10.3 Check My Benefits: Member
The member can select Manage my HMO under Manage Benefits on the account homepage to be taken to the HMO homepage.
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10.3.1 Manage My HMO
The HMO homepage is where members can view their household’s HMO enrollment details, change their HMO during the open enrollment period, and view household members with an exemption, or household members who are enrolled in a non-BadgerCare Plus or SSI Medicaid plan.
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Member HMO enrollment details display on the HMO card. Multiple HMO cards display on the page if household members are enrolled in different HMO plans.
Each HMO card displays the following:
- HMO Name
- Coverage start date
- Enrolled members
- Lock-in date
The Lock-in period is the time during which members cannot change their HMO enrollment. If the open enrollment has passed, the member is in the Lock-in period and this displays as Lock-in end date. Members can select Learn more about lock-in for more information about the lock-in period.
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Select View plan details for more information:
- Preferred provider coverage
- HMO ratings
- HMO contact information (Member Services)
HMO ratings are maintained by DHS and evaluate the quality of care that Wisconsin Medicaid members receive from BadgerCare Plus and SSI Medicaid HMOs. Members can select Learn more about HMO ratings for more information.
At the bottom of the page members can view household members not enrolled in an HMO plan. They either have an exemption and do not need to enroll in an HMO, or they are enrolled in a different health care program (not BadgerCare Plus or SSI Medicaid).
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| Note | An exemption means the member does not need to be enrolled in an HMO at this time and are receiving fee-for-service coverage. However, exemptions are often temporary. To learn more about the exemptions for your household, contact an enrollment specialist at 800-291-2002. |
10.3.1.1 Change HMO
On the member card, the Change plan button can be selected for the first three months after enrollment when the member is not in the lock-in period.
| Note | Once the lock-in period begins (see the Lock-in starts on date), the Change plan button is disabled, and members need to call an HMO enrollment specialist at 800-291-2002 to change their HMO. |
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Select Change plan to get to the Change your HMO page and choose a new HMO.
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The member can view their current HMO, as well as other HMOs in their service area. For each plan, members can view the following information:
- HMO Name
- Preferred provider coverage
- HMO ratings
- HMO contact information (Member Services)
Select the Select plan button, and the confirmation page displays.
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Select Confirm to submit the change. The Success page displays.
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Select Go to HMO home. A notification displays on the member’s current HMO card that indicates the change was made.
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10.3.1.2 Compare HMOs
On the Compare plans page, review HMO plan comparisons before choosing an HMO. Up to three plans can be compared at one time. To get to the Compare plans page:
- Applicants can select Compare plans tool from the Choose a BadgerCare Plus HMO page (or Choose an SSI Medicaid HMO page).
- Members can select Compare HMO plans at the top of the page to access the Compare HMOs page from any page within the HMO module.
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| Note | The following page displays for households that need to compare BadgerCare Plus HMOs for some members and SSI Medicaid HMOs for others. Show/Hide an example of the pageShow/Hide an example of the page The member must select a program and select Compare to continue.
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The Compare plans page displays. Applicants and members can check the Compare plan box for two or three plans. Select Compare plan.
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The Compare BadgerCare Plus HMOs page displays.
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Select Search and add providers to add one or more to a profile on the Provider Search page, see SECTION 10.3.1.3 PROVIDER SEARCH.
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| Note | Applicants and members must add preferred providers to their profile to include them in a comparison of HMO plan coverage (even if they are not currently under their care). After the comparison, applicants and members can remove those preferred providers from their profile. |
If the applicant or member tries to compare HMO plans without adding preferred providers to their profile, a message displays asking the applicant or member to search for a preferred provider, with a link to the Provider Search page.
Applicants and members can choose the plans they want to compare from the drop-down menu.
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For each drop-down choice, applicants and members can review the card for that HMO. The card contains the following information:
- HMO name
- HMO logo
- Information identifying in-network providers
View more detailed information below each card, including:
- Preferred provider coverage
- HMO rating
- Members can select Learn more about ratings for more information. The HMO ratings are maintained by DHS and evaluate the quality of care that Wisconsin Medicaid members receive BadgerCare Plus and SSI Medicaid HMOs.
- Other information
- HMO Contact Information (Member Services)
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Select the hyperlink(s) to get to the HMO Report Card website (if one is available).
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If a member wants to enroll in a new HMO from the Compare HMOs page, select, Select new plan.
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The Confirm your HMO selection page displays. Select Confirm to submit the change.
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The member receives the following Success page.
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Select Go to HMO home.
10.3.1.3 Provider Search
The Provider Search page is where members can search and add providers and facilities to their profile. There are three ways to get to the Provider Search page:
- Select Search for a doctor or clinic on the top of any page.
- Select Search for a doctor or clinic on the Compare HMOs page.
- Members can select Add Provider on the Your household information page.
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On the Provider search page, applicants or members must enter the WI Healthcare Program (either BadgerCare Plus or SSI Medicaid), a nearby address or zip code, and a search radius. Applicants and members can also enter a doctor or clinic name if they know what they are looking for.
Suggested results appear as characters are entered into the Search fields.
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Select Search to find results.
Applicants and Members can apply filters to refine their search. Filters are not required, but they can help identify doctors or clinics that meet the specific needs.
Available filters include the following:
- Category (this refers to the type of provider, such as Medical or Dental)
- Doctor or clinic
- HMO
- Specialty (this refers to the provider’s medical specialty, such as Pediatric)
- Gender
- Language
- Clinic type
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Applicants and members can choose how results display on the page:
- Select View Map to display results within a map.
- From the Sort drop-down menu, choose Distance or sort alphabetically to display results in a list.
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Applicants and members can add doctors and clinics to their profile which helps them see if their own providers are covered when comparing HMOs or choosing a new HMO.
On the results card, the applicant or member can select Add to account.
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A pop-up window displays. On the pop-up window, check a box for each household member to match the doctor or clinic to that person. Select Confirm to add the doctor or clinic to the corresponding profile(s).
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A Success pop-up window displays. The applicant or member can either return to the Provider Search page or go the Manage your HMO page.
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See SECTION 10.3.1.2 COMPARE HMOS for a note how an applicant or member can add preferred providers to their profile to compare HMOs, then remove them.
10.3.1.4 Your Household Information
The Your household information page is where applicants and members can review household member details, health care service information, and HMO enrollment history.
Select View household details at the top of the page to get to the Your household information page.
On the Your household information page, members can view a card for each household member. The card displays the following information about each household member:
- Legal first and last name
- Age
- Preferred language
- Benefit program (BadgerCare Plus or SSI Medicaid)
- HMO name
- Dental coverage (and whether it is covered by an HMO or Fee-for-Service)
- Chiropractic services (and whether it is covered by an HMO or Fee-for-Service)
- Providers
- Facilities
- Pharmacy services (such as prescription drugs and diabetic supplies covered by Fee-for-Service)
Select View enrollment history to expand the member card and view the enrollment history for that member (current and previous HMO enrollment).
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| Note | Only HMO enrollment information from January 1, 2018, forward displays. |
Select Add providers or Edit on the Your household information page, see SECTION 10.3.1.3 PROVIDER SEARCH.
This page last updated in Release Number: 25-01
Release Date: 10/18/2025
Effective Date: 10/18/2025