BadgerCare Plus and Medicaid SSI Benefits

Your Medicaid benefits include:

• PCP visits
• Specialist visits
• Urgent care
• Emergency care*
• Physical therapy
• Disposable medical supplies
• Lab and X-ray services
• Pregnancy services
• Family planning
• Hospital care

Some services require a referral from your PCP.

Registered nurses are available anytime, day or night. They can:

• Advise you on where to go when you need care.
• Help you with any health questions you have.

Call the 24/7 NurseLine 24 hours a day, seven days a week at 1-855-690-7800 (TTY 711).

We’re here if you or a family member needs help. We have doctors, therapists, and counselors to help you with your behavioral health needs, like depression, anxiety, family issues, and substance use disorder. This includes:

• Inpatient mental health care
• Outpatient mental health care and/or care for substance use
• Partial hospitalization
• Intensive community-based treatment
• Mental health rehabilitative treatment services

Members in Kenosha, Milwaukee, Ozaukee, Racine, Washington and Waukesha County:

Dental benefits provided through DentaQuest

Call DentaQuest at 1-888-271-5210 (TTY 1-800-466-7566), or visit the DentaQuest website.

Members in all other Wisconsin counties:

Dental benefits provided through the state ($0.50 to $3 copay per service)

Call ForwardHealth Member Services at 1-800-362-3002, or visit the ForwardHealth website.

Your vision benefits includes the following once per year:

• Eye exam
• Eyeglass frames and lenses
• Eyeglass lens replacement
• Contact lenses (instead of frames and lenses for select members)
• Contact lens replacement (for select members)

For more information, call MARCH Vision Care at 1-855-516-2724 (TTY 1-877-627-2456), or visit the MARCH Vision Care website.

Your benefits include generic and brand-name prescription drugs and some over-the-counter (OTC) drugs.

Copays:

• OTC drugs: $0.50
• Generic drugs: $1
• Brand-name drugs: $3

Copays are limited to $12 a month per member, per provider. OTC drugs do not count toward the $12 maximum. Members are limited to five opioid prescriptions per month.

Get your drugs from any pharmacy that accepts your ForwardHealth ID card.

Get no-cost rides to your health care appointments.

Health care can be overwhelming. We’re here to help you stay on top of it. Anthem members can get care management services at no cost. Get a care plan designed for you to help you meet your health care goals

Learn more

As an Anthem member, you get extra benefits — beyond what you expect.These include:

• Anthem Community Resource Link: Find free or low-cost services for food, jobs, housing, and education near you. Search now.
• Baby essentials: Pregnant members can select baby catalog items, such as a car seat or a crib when they complete their prenatal visits.
• Blood pressure cuff: For members 18 and older with certain health conditions.
• Cellphone service: A no-cost cellphone with no-cost monthly minutes, data, and text messages through the federal Lifeline Assistance program.
• ChooseHealthy^®: Access free educational health videos and over 1,000 online resources to help you live an active and fit lifestyle. Sign up through your secure account.
• Fresh fruit and vegetables: Up to three boxes of healthy food delivered to your home. For members 18 and older with certain health conditions.
• GED test vouchers: We’ll cover the cost of the test for members ages 18 and up.
• New Baby, New Life^SM program: Extra support during and after pregnancy.
• Personal care items: Receive shampoo, deodorant, and other personal products (up to $25 worth). Members must be 18 or older to qualify.
• WW^® (formerly Weight Watchers): Vouchers to attend 13 wellness workshops near you and access to digital tracking tools. For members 18 and older.

Limits and rules apply. Benefits may change.

Requesting benefits
You can redeem some benefits online through your secure account. View the extra benefits you’re eligible for by logging in to your Anthem account and visiting the Benefit Reward Hub or call Member Services at 855-690-7800 (TTY 711) Monday to Friday from 8 a.m. to 5 p.m. local time.

Healthy Rewards is a no-cost, optional program for Anthem members. The program encourages you to get the care you need to create a healthy lifestyle and then rewards you with gift cards to popular retailers. You may be eligible to earn the following rewards for these healthy activities:

• $25 for lead screening
• Up to $80 for well-child visits
• $20 for ADHD medication management
• $25 for breast cancer screenings
• $25 for a well-child and adolescent visit
• $25 for getting your child’s childhood immunizations (shots) on time
• $25 for getting your child’s adolescent immunizations (shots) on time
• $25 for a diabetic A1c screening
• $25 for pregnant members who go to a prenatal visit in their first trimester or within 42 days of enrollment
• $25 for new moms who go to their postpartum visit 7-84 days after delivery
• $5 for a vaccination importance quiz
• $5 for a diabetes management quiz
• $25 for a follow-up visit with a provider after an emergency department visit for alcohol and substance abuse (within 30 days).
• $25 for a follow-up visit with a provider after an emergency department visit for mental health (within 30 days).
• $25 for a 30-day follow-up after a behavioral health discharge.

Enroll and earn rewards

To see what you are eligible to earn, enroll in Healthy Rewards by logging in to your Anthem account and visiting the Benefit Reward Hub. You can also enroll in the program or learn more by calling Healthy Rewards at 888-990-8681 (TTY 711) Monday through Friday from 8 a.m. to 7 p.m. Central time. If you need help setting up your Anthem online account, call Member Services at 855-690-7800 (TTY 711).

A premium is a set amount of money you pay each month to have health care coverage from BadgerCare Plus. To keep your BadgerCare Plus benefits, you’ll need to pay your premium monthly or all at once when you renew.

You will have to pay a monthly premium if your household income before taxes is more than:

• $531 per month for one person.
• $718 per month for a family of two.

These amounts change every year on February 1.

You don’t have to pay monthly premiums if you:

• Are an Alaskan native or American Indian.
• Were homeless at any point in the last 12 months.
• Were in a medical institution for at least 30 days.
• Have a disability.

$8 per household

You can lower your monthly premium to as low as $4 per household by taking an optional health survey. To take the survey, call 1-800-291-2002 or log in to the ACCESS website.

Your monthly premium will be due on the 10th of every month. ForwardHealth will send you a letter before your first payment is due.

How to pay:

• On the ACCESS website
• On the MyACCESS mobile app
• Mail in a check or money order

You must pay the premium to keep your BadgerCare Plus benefits. You can pay your premium each month, or pay all of your premiums at once when you renew your benefits each year.

If you do not pay all owed premiums at your yearly renewal time or when your BadgerCare Plus coverage ends, you will not be able to reenroll for six months. In order to reapply for benefits, you can pay all of your owed premiums or wait for six months to apply again.