaries In Wisconsin

Many Medicare beneficiaries receive assistance from Medicaid with Medicare premiums, prescription drug costs, and expenses not covered by Medicare including long-term care.

Our guide to financial assistance for Medicare enrollees in Wisconsin includes overviews of these benefits, including Medicare Savings Programs, Medicaid nursing home coverage, and eligibility guidelines for assistance.

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What Do I Have To Pay

You may have to pay a copay for some health services. Members who dont have copays include:

• Kids under age 19.
• Kids in foster care.
• Kids in adoption assistance.
• Youth who were in foster care on their 18th birthday. They dont have to pay any copays until age 26.
• American Indians or Alaskan Native Tribal members, children or grandchildren of a tribal member, or anyone who can get Indian Health Services. Age and income do not matter. This applies when getting items and services from an Indian Health Services provider or from the Purchase and Referred Care program.
• Members who join by Express Enrollment.
• People in hospice care who are very ill.
• People who live in a nursing home.
• Women who are pregnant or who had a baby in the past 60 days.

Other members may have copays. This is based on if your family income is at or below the monthly limit based on family size. Use Table 1 below to find your family size and income limit.

For example: If you are a single parent with one child , your family size is two. That means your income each month must be lower than $718. If its lower, you wont have a copay. If its higher, you will have a copay. You wont have a copay for services for your child since they are under age 19.