Covered BadgerCare Plus services
As a BadgerCare Plus member, you have special insurance coverage. We work with the State of Wisconsin to provide that coverage to you and your family. That means you should receive health care services from doctors and hospitals in our network. There might come a time when you need extra or special health care services. If so, you will need to get a doctor's referral (sometimes called a prior authorization) before you get those services.
Your doctor is responsible for getting any referrals (prior authorizations) you need from us. The services that require a referral can be found at the ForwardHealth website. You can also call Member Services at 1-800-279-1301 (TTY: 711) to help. Benefits can change, so contact Member Services to be sure of coverage.
Services covered by the State of Wisconsin
Use any provider that will accept your ForwardHealth ID card:
Chiropractic
- Full coverage
- $.50 to $3 copay per service
Dental
- Full coverage
- $.50 to $3 copay per service
Drugs
- Comprehensive drug benefit includes coverage of generic and brand name prescription drugs and some over-the-counter (OTC) drugs.
- Members are limited to five prescriptions per month for opiod drugs.
- Copays:
- $0.50 for OTC drugs
- $1 for generic drugs
- $3 for brand name drugs
- Copays are limited to $12 per member, per provider, per month. OTCs are excluded from this $12 maximum.
- You can go to any pharmacy that accepts your ForwardHealth ID card. See our online directory to find a pharmacy.
Covered services
Review how services are covered when you visit an in-network provider.
- Full coverage
- $.50 to $3 copay per service
- Full coverage
- $0.50 to $3 copay per item
- Rental items are not subject to copay
- Full coverage of HealthCheck screenings and other services for individuals under age 21 years
- No copay
- Full coverage
- $.50 to $3 per procedure
- No copay for hearing aid batteries
- Full coverage of private-duty nursing, home health services, and personal care
- No copay
- Full coverage
- No copay
- Full coverage
- $3 copay per day with a $75 cap per stay
- Full coverage (not including room and board)
- $.50 to $3 copay per service, limited to the first 15 hours or $825 of services, whichever comes first, provided per calendar year
- Copay not required when services provided in hospital setting
- Full coverage
- No copay
- Full coverage
- No copay
- Full coverage
- $.50 to $3 copay per service
- Copay limited to the first 30 hours or $1,500, whichever occurs first, during one calendar year (copay limits are calculated separately for each discipline)
- Full coverage, including laboratory and radiology
- $.50 to $3 copay per service limited to $30 per provider per calendar year
- No copay for emergency services, anesthesia, or clozapine management
- Full coverage, including prenatal care coordination and preventive mental health and substance abuse screening and counseling for women at risk of mental health or substance abuse problems
- No copay
- Full coverage, excluding infertility treatments, surrogate parenting, and the reversal of voluntary sterilization
- No copay for family planning services
- Full coverage including coverage of eyeglasses
- $0.50 to $3 copay per service
- Coverage includes prescription and over-the-counter (OTC) tobacco cessation products
- Refer to the drug benefit for information on copayments
- Full coverage of emergency and non-emergency transportation to and from a certified provider for a BadgerCare Plus covered service
- $2 copay for non-emergency ambulance trips
- $1 copay per trip for transportation by SMV
- No copay for transportation by common carrier or emergency ambulance
If you receive a bill in the mail:
If you get a bill, contact the provider who is billing you. It may only be a request for more information about your BadgerCare Plus status or it could be a bill for copays.
We pay your provider for the services you receive. A provider cannot require you, your relatives, or others to pay additional charges for these covered services. Providers know the limits placed on their services and are required to explain if any services are not covered, before the service is provided.