State of Wisconsin
Department of Health Services


The policy on this page is from a previous version of the handbook. 

38.2 Standard Plan

38.2.1 Introduction

38.2.2 Copayment

38.2.1 Introduction

Effective April 1, 2014, all BadgerCare Plus members are covered under the Standard Plan. The following chart shows some of the covered services and co-payments under the Standard Plan.



BadgerCare Plus Standard Plan

Chiropractic Services

Full coverage.


Co-payment $.50 to $3 per service (varies by service provided).


Full coverage of preventive, restorative and palliative services.


Co-payment $.50 to $3 per service

(varies by service provided).

Disposable Medical Supplies (DMS)

Full coverage.


Co-payment $0.50 to $3.00 per service.

Drugs  (See also 38.7 Impact on Dual Eligible Individuals)

Comprehensive drug benefit with coverage of generic and brand name prescription drugs and some over-the-counter (OTC) drugs.  


Members are limited to 5 prescriptions per month for opioid drugs.




$0.50 for OTC Drugs

$1.00 for Generic Drugs

$3.00 for Brand Name Drugs

Co-payments are limited to $12.00 per member, per provider, per month.  OTCs are excluded from this $12.00 maximum.

Durable Medical Equipment (DME)

Full coverage.


Co-payment $0.50 to $3.00 per item (varies by item provided).


Rental items are not subject to a co-payment.

Health Screenings for Children

Full coverage of Health Check screenings and other services for individuals under age 21 years.


Co-payment $1 per screening for those 18, 19 and 20 years of age.

Hearing Services

Full coverage.


Co-payment $.50 to $3 per procedure.


No co-payments for hearing aid batteries.

Home Care Services (home health, private duty nursing and personal care)

Full coverage.


No co-payment.


Full coverage.


No co-payment.

Hospital - Inpatient

Full coverage.


Co-payment $3 per day with a $75 cap per stay.

Hospital - Outpatient

Full coverage.


Co-payment $3 per visit.

Hospital - Outpatient Emergency Room

Full coverage.


No co-payment.

Mental Health and Substance Abuse Treatment

Full coverage (not including room and board).


Co-payment $.50 to $3 per visit

(limited to the first 15 hours or $500 of services, whichever comes first, provided per calendar year).


Co-payment not required when services are provided in a hospital setting.

Nursing Home

Full coverage.


No co-payment.


Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST)

Full coverage.


Co-payment $.50 to $3 per provider, per date of service.


Co-payment obligation is limited to the first 30 hours or $1,500 whichever occurs first, during one calendar year (co-payment limits are calculated separately for each discipline.)

Physician Visits

Full coverage, including laboratory and radiology.


Co-payment $.50 to $3 co-payment per service (varies by service provided).


Llimited to $30 per provider per calendar year.


No co-payment for emergency services, anesthesia or clozapine management.

Podiatric Services

Full coverage.


Co-payment $.50  to $3 per service.

Prenatal/Maternity Care

Full coverage, including prenatal care coordination and preventive mental health and substance abuse screening and counseling for pregnant women at risk of mental health or substance abuse problems.


No co-payment.

Reproductive Health Services

Full coverage, excluding infertility treatments, surrogate parenting and related services, including but not limited to artificial insemination, and subsequent obstetrical care as a non covered service, and the reversal of voluntary sterilization.  


No co-payment for family planning services.

Routine Vision

Full coverage including coverage of eye glasses.


Co-payment $.50 to $3 per service (varies by service provided).

Smoking Cessation Services

Coverage includes prescription and over-the-counter tobacco cessation products.  


Co-payment (see drugs)


Full coverage of emergency and non-emergency transportation to and from a certified provider for a BadgerCare Plus covered service.


Co-payments are:

  • $2 for non-emergency ambulance trips.

  • $1 per trip for transportation by an SMV.


No co-payment for transportation by common carrier or emergency ambulance.


If you or the member has additional questions, contact Member Services at 1-800-362-3002.

38.2.2 Copayment

A BadgerCare Plus member may be required to pay a part of the cost of a service. This payment is called a "co-payment” or "co-pay”.


Through March 31, 2014, the co-payment policy is as follows:


Exempt from Co-payments



Standard Plan -  Nominal Co-payments



Members covered under the Standard plan will have co-payments ranging from $0.50 to $3.00.  Providers are required to make a reasonable effort to collect the co-payment but may not refuse services to a member who fails to make that payment.


Effective April 1, 2014, the co-payment policy is as follows:


Providers are prohibited from collecting co-payment from the following members:



The following services do not require co-payment:





This page last updated in Release Number: 14-02

Release Date: 05/14/14

Effective Date: 04/01/14

The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171