GOOD TO KNOW: BadgerCare Plus Basic Plan – an overview

On Jan. 21, Gov. Jim Doyle unveiled the BadgerCare Plus Basic Plan, a healthcare plan for adults without dependent children who are on the waitlist for the BadgerCare Plus Core plan. Pending legislative approval, BadgerCare Plus Basic will provide beneficiaries with limited access to physicians, hospital services, generic prescriptions, and catastrophic coverage. It will be paid for entirely through members’ monthly premium payments of $130. The basic plan is designed to be a bridge plan to keep those on the BadgerCare Plus Core plan waitlist healthy.

As a reminder, Basic Plan details are not yet finalized. We will keep you updated with developments regarding the program as they are released.

Enrollment details

Only individuals who are on the Core Plan waitlist can enroll in the Basic Plan. The earliest coverage can begin is April 1, 2010. If an applicant is already on the waitlist, he or she will receive a fact sheet and letter with a premium payment slip that allows for enrollment in the basic plan. The applicant may also print a premium payment slip form ACCESS.

For a prospective applicant to add his or her name to the Core Plan waitlist, go to access.wi.gov, and click on “apply for benefits.” The applicant will get a letter confirming placement on the waitlist and information on how to enroll in the Basic Plan.

All members must pay a monthly $130 premium per person to enroll in the plan. Premiums may change based on the costs of the plan. Payment of the initial premium can be made by using the premium payment slip sent in the mail, by printing out a payment slip from ACCESS, by paying over the phone using a credit/debit card, or electronic check.

Enrollment in the Basic Plan starts on the first day of the month; however, which month coverage begins depends on when the applicant pays the first premium. If the first premium is received before 4:30 p.m. the 15th day of the month, enrollment will begin on the first of the next month. If the first premium is received after 4:30 p.m. the 15th day of the month, enrollment will be delayed one month.

• Each month, members will get a premium payment slip in the mail. The premium will be due on the fifth of each month for coverage to continue the next month. If the member fails to pay the monthly premium by the due date, coverage will end and the member will not be able to re-enroll in the Basic Plan for 12 months.

Covered services

and cost share

Services that are covered under the Basic Plan may change – check with a health care provider to confirm the service is covered. The Basic Plan covers the following limited services:

• Diagnostic services (laboratory/radiology; includes mammograms) – Emergency dental services

– Emergency ambulance rides

• Disposable Medical Supplies (DMS): limited to syringes, diabetic pens, ostomy supplies and DMS that is required with the use of a DME item.

• Durable Medical Equipment (DME): full coverage up to $500 per year

• Emergency Room visits: limited to five per enrollment year

• Hospital: one inpatient hospital stay and five outpatient visits. A $7,500 deductible will need to be met to receive additional covered hospital services.

• Physician Services: Services are limited to 10 visits per enrollment year and include – Primary and preventative care; – Specialist; – Surgical and medical services;

– Chronic disease management.

• Prescription drugs are limited to the following: generic drugs, some over the counter drugs, preferred brands insulin, Tamiflu, and Relenza.

– Brand name drug discounts will be available to Basic Plan members through the Badger Rx Gold plan. If you are enrolled in the Basic Plan, you will also be enrolled in the Badger Rx Gold Plan.

• Therapy: services are limited to 10 visits per therapy, per enrollment year: physical, occupational, speech.

Members enrolled in the Basic Plan will not be required to complete a health survey or a physical exam. They will stay enrolled in the Basic Plan as long as premiums are paid and they remain on the Core Plan waitlist. Members cannot request fair hearings and do not have appeal rights; however, a request can be made to DHS to review a decision within 60 days of an adverse action.

If you have any additional questions, you may call Pat Hafermann, elderly benefits specialist with the Aging and Disability Resource Center, at (920) 467-4076.

Resource: “The Specialist” January 2010