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BadgerCare Plus Core Plan Home
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Core Plan - Health Care For Adults With No Dependent Children
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Covered
Services for Those who were enrolled in a General Assistance/General
Relief Medical Program
If you were enrolled in Milwaukee County’s General Assistance Medical Program (GAMP) or in any
other counties’ General Assistance/General Relief Medical Program from
December 1, 2008 through December 31, 2008, you were automatically enrolled in the BadgerCare Plus
Core Plan on January 1, 2009. This plan replaces the health care benefits you
had under the
General Assistance/General Relief Medical Program in your county.
These are the services BadgerCare Plus will cover under the Core Plan. These covered services may change.
| BadgerCare Plus Core Plan will cover these services: |
- Chiropractic services
- Doctors visits
- Hospital services
- Emergency room visits
- Emergency ambulance rides
- Emergency dental services
- Prescription drugs (see
below for more details)
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- Physical therapy
(includes cardiac rehab)
- Occupational therapy
- Speech therapy
- Durable medical equipment
- Disposable medical
supplies
- Dialysis/kidney-related
services
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Some services covered under the BadgerCare Plus
Core Plan will have a co-payment. The co-payments listed below are for those who
were automatically enrolled
in the BadgerCare Plus Core Plan effective January 1,
2009.
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COVERED SERVICES
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CO-PAYMENT
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Chiropractic services
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$0.50 to $3 per service |
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Visits to the doctor
- Includes office visits and surgical procedures.
- Mental health visits are only covered when they are with a
psychiatrist.
- For substance abuse, physician services are covered.
- Routine eye exams are not covered.
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$0.50 to $3 per service, limited to $30 per provider per calendar year.
No co-payments for emergency services, preventive care, anesthesia, or
clozapine management. |
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Hospital services
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For outpatient visits, $3 per visit.
For inpatient visits, $3 per day. For
each stay, you will not have to pay more than $75 in co-payments.
You will not have to pay more than $300 per year in co-payments for all
of your hospital services. |
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Emergency room visits and ambulance rides for emergencies.
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$0
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Emergency dental services.
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$0
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Prescription drugs - See below.
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See below
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Physical therapy, occupational therapy, and speech therapy
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$0.50 to $3 per service.
Co-payments will not be charged after the first 30 hours or $1,500 of each type
of therapy, whichever occurs first, each calendar year. |
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Durable Medical Equipment
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$0.50 to $3 per priced unit.
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Disposable Medical Supplies
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$0.50 to $3 per priced unit.
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Dialysis and other kidney-related services for people with end-stage renal
disease, who do not qualify for Medicare end-stage renal disease
services.
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$0
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General Assistance/General Relief Medical Program Prescription Drug Coverage
In most cases, generic drugs and some over-the-counter drugs are covered at a cost
to you of up to $5 for each item. Your co-pay will be $20 per pharmacy, per month for drugs prescribed by your
physician. Certain “brand name” drugs may also be covered by the BadgerCare Plus Core Plan. Your drug coverage information is below.
If you have any questions, please contact Member Services at
1-800-362-3002.
Prescription services and drugs administered by a physician are covered through fee for
services.
Mental Health Drugs*
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From January 1, 2009 through March 31, 2009, the Core Plan will cover any
mental health drug you are currently taking to treat depression,
Alzheimer’s disease, Parkinson’s disease, epilepsy and other
seizure disorders, bipolar disease and schizophrenia, and drugs used
to treat attention deficit disorder.
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Beginning April 1, 2009, the Core Plan will cover your mental health drugs.
If you are taking drugs for Alzheimer’s disease, bipolar
disease or schizophrenia, you will continue on any drug used to treat
these two conditions as long as you remain enrolled in the Core Plan.
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Beginning April 1, 2009, the Core Plan will continue to cover the specific drug
you are currently taking to treat depression, Parkinson’s disease,
epilepsy and other seizure disorders, and attention deficit disorder,
as long as you remain enrolled in the Core Plan. If you need to change to a
different drug for these conditions, it may not be covered under the BadgerCare
Plus Core Plan. Please see the “All Other Medications” section below.
Asthma and Diabetes Drugs*
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From January 1, 2009 through March 31, 2009, the Core Plan will cover any
insulin you are currently taking to treat diabetes and some inhalers
you are currently taking to treat asthma.
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Beginning April 1, 2009, the only insulin that will be covered under the Core
Plan are Humalog and Lantus.
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Beginning April 1, 2009, the only asthma inhalers that will be covered under the
Core Plan are Flovent, Serevent and Proventil HFA.
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Other asthma and diabetes medications may be covered under the Badger Rx
Gold program.
All Other Medications*
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Beginning January 1, 2009, generic drugs and a limited number of over the
counter (OTC) drugs will be covered under the Core Plan.
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Beginning January 1, 2009, brand name drugs and other drugs not covered under
the Core Plan will be available through the Badger Rx Gold program.
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If you have any questions, please contact Member Services at 1-800-362-3002.
| The BadgerCare Plus Core Plan does not cover these services: |
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P-10190 (07/09)
Last Revised: July 12, 2010
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