17.7 Remaining Deductible

When the member receives a medical bill that is equal to or greater than the amount they still owe on the deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan., they can be certified for BadgerCare Plus. However, they are still responsible for the part of the bill that equals the deductible. BadgerCare Plus will consider the remainder of the bill for payment (see Process Help, Chapter 19 Medicaid Deductible).

To make sure that BadgerCare Plus does not pay what the member still owes on the deductible, send a BadgerCare Plus Remaining Deductible Update (F-10109) to the fiscal agency indicating the amount of the bill that the member owes. The Fiscal Agent subtracts this amount from the bill and BadgerCare Plus pays the rest.

Fill out the BadgerCare Plus Remaining Deductible Update (F-10109) only if:

A BadgerCare Plus certified provider has provided the billed services.
The person, having met the deductible, is being certified. If they are not being certified, BadgerCare Plus will not pay any of the bill.

The date of the bill is the date the deductible was met. Since the member is not eligible until they have met the deductible, they still owe for all bills prior to that date.

If more than one bill was incurred on the date the deductible was met, send the BadgerCare Plus Remaining Deductible Update (F-10109) for any other bills for which the member would be responsible.

This page last updated in Release Number: 20-03
Release Date: 08/03/2020
Effective Date: 07/01/2020

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.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10171