Changes to BadgerCare Plus for Childless Adults

What is a premium?

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.

Who has to pay premiums?

You may 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.

You don’t have to pay a monthly premium 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.

How much is the monthly premium?

$8 per household

You can lower your monthly premium to as low as $4 per household by taking an optional health survey. Learn more about the survey below.

How do I pay my premium?

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.

What if I don’t pay my premium?

Your monthly premium will be due on the 10th of every month. You can pay your premiums at any time before your yearly renewal time, or before your BadgerCare Plus coverage ends.

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 re-enroll 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.

Call the 2-1-1 Helpline if you can’t pay your monthly premiums.

If you have healthy habits, you could lower your monthly premium to as low as $4 per month.

Examples of healthy habits include:

• Wearing a seatbelt.
• Exercising.
• Not smoking.

There are four ways to take the health survey:

1. Online: Log in to the ACCESS website
2. App: Download the MyACCESS mobile app
3. Phone: Call 1-800-291-2002
4. Mail: Download the paper survey from dhs.wisconsin.gov and mail to the address on the survey.

You don’t have to take the survey. Your answers won’t affect your health care benefits in any way.

A copay is a payment you make for a health care service. You’ll pay an $8 copay for each visit to the emergency room that is not an emergency. You won’t pay anything for visits to the emergency room that are true emergencies. The doctor will decide if your visit was an emergency. You do not have an emergency room copay if you are an Alaskan native or American Indian.

What if I’m sick and it’s not an emergency?

Emergencies are times when there could be serious danger or damage to your health if you don’t get medical care right away. Only go the emergency room if it’s an emergency. An urgent care center and your primary care provider (PCP) can help with minor cuts and burns, earaches, sore throat, sprains, and fevers. 

If you need same-day care, you can:

• Call your PCP.

• Call the 24/7 NurseLine at 1-855-690-7800 (TTY 711).

• Go to an urgent care center.
  
  Learn more about your options when you’re sick. 

When you apply or renew your benefits, you’ll be asked:

• If you’ve used drugs in ways that have caused problems for you or those around you in the past 12 months.
• If you’re open to getting help.

After February 1, 2020, you cannot get BadgerCare Plus benefits if you don’t answer the question. Your answer won’t affect your health care benefits in any way, and you can change your answer at any time.

You don’t have to answer the question if you:

• Are an Alaskan native or American Indian.
• Are residing in a medical institution for at least 30 days.
• Have a disability.