BadgerCare is Wisconsin's Medicaid program, not Medicare

BadgerCare is Medicaid — the joint federal and state health insurance program for people with lower incomes. It is not Medicare, which is the federal program for people 65 and older or with certain disabilities. Wisconsin calls its Medicaid program BadgerCare, just as other states have their own names for the same federal program.

If you live in Wisconsin and have a low income, you may hear about BadgerCare as an option. It covers doctor visits, hospital care, prescription drugs, and other medical services. The program is run by the state of Wisconsin but funded partly by federal money, which is how all Medicaid programs work.

The confusion between Medicaid and Medicare is common because the names sound alike and both are government health programs. But they are separate programs with different rules, different income limits, and different coverage. Understanding which one you might be covered by matters because the rules for each are very different.

Key Takeaways

  • BadgerCare is Wisconsin's name for Medicaid, a program for people with lower incomes, not a Medicare program.
  • Medicaid and Medicare are two separate programs: Medicaid is based on income, while Medicare is based on age or disability status.
  • You can be on both BadgerCare and Medicare at the same time if you meet the income and age or disability requirements for each.
  • Wisconsin determines BadgerCare income limits and coverage rules, though the program must follow federal Medicaid guidelines.
  • To learn about you can enroll in BadgerCare, you contact Wisconsin's Department of Health Services, not Medicare.

How BadgerCare (Medicaid) differs from Medicare

Medicaid is a program for people with low income. There is no age requirement — children, working-age adults, and seniors can all be on Medicaid if their income is low enough. BadgerCare, Wisconsin's Medicaid program, follows this same rule. You do not have to be 65 or older to enroll.

Medicare is different. It is primarily for people 65 and older, regardless of income. Some younger people with disabilities or end-stage renal disease can also get Medicare, but age is the main factor. If you are 65 and have a high income, you still get Medicare. If you are 40 and have a low income, you do not get Medicare — you might get BadgerCare instead.

The way each program is funded is also different. Medicare comes from payroll taxes (Social Security taxes) that workers and employers pay during working years. Medicaid, including BadgerCare, is funded by both federal and state taxes, and the state decides how much to contribute.

Income limits and who can enroll in BadgerCare

BadgerCare has income limits that change depending on your household size and family situation. A single adult has a different limit than a family of four. Wisconsin sets these limits within federal Medicaid rules, so they can change from year to year.

BadgerCare covers children, pregnant people, parents and caretakers of children, people over 65, and people with disabilities. You must meet both the income limit for your group and live in Wisconsin. If your income is above the limit, you would not be able to enroll in BadgerCare, even if you have no other health insurance.

To find the current income limits for your situation, you contact the Wisconsin Department of Health Services. They can tell you whether your household income falls within the range for BadgerCare. You can also reach them through the state's online portal or by calling their customer service line.

Can you have both BadgerCare and Medicare at the same time?

Yes. If you are 65 or older and have a low income, you can be enrolled in both Medicare and BadgerCare at the same time. People in this situation are sometimes called "dual may be able to access." BadgerCare would cover costs that Medicare does not, such as some copayments and deductibles.

If you are under 65 and have a disability that qualifies you for Medicare, you might also be able to enroll in BadgerCare if your income is low enough. Again, you would have both programs working together, with BadgerCare filling in some of the gaps in Medicare coverage.

Having both programs can actually be helpful because Medicare has costs (deductibles, copayments, and premiums), and BadgerCare can help pay some of those. However, you must meet the requirements for both programs separately — being on one does not automatically put you on the other.

How to learn about you can enroll in BadgerCare

Contact the Wisconsin Department of Health Services directly. You can explore online through the state's portal, by phone, by mail, or in person at a local office. The state will ask about your income, household size, citizenship status, and other information to determine if you meet BadgerCare requirements.

When you contact them, have your Social Security number, proof of income (recent pay stubs or tax returns), and proof of Wisconsin residency ready. The process usually takes a few weeks. If you are approved, your coverage can start as early as the first day of the month after you explore, depending on when the state processes your information.

If you are already on Medicare and think you might also may have access to for BadgerCare, tell the state that when you explore. They can review both your Medicare status and your income to see if BadgerCare coverage would help reduce your out-of-pocket costs.

What BadgerCare covers

BadgerCare covers doctor visits, hospital stays, emergency care, prescription drugs, mental health services, and dental care for children. It also covers preventive services like screenings and vaccinations. The exact coverage can vary slightly depending on which BadgerCare plan you are on, as Wisconsin offers different options.

Unlike Medicare, which has different parts (Part A for hospital, Part B for doctor, Part D for drugs), BadgerCare is one program that covers most services in one place. You do not have to sign up for separate parts or pay separate premiums for different types of care.

Some services may require you to pay a small copayment when you use them, but BadgerCare limits how much you pay out of pocket. If you are also on Medicare, BadgerCare would help cover some of those Medicare copayments and deductibles.

Questions to ask your doctor or the state

If you are thinking about enrolling in BadgerCare, ask your current doctor whether they accept BadgerCare. Not all doctors do, and you want to know before you enroll whether you can keep seeing the same provider.

Ask the Wisconsin Department of Health Services what the current income limit is for your household size and whether your income falls within it. Ask how long the approval process takes and what documents you need to provide. If you are already on Medicare, ask whether BadgerCare would reduce your out-of-pocket costs.

Ask what happens to your coverage if your income changes during the year. Some people worry that earning a little more money will disqualify them, and it is worth understanding the rules before that happens.

When to contact the state about BadgerCare

Contact the Wisconsin Department of Health Services if you have no health insurance and your income is low. Contact them if you are on Medicare but struggling to pay copayments and deductibles — BadgerCare might help. Contact them if your income has dropped due to job loss, retirement, or a change in family situation.

You can explore at any time during the year. Unlike Medicare, which has specific enrollment periods, BadgerCare accepts applications year-round. If you are approved, your coverage can begin as soon as the state processes your information.

Frequently Asked Questions

Is BadgerCare the same as Medicare?

No. BadgerCare is Wisconsin's Medicaid program for people with low income. Medicare is a federal program for people 65 and older or with certain disabilities. They are separate programs with different rules and different ways of determining who can enroll.

Can I be on BadgerCare if I am 65 or older?

Yes, if your income is low enough. Many people 65 and older are on both Medicare and BadgerCare at the same time. BadgerCare helps cover some of the costs that Medicare does not, such as copayments and deductibles.

What is the income limit for BadgerCare in Wisconsin?

The income limit depends on your household size and situation. It changes from year to year. Contact the Wisconsin Department of Health Services to find out the current limit for your household and whether your income qualifies.

How do I explore for BadgerCare?

You can explore online through Wisconsin's portal, by phone, by mail, or in person at a local office. Contact the Wisconsin Department of Health Services to start the process. Have your Social Security number, proof of income, and proof of residency ready.

What happens if my income goes up after I enroll in BadgerCare?

You must report income changes to the state. If your income rises above the BadgerCare limit, your coverage may end. However, the state will tell you about this before it happens, and you may be able to transition to another type of coverage.