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Learn About CHIP in Wisconsin

Wisconsin CHIP serves children living in low-income households who do not have medical insurance. The program is designed to assist children younger than 19 years of age who live in families that earn too much to qualify for Medicaid but do not earn enough income to afford private health insurance. In WI CHIP and Medicaid are combined to make up the BadgerCare Plus program. CHIP insurance enrollees and Medicaid beneficiaries are grouped together into this program, which is administered by the Department of Health Services (DHS).

The Children’s Health Insurance Program (CHIP) is funded by the federal government but implemented by state governments across the country. Therefore, states are individually responsible for administering benefits and developing processes for the program. To qualify for this plan, applicants must prove their children meet age restrictions, residency requirements, citizenship status and low-income guidelines. To learn more about why health insurance for kids in WI is important and how the program provides comprehensive benefits, review the following sections.

What is CHIP in Wisconsin?

Many residents often wonder, “What is CHIP in WI?” The program is referred to as BadgerCare Plus in the state and it offers comprehensive health insurance benefits for eligible applicants. Since the program is designed to assist children living in low-income households, it sets strict eligibility criteria that must be met by applicants before coverage is provided. This ensures that any funding the program receives from federal and state resources is not used on families that do not truly need this insurance.

The child health insurance plan in Wisconsin is an important assistance program because it ensures that all families throughout the state can seek medical treatment and preventive health care for their children without dealing with medical expenses they cannot afford. Children who are provided with adequate health care throughout their growing years are more likely to do well in school and be healthier adults. CHIP health insurance also provides low-cost or free health insurance to eligible pregnant women in the state. This ensures these mothers and their babies have access to the right education and care to stay healthy.

Who does Wisconsin CHIP cover?

The Wisconsin CHIP application process allows program representatives to learn more about applicants and determine who qualifies for benefits and who is not eligible for coverage. The program only provides benefits to children younger than 19 years of age or pregnant women who meet all other guidelines. Additionally, to be eligible for benefits, these applicants must:

  • Meet the low-income guidelines set by the program.
  • Be current Wisconsin residents.
  • Be U.S. citizens or legal permanent residents.
  • Not currently be covered by another health insurance.
  • Not qualify for Medicaid.

The low-income CHIP eligibility guidelines are slightly higher than the requirements for Medicaid, allowing many families to qualify for coverage with the program. These guidelines are set using a percentage of the government’s Federal Poverty Level (FPL). Since the FPL changes annually, the low-income guidelines set by the program can also change. Children who qualify for their parents’ employer-based health insurance plans may be ineligible for benefits through the BadgerCare Plus plan.

To find out more about CHIP, review our informative CHIP guide.

How to Apply for CHIP in Wisconsin

There are many application methods available for CHIP benefits in Wisconsin, including online, by mail, by phone or in person. Most potential applicants prefer to apply for benefits online through the ACCESS system because the process is fast, simple and convenient. The online system also allows the applicant to check his or her application status at any time. To apply for CHIP online, an applicant must visit the state’s government assistance website and create an online account. Then, he or she must provide important information about the household, including but not limited to:

  • Income earned.
  • Number of household members and their ages.
  • Health insurance and other government benefits received.

Potential applicants who prefer to call the WI CHIP number and apply by phone should gather and prepare all necessary information before calling. This will allow the program representative to move through the application process quickly to determine eligibility. A potential applicant can also download and print an application, complete the questions and mail it to the office. If preferred, an interested resident can also visit a local office and complete the CHIP application process in person with assistance from a representative.

What is included with Wisconsin CHIP coverage?

Wisconsin CHIP benefits gives enrollees access to a variety of health care services and offer the same level of coverage to eligible applicants that are provided through the Medicaid program. This medical coverage includes the following:

  • Immunizations and vaccinations
  • X-rays and lab work
  • Mental health care
  • Prescription drugs
  • Hospital care

While the program does offer limited vision care, CHIP dental insurance is not included with BadgerCare Plus benefits. However, some dental care providers may offer discounted services to qualifying residents, including young children.

How much is CHIP health insurance in Wisconsin?

Residents who are concerned with how much they will pay for CHIP coverage in Wisconsin should keep in mind that there are no monthly premiums, and copayments for services are affordable. Generally, a program beneficiary will pay between 50 cents and $3 as a co-payment for a covered service. If the beneficiary is seeking more than one covered treatment or service, he or she may be responsible for more than one copayment. Services can only be rendered by medical providers that participate in the program and accept BadgerCare Plus insurance.

How long do CHIP benefits last in Wisconsin?

Once beneficiaries learn who qualifies for CHIP in Wisconsin, they may want to find out how long their children can receive this coverage. Beneficiaries are provided with information on participating medical providers, copayments and policy terms as soon as they are approved for program coverage.

CHIP benefits last for one year, but when the coverage is nearing the end of the term, beneficiaries can choose to renew their policies. Before this insurance is renewed, the eligibility criteria are examined again to ensure all qualifications are still met by the beneficiary. All program enrollees are also required to consistently inform the department of any updates to household composition, residency, income or health insurance plan enrollment.

To learn more about WI CHIP copayments, read through our informative guide.