Healthcare

MARKETPLACE

The Marketplace, shorthand for the “Health Insurance Marketplace,” is a shopping and enrollment service for medical insurance created by the federal Affordable Care Act in 2010 (sometimes known as ACA, PPACA, or “Obamacare”). In most states, the federal government runs the Marketplace for individuals and families. Get a quick overview of the Marketplace.

You can shop for and enroll in affordable medical insurance online, by phone, or with in-person help from a trained assister or an agent or broker:


MEDICAID IN WISCONSIN

Wisconsin Medicaid is a joint federal and state program that provides high-quality health care coverage, long-term care, and other services to over one million Wisconsin residents. There are many types of Medicaid programs. Each program has different rules, such as about age and income, that you must meet to be eligible for the program.

Find out about options for applying for BadgerCare Plus, Medicaid, FoodShare, Caretaker Supplement, Medicare Savings Programs, or Family Planning Only Services benefits by visiting the website or talking with an Income Maintenance worker:


MEDICARE

Medicare is the federal health insurance program for:

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

The different parts of Medicare help cover specific services:

MEDICARE PART A (Hospital Insurance):

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

MEDICARE PART B (Medical Insurance):

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

MEDICARE PART D (Prescription Drug Coverage):

Part D adds prescription drug coverage to:

  • Original Medicare
  • Some Medicare Cost Plans
  • Some Medicare Private-Fee-for-Service Plans
  • Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare.

MEDICARE ADVANTAGE (also known as Part C):

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.

MEDIGAP (Medicare Supplement Health Insurance):

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs.

Find out more about Medicare:

  • Phone: 1-800-MEDICARE (1-800-633-4227)
  • Online: medicare.gov


Disability Benefit Specialists (DBS)
help answer questions and solve problems related to Social Security, Medicare, health insurance, and other public and private benefits for people with disabilities.  They serve people ages 18-59 who have a disability.  Services are free and confidential. Elder Benefit Specialists (EBS) offer similar services for people age 60 or older.

  • If you need the assistance of a DBS or EBS and live in the ADRC-North service area, please call 866-663-3607 for more information.

If you are deaf, hard of hearing or Deaf-Blind and need help with your benefits, you may choose to contact the Deaf Disability Benefit Specialist at the Office for the Deaf and Hard of Hearing.

Enrolled tribal members who live on or near a reservation in Wisconsin may opt to work with a tribal benefit specialist.

The State Health Insurance Assistance Program (SHIP) offers free personalized health insurance counseling. In Wisconsin, call 800-242-1060 for assistance.