Written by a parent, not a doctor. Nothing here is medical advice.

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Wisconsin program

Coverage after medical bills reach a set amount (BadgerCare Plus deductible)

A route into BadgerCare Plus when income or existing insurance blocks ordinary coverage.

What it is

A route into BadgerCare Plus when income or existing insurance blocks ordinary coverage.

Wisconsin calls this route a deductible, also known as spend-down. The agency calculates income above a set line over six months. Eligible bills can meet that amount, even when ordinary coverage is unavailable.

Eligibility rules
  • The calculation uses income above 150% of poverty over six months.
  • The line by household size, per month: 2: $2,705 · 3: $3,415 · 4: $4,125 · 5: $4,835 · 6: $5,545. Everything above it over six months has to be matched by medical bills before coverage starts.
  • A child under 19 excluded by current coverage can use this route. Eligible unpaid and recently paid medical or remedial bills are subject to the program's billing-period rules.
  • There is no upper income limit; the higher the income, the larger the bills needed.
What you get
  • Full BadgerCare Plus benefits after the deductible is met, through the end of the six-month period.
  • No savings test.
If you decide to apply
  1. Your social worker can help you decide whether to talk with the income maintenance or tribal agency for a deductible calculation.
  2. Bring current income, itemized medical bills and older bills still owed. Keep copies of what you submit.

Your income maintenance or tribal agency; agency referral: 800-362-3002 · Official page ↗

Good to know

A sibling's bills cannot meet your child's deductible. This route does not bring 12 months of continuous coverage.

Other details
  • The agency decides which bills count and when the deductible has been met. Its notice gives the coverage end date.
  • The deductible can also be paid to the agency. The agency can explain how payment changes the start date.
  • The agency can review your child's bills and qualifying parent or spouse bills, but not a sibling's bills. Older bills still owed and some recently paid expenses may count under the period's rules; insurance-paid amounts and expenses already used cannot simply be counted again. Coverage may start on the day enough allowable bills were incurred, at the start of a qualifying hospital stay, or from the period's first day when payment to the agency meets the rules. Your social worker can help request a written calculation showing which bills count, the start date and what remains your responsibility.
  • The agency confirms the processing time for submitted bills. The ordinary application clock is not a separate deadline for reviewing a deductible calculation.

Federal background: Medicaid through a medically needy or spend-down route.

Official sources
Ask your social worker

“Would a BadgerCare Plus deductible help with our bills, what would we still owe, and would you help us request the calculation if it makes sense?”

Why I’m asking: I want to compare the amount we must meet with the coverage it would open.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask for the deductible in writing, then hand in bills as they arrive and keep copies.

Your social worker

The hospital financial counsellor gives you itemised bills quickly and can hold collections while the agency decides.

The care team

Records and letters when the application asks for them.

Who decides
Your local income maintenance or tribal agency works out the amount and decides when the bills have met it.
Ask your social worker
“We are over the income limit. Can the agency work out a deductible for us, and can the hospital give us itemised bills to take in?”

How to apply

First step: Apply at access.wi.gov and ask the agency to work out a deductible for your child, then take in the hospital bills as they arrive.

  1. Apply as usual and ask the agency in writing to work out a deductible.
  2. Keep every bill and take them in as soon as they arrive.
  3. Ask whether paying the deductible in would open the whole six months.

Official application / program page ↗

Where it starts: Apply at access.wi.gov as usual and ask the agency to work out a deductible. Take the bills in as they arrive.

What to gather

  • Itemised hospital and clinic bills
  • This month's income for each adult in the group
  • Any bills still owed from before

How long: The state publishes no measured time for processing bills against a deductible, so ask the agency when you hand them in.

What a yes looks like

A notice saying the deductible is met and coverage runs to the end of the six-month period.

What a no looks like, and the next move

The bills do not reach the figure yet. Ask what is still needed, and ask whether paying part of it in would help.

Watch out

  • A brother or sister's bills cannot be used to meet this child's deductible.
  • Bills count while they are still owed during the period, so hand them in early.
  • This route does not carry the 12 months of continuous coverage that an ordinary approval does.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Coverage for the rest of a six-month period once bills reach the amount your income sits above $2,705 for two, $3,415 for three, $4,125 for four, $4,835 for five or $5,545 for six.

  • $2,705/month — Household of 2, the monthly line the deductible is measured from (150% of poverty)
  • $3,415.01/month — Household of 3, the monthly line the deductible is measured from (150% of poverty)
  • $4,125/month — Household of 4, the monthly line the deductible is measured from (150% of poverty)
  • $4,835/month — Household of 5, the monthly line the deductible is measured from (150% of poverty)
  • $5,545.01/month — Household of 6, the monthly line the deductible is measured from (150% of poverty)
  • $6 — Length of the period the deductible is worked out over

Covers: The full BadgerCare Plus benefit once the deductible is met, for the rest of the six months

Legal protection: No asset limit for BadgerCare Plus, including this route

What it costs the family: The deductible amount, met in bills or paid in at the agency.

The eligibility facts, as published

Income
income above 150% of the poverty line, measured over a six-month period
Assets
no asset limit for BadgerCare Plus
Bills
unpaid and recently paid medical or remedial bills; still owed during the period; a sibling's bills cannot be used
Insurance
a child under 19 shut out by current coverage can qualify by meeting a deductible
Route
the ordinary application, with a request that the agency work out a deductible

The trap: Bills only count while they are still owed during the deductible period, and a brother or sister's bills cannot be used for this child. An old bill is not automatically excluded just because it predates the period. You can also pay the deductible in, in full or in part, at the local agency; paying it all can open coverage for the whole six months.

Where I read this

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