Residents with pre-existing conditions may qualify for state and federal insurance programs.
According to the 2009 ranking report of the United Health Foundation, Wisconsin is the twelfth healthiest state in the country. The state also ranks among the best in the nation for occupational fatalities, infectious disease and immunization coverage. Health insurance is available in Wisconsin through a variety of sources including employer sponsored plans as well as individual plans. For high risk residents who cannot qualify for individual insurance, high risk insurance plans through state and federal government programs may be available.
Employer Plans
The most reasonable option to obtain health insurance for high risk Wisconsin residents is through an employer. Employer sponsored insurance plans cannot turn away an insured because of health status or pre-existing conditions. Further, the health plan must cover eligible dependants as long as premiums are paid. For high risk residents who change employers or lose their insurance because of layoff or reduction in hours, the Health Insurance Portability and Accountability Act (HIPAA) protects the insurability of the participant and his ability to obtain coverage through a new plan.
Health Insurance Risk Sharing State Plan
The Health Insurance Risk Sharing Plan (HIRSP) is available to Wisconsin residents who have lost their employer-sponsored insurance or cannot qualify for insurance because of their current health status or existing medical condition. The plan provides benefits such as medical and surgical services, anesthesia, prescription drugs, radiology and laboratory services, pap and pelvic exams, nursing care, hospice care and more.
To qualify for state-level HIRSP, plan participants must be a resident of Wisconsin and under the age of 65. Residents must not be eligible for Wisconsin Medicaid services or eligible for insurance with an employer. Residents only qualify if a pre-existing medical condition exists. A six-month pre-existing condition waiting period applies to residents who need coverage for reasons other than the loss of employer-sponsored insurance.
Health Insurance Risk Sharing Federal Plan:
The Health Insurance Risk Sharing Federal Plan is very similar to the state level HIRSP plan but does not have a six month waiting period for pre-existing conditions. Residents who have been uninsured for the past six months and have received a rejection notice from an insurer based on medical underwriting within the past 9 months are eligible for the federal plan. Similar to the state-level HIRSP plan, the federal plan covers preventative and emergency care, hospital and doctor's visits as well as annual exams. The federal plan does not cover routine dental care, cosmetic procedures, eyeglasses and infertility.
Badger Care Plus
The Wisconsin Department of Health Services offers the Badger Care health program which provides limited health plan benefits for residents who have medical need but cannot afford comprehensive medical coverage. Plan benefits include chiropractic services, dialysis related services, disposable medical supplies, doctor's visits, home health services, emergency services, physical therapy, podiatry, some prescription drugs and more. Residents must meet income qualification criteria to be eligible for Badger Care benefits.
Tags: Health Insurance, Health Insurance Risk, Insurance Risk, Insurance Risk Sharing, Risk Sharing, Badger Care
