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Medicaid is a federally funded program that allows state governments to supply qualified residents with much-needed healthcare benefits. Wisconsin Medicaid supports various health programs, like BadgerCare Plus, Family Care, and SeniorCare. Each program assists the elderly, disabled, and low-income populations in acquiring prescriptions, medical services, and professional healthcare.
Wisconsin residents who meet Medicaid eligibility requirements may apply for and use these benefits to improve their health and quality of life. As of May 2023, 1.47 million Wisconsinites were enrolled in Medicaid.
As a Wisconsin resident, you want affordable healthcare coverage to protect you and your family throughout each stage of life. Wisconsin Medicaid and its additional Badgercare Plus coverage might fit your needs. Like many candidates, you likely have several questions about what your state’s Medicaid program covers.
The following guide will answer those and other questions in-depth. It will also help you determine whether you need extended coverage options and direct you to where to find them. To avoid additional medical costs, many people using Wisconsin Medicaid also secure private health insurance to extend their coverage. Start your journey toward a healthier, happier family by diving deeper into Wisconsin Medicaid below.
Wisconsin Medicaid assists over 1 million state residents in accessing quality coverage for medical services and healthcare benefits. State and federal governments fund this program to help low-income individuals and families protect their health with much-needed medical assistance and maintenance services. Some commonly asked questions regarding the Medicaid program include:
Your household’s Medicaid eligibility depends on various factors that include collective income, diagnosed disabilities, and age. Each qualifying person must have a Medicaid card to prove their eligibility and access program benefits.
A Medicaid card contains information about the cardholder and proves their certified program eligibility. When you apply for BadgerCare Plus coverage, you’ll receive a Medicaid or Forward Health card in the mail upon acceptance. You must keep this card on hand when seeking medical and health services at program-approved practices and facilities.
Ready to learn how to apply for BadgerCare Plus in Wisconsin? First, collect and keep basic identification information, such as social security number, marital status, citizenship status, and annual income, on hand throughout the process. Then, you can apply for Wisconsin Medicaid using one of four methods listed below:
Are you eligible for Wisconsin’s Medicaid coverage? Residents who meet the following qualifications can apply for and acquire government-funded health care:
After receiving your application for Wisconsin Medicaid, the Wisconsin DHS processes it. Upon acceptance, the department will automatically provide a ForwardHealth identification card in the mail. The card contains your unique ID number. You must present your ForwardHealth card to medical personnel during appointments and emergency services.
You must renew your Wisconsin Medicaid membership annually. Otherwise, your coverage may lapse, leaving you or your household without what BadgerCare Plus covers alongside Medicaid.
The DHS will mail a renewal notice to your home address. Otherwise, you can check your ACCESS portal for pertinent notifications.
What should you do if you lose or damage your card? Call Wisconsin’s Member Services at 800-362-3002. Verify your information with the associate who responds to your call, and you’ll receive a new card in the mail. You can still access health services by supplying your 10-digit membership number and documents proving your identification.
What is BadgerCare Plus coverage? Qualifying members can use their plan to cover the costs of several necessary medical services, such as primary care, medications, and procedures.
Explore some of the details of what BadgerCare Plus Covers to better understand what you can access with your ForwardHealth card.
Wisconsin Medicaid covers full or partial costs for limited dental services for residents using their standard benefits. If you qualify for BadgerCare Plus or additional government programs, you may access a broader range of oral health services. Most members can access basic services like cleanings and evaluations without prior authorization.
If you are pregnant or aged 21 or younger, you’ll access a bigger pool of dental and oral health procedures and services.
If you have more serious dental issues, and anticipate requiring more trips to the dentist, investing in private dental plans in Wisconsin is advisable.
Wisconsin Medicaid covers a diverse variety of prescription drugs ranging from acne medication to antidepressants and antibiotics. Restrictions and prior authorizations may apply to some prescriptions. You may also use your coverage to purchase specific over-the-counter drugs by your general practitioner's recommendations.
If you need additional financial assistance to afford your much-needed prescription medications, you can explore Wisconsin’s additional programs developed to improve prescription access. For example, Wellcare by Allwell offers captive pharmacy benefits to qualifying members. SeniorCare offers senior adults assistance in affording various generic and brand-name prescriptions alongside some over-the-counter products at participating pharmacies.
An extended healthcare service refers to long-term treatment programs to improve an individual’s quality of life. If you struggle with mental health conditions, substance addictions, or chronic conditions that affect your independence, you may benefit from extended services to help you manage and rehabilitate from these obstacles. Wisconsin Medicaid covers the following extended healthcare treatments for qualifying individuals:
While extended healthcare options through Wisconsin are comprehensive, they do not cover your finances should a temporary or permanent illness arise. Consider investing in quality disability insurance to protect your finances.
What happens if you need assistance when traveling out of state? You can use Wisconsin Medicaid and BadgerCare Plus benefits to access and pay for medical emergencies. This coverage applies to all United States, American territories, Mexico, and Canada.
However, you cannot schedule out-of-state services and cover the costs via your Wisconsin Medicaid assistance or accompanying programs. You must schedule doctor’s appointments and planned treatments within Wisconsin borders at facilities that accept your coverage.
If you are traveling outside of the coverage areas, always purchase proper travelers insurance.
College students who meet the previously listed eligibility requirements can apply for and use Wisconsin Medicaid and other healthcare programs for in-state services.
For example, you attend a university in a bordering state. While your coverage won’t assist you with regular doctor’s appointments, it can help with emergencies. You must return to Wisconsin to purchase covered prescriptions or undergo other treatments.
