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Health Plan of Last Resort

State offers basic health plan for people with no alternatives

A fall at the post office last December tore tendons in Bob Campbell's right shoulder and left him with a compression fracture.

The 52-year-old Somerset man still owes money for emergency treatment. But surgery to fix the injury? Forget it. Campbell had no insurance. He previously worked in low-paying jobs and since 2006 he's had no job at all—except as full-time caregiver for his 84-year-old mother.

On July 1, help arrived for Campbell and thousands of other uninsured Wisconsin residents: BadgerCare Plus Basic. It is a self-funded, stripped-down health plan for state residents with no other alternatives.

"Just knowing that I have some health insurance takes a big burden off my shoulders," said Campbell, who signed up in June.

BadgerCare Plus Basic is for people stuck on the waiting list for BadgerCare Plus Core Plan, a program for adults with incomes below 200 percent of the federal poverty level and no dependent children. The Core plan expanded the state's BadgerCare health coverage, originally for poor families with children. Just four months after the Core plan was added in July 2009, enrollment was closed at 54,000 patients because of budget restrictions. A waiting list grew to 50,000— many of them middle-age workers who retired early without health inurance or lost jobs in the economic downturn.

Basic is "pretty much the bridge plan," said Stephanie Smiley, spokeswoman for the Wisconsin Department of Health Services. "It's a very limited plan, and people do have to pay out-of-pocket," she said. "But it's a better option than having nothing."

To enroll in Basic, Wisconsin residents must first be accepted to the Core plan waiting list. The Basic plan is funded solely by premiums, $130 a month paid by each enrollee. The state projects that about 5,000 people will be enrolled at any given time.

It's as basic as its name, covering up to 10 doctor's office visits a year, one hospital stay with prior authorization, five outpatient clinic visits and five emergency room visits. Dental coverage is provided in emergencies only. There is also limited prescription coverage. Besides premiums, patients make copayments for services, ranging from $5 per prescription and $10 for an office visit to $100 for a hospital stay.

Lisa Lamkins, AARP Wisconsin advocacy director, said BadgerCare Plus Basic provides an important stopgap as people await federal health insurance reforms that kick in over the next four years. She said people with chronic preexisting health conditions that would qualify them for a new high-risk insurance pool that started Aug. 1 should weigh carefully whether to sign up for Basic. It could disqualify them from the pool created by federal health reform, which is limited to people who haven't had insurance for at least six months.

Still, BadgerCare Plus Basic brings Wisconsin closer to "making sure that as many people as possible have coverage," Lamkins said.

"When people don't have access to health insurance, they're more likely to delay getting treatment," Lamkins said. That's not only worse for the patient—it makes the whole system cost more for everyone.

Campbell is grateful for the option and hopes he can get the surgery he needs.

"I understand that there's some copayments. I can live with that. I would expect to have to pay something," he said. "It just gives you reassurance that if something happens, you will be treated and not have to worry too much."

You can find more information online about BadgerCare Plus Basic and also sign up for the Core Plan waiting list through ACCESS (Access to Eligibility Support Services) or you can call the Enrollment Services Center at 1-800-291-2002.

Erik Gunn is a freelance writer based in Wisconsin.

 

 

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