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Access to Other Insurance

Q: If a child is under 150% of FPL, will they still need to verify access to employer insurance or are they automatically receiving BC+ and the State will not need to verify that information?
A: If children are at or under 150% of FPL, access to employer-sponsored insurance is not considered and does not need to be verified.

Q: Can someone get assistance in paying for COBRA Premiums?
A: No. BadgerCare Plus does not help to pay for COBRA premiums.

Q: Is there a three-month waiting period to get BadgerCare Plus if you voluntarily drop COBRA coverage?
A: No. There is not a waiting period for dropping COBRA coverage for most people.

If a pregnant woman has already used her COBRA coverage (usually a period of 18 months), it is considered a “good cause” reason for dropping insurance coverage, and she would be able to apply for BC+ without the 3 month waiting period.

If a pregnant woman voluntarily drops COBRA coverage, there would be a 3 month waiting period before she can become enrolled in BadgerCare Plus.

Q: What are the rules related to COBRA and exceptions to losing health insurance through no fault of your own? Is there a three-month wait for a person who voluntarily drops his/her COBRA coverage?

COBRA coverage will only be of concern for:

1. A pregnant woman in the prenatal program group, and
2. A pregnant woman with income over 200% of poverty and who has COBRA coverage at the time that she is eligible for BC+ benefits as a pregnant woman.

For a woman in one of these situations, she is ineligible for the three calendar months following the month the COBRA coverage ends unless she has already used all of her COBRA coverage (usually after 18 months.)

Q: If a family member, adult caregiver, or parent starts a new job through which health insurance will be offered, can they receive BC+ until their coverage starts with their employer?
A: If the employer pays less than 80% of the cost of the premiums, there’s no affect on eligibility. If the employer pays 80% or more of the cost of the premiums, they may not receive BC+ if the coverage begins in the month of application or in the following three calendar months.

Q: Can pregnant women have BadgerCare Plus and personal insurance, like they used to be able to have Healthy Start and private insurance to cover what private insurance wouldn’t?
A: Yes, except for the Non-Qualified Immigrant and Inmate Pregnant Women (NQIPW) in the prenatal program. Those women must be uninsured to get the prenatal benefit.

Q: Can a pregnant woman receive BadgerCare Plus for her pregnancy when health insurance is available through her employer but it is not an open-enrollment period?
A: Yes.

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