17.6 Prepaying a Deductible

17.6.1 Insufficient Funds
17.6.2 Payment of Entire Deductible Amount
17.6.3 Combination of Payment and Incurred Expenses
17.6.4 Combination of Payment and Outstanding Expenses
17.6.5 Calculation Errors

Anyone can prepay a BadgerCare Plus deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. for their self or for someone else. It can be paid in installments or all at once. A prepaid deductible may be refunded if the member requests a refund of the prepayment prior to the begin date of the corresponding deductible period.

Instruct the member to make the payment payable to the local Income Maintenance Agency. Report the receipt on the Community Aids Reporting System (CARS) labeled as a Medical Refund.

With the payment, include:

Documentation that the payment is voluntary.
The member’s name and BadgerCare Plus ID number.

17.6.1 Insufficient Funds

If the deductible is paid with a check that is returned for insufficient funds, discontinue the person's eligibility, determine if an overpayment occurred and if so, establish a claim for benefit recovery.

17.6.2 Payment of Entire Deductible Amount

If the entire deductible amount is paid at any point during the deductible period, eligibility begins on the first date of the deductible period.

Example 1

Laura’s deductible period is from March 1 through August 31. The total deductible amount is $1,000. Laura submits payment of $1,000 on August 15. Laura’s BadgerCare Plus eligibility begins on March 1.

17.6.3 Combination of Payment and Incurred Expenses

If the deductible is met through a combination of payment and incurred medical expenses, count the incurred medical expenses first. Eligibility, by paying the remaining deductible amount, can begin no earlier than the last date of incurred medical expense within the deductible period.

Example 1

Gloria’s deductible period is from March 1 through August 31. The total BadgerCare Plus deductible amount is $1,800. Gloria submits a medical bill with a March 8 date of service for $800. On July 15, she submits payment of $1,000. Gloria’s BadgerCare Plus eligibility begins March 8. A BadgerCare Plus Remaining Deductible Update (F-10109) must be submitted to identify the provider of service on March 8 and the $800 member share amount.

17.6.4 Combination of Payment and Outstanding Expenses

If the deductible is met through a combination of payment and outstanding medical expenses (incurred prior to the beginning of the deductible period), eligibility begins on the first date of the deductible period.

Example 1

Roberta’s deductible period is from March 1 through August 31. The total BadgerCare Plus deductible amount is $1,500. She submits an outstanding bill from January 10 for $500. On August 15, she submits payment of $1,000. Roberta’s BadgerCare Plus eligibility begins March 1.

Enter the first date of the deductible period on AGTM as the date the payment was received.

17.6.5 Calculation Errors

If any portion of the deductible is paid and you find the amount was wrong due to agency error, refund the paid amount that was incorrect and report the refund on CARS. If the error was caused by an applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. or member error, see Section 28.2 Recoverable Overpayments for determining the overpayment amount.

This page last updated in Release Number: 18-03
Release Date: 12/14/2018
Effective Date: 12/14/2018