Alternatively, you can:
Comprehensive healthcare coverage might be at the top of your priority list if you are a senior citizen. You can access various programs to help you manage your healthcare needs, including:
Senior adults and children are not the only groups that can receive coverage from Wisconsin Medicaid and related programs. If you fall into one of the following categories, you might qualify for access to supplemental benefits for free or at a low cost.
Wisconsin DHS recognizes and values the culture of Indigenous American tribes. Therefore, the department designed state-backed Medicaid services to meet the unique needs of its native tribes.
Indigenous Americans with a tribal membership automatically qualify for full Medicaid coverage with no out-of-pocket copays. Your benefit entitlement might also extend to assistance from the Indian Health Service.
Veterans and qualifying family members can use Medicaid coverage to supplement benefits from Veterans Affairs, TRICARE, and the Civilian Health and Medicare Program of the Department of Veterans Affairs. As a veteran, you might be eligible for military-specific plans and Wisconsin Medicaid programs according to your disability status and age group.
If you are the spouse or child of a veteran, you may qualify for CHAMPA assistance if:
Qualifying immigrants can access Wisconsin Medicaid and its associated programs.Immigrants who do not meet the eligibility requirements might qualify for assistance from Emergency Services. Unqualified pregnant immigrants can also gain benefits from the BadgerCare Plus Prenatal Plan. The Wisconsin DHS will not share your immigration status with the U.S. Citizenship and Immigration Services.
Noncovered services are medications, equipment, treatments, and visits that a Wisconsin Medicaid plan will not cover. Some examples of noncovered services include:
Although some aid is provided through WCMEA, the funding will not cover the entire cost of funerals. Consider investing in funeral insurance to protect your family.
Additionally, many procedures require authorization from the DHS to qualify for Medicaid coverage. Speak with your primary care physician and other practitioners to determine whether you need authorized treatments to maintain your health.
What procedures, prescriptions, and treatments can you expect to access through your Medicaid-approved provider? Discover how your plan enhances your day-to-day health.
| Dental | |
|---|---|
| Oral evaluations | Your dentist can perform oral evaluations every six months to three years, depending on the type of examination. |
| Fluoride treatments | Medicaid covers an annual topical fluoride treatment for adults. Children may undergo treatments twice annually. |
| Restoration procedures | You can access various restorative treatments like crowns and composites. |
| Minor emergency treatments | If you have a small dental emergency, don’t hesitate to contact your dentist and cover the treatment with your plan. |
| Find a list of other covered oral treatments here. | |
| Vision | |
|---|---|
| Low-vision exams | Has your physician or ophthalmologist diagnosed you with low vision? If so, Wisconsin Medicaid covers one annual exam. |
| Glasses prescriptions | If your eye-care provider determines you need glasses, they can supply them without authorization. Your plan should cover your prescription. |
| Contact lenses | Do you have keratoconus or aphakia? You can request contact lenses or replacement lenses from your provider with the authorization necessary. |
| Surgery | |
|---|---|
| Inpatient procedures | Wisconsin Medicaid programs cover most inpatient surgeries in full. |
| Outpatient procedures | Outpatient treatments may require authorization to qualify for coverage. |
| Multiple surgeries | If your surgeon performs numerous procedures simultaneously, your plan may cover most costs with a small copay. |
| Pre-operative and post-operative care | Medicaid covers care requirements associated with surgery. |
| You can find more information about surgical coverage here. | |
| Hospital | |
|---|---|
| Emergency visits | BadgerCare Plus and Emergency Services will cover costs associated with medical emergencies at any time. |
| Non-emergency visits | Wisconsin Medicaid covers transportation and appointment fees for qualified members. |
Learn more details regarding mental health treatment here.
| Sexual Health | |
|---|---|
| Gynecologist | Protect your reproductive and sexual health with vaccines targeting sexually transmitted viruses, contraceptives, pap smears, sterilizations, and STI tests. |
| Pregnancy | The BadgerCare Plus Prenatal Plan helps expectant mothers access the care they need throughout their pregnancy. |
| Fertility Treatment | Family Planning Only Services allow members to acquire fertility trackers to determine the best time to conceive. You cannot access fertility treatments beyond this. |
| Erectile dysfunction | Wisconsin Medicaid does not cover treatments for erectile dysfunction and similar conditions. |
| Specialist Services | |
|---|---|
| Dermatologists | Medicaid cardholders can visit a dermatologist who accepts program assistance to treat acne and other skin conditions. |
| Physiotherapy | Treat qualifying injuries, chronic conditions, and disabilities with assistance from a physiotherapist. |
| Massage Therapist | Medicaid typically will not cover the costs of a massage therapist unless your doctor deems it medically necessary. |
| Podiatrists | Ask your primary provider whether your foot condition requires a podiatrist’s opinion. If it does, you could qualify for treatment from a foot and leg specialist. |
| Allergist and allergy Testing | If your doctor deems allergy testing medically necessary, Wisconsin Medicaid may pay for it. |
| Sleep Physician Services and CPAP Machines | Medicaid often covers the costs of essential medical devices. However, your primary care physician must deem it medically necessary, including sleep equipment. |
| Your primary doctor can refer you to these and other specialists when they find that your health concern warrants a specific focus. Keep your doctor informed about your needs to ensure you can quickly access these services. | |
While Wisconsin Medicaid programs offer generous benefits, they still have significant limitations. However, you can work with your plan provider or other third party to extend your health insurance coverage and improve your quality of life. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
You should consider supplemental policies for:
Insurdinary can help you find the perfect healthcare match to work with your budget and current Wisconsin Medicaid coverage. Compare quotes in your area for free to improve your life, health, and financial capabilities.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
