Insurance/Payment Information

Insurance/Payment InformationQUICK LINKS

 

Employer-Sponsored or Private Health Insurance

If you are insured through your employer or if you have purchased a private plan, check with your insurance company or human resource department to find out if the plan covers mental/behavioral health and, if so, what services are covered, what your co-pays will be, etc. If your plan does provide coverage, you will need to be sure to use a provider that will be covered. Most insurance companies provide a searchable directory on their web site or provide a Member Services toll-free number on the insurance card.
 
If you are not covered by your employer or through a private plan, you may qualify for one of the following:
 

State Programs

ACCESS Wisconsin: An internet tool that can help determine which low or no-cost health, nutrition, or other programs a person may be eligible for including Medicaid and BadgerCare.

BadgerCare Plus: Wisconsin's program to provide health care coverage for uninsured families with children under age 19 living with them and whose income meet guideline limits. Adults with no dependent children may qualify for the Core plan.


Medicaid: Medicaid is a joint federal/state program to pay for medical services for people with disabilities; people 65 years and older; children and their caretakers; and pregnant women who meet the program's financial requirements. Wisconsin Medicaid is also known as the Medical Assistance (MA) Program, Title XIX, or T19.


Federal Programs

Medicare  is available to those over the age of 65. Medicare Part A covers hospital expenses, including home health care and hospice care. Part B covers medical services, such as physician services, outpatient hospital care, and laboratory services. Part D covers some prescription medications.

Supplemental Security Income (SSI) and Social Security Disability (SSD): Federal programs that provide assistance to people with disabilities. Both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program.


Resources for the Uninsured or Underinsured

It can be challenging to find affordable care. The following resources may be able to assist you if you are uninsured:

Dial 2-1-1:  2-1-1 is the three digit dialing code designated to provide widespread access to human services, community information and referral. Each county in Wisconsin is connected to a 2-1-1 service. Simply dial 2-1-1 on your phone. Specific contact information for each county can be found in the Statewide Resources section.

Department of Health and Human Services: Contact your county's Department of Health and Human Services to find out which clinics or hositals serve those without insurance. Contact information for each county can be found in the Statewide Resources section.

Free or Low Cost Clinics: The Department of Health Services provides listings for free or low cost clinics throughout the state. Please note that some but not all clinics listed offer mental health treatment.

Sliding Fee Scale: Many mental health clinics will provide services on a sliding fee scale; you may be able to obtain services for a reduced price based on your income. Search the Therapist Directory for providers in the Milwaukee County area that may offer a sliding fee scale. Or, check the Wisconsin Community Substance Abuse and Mental Health Directory for listings in your county.

Colleges or Universities: May have reduced fee or free mental health services through their education or training programs. Services may be available for both students and the community.

For resources in Milwaukee County, you may also MHA at (414) 276-3122 or by email at info@mhawisconsin.org.



Additional Resources

ABC for Health, Inc.- Advocacy and Benefits Counseling (ABC) for Health provides health care consumers with information, advocacy tools, legal services, and expert support they need to navigate through America's complex and confusing health care financing system.

Medigap Helpline- The Medigap Helpline will help you make wise insurance decisions. This is a statewide toll-free number provided by the Wisconsin Board on Aging and Long Term Care. It has no connection with any insurance company.

Wisconsin Consumer Guide to Health Care (Wisconsin Department of Health and Family Services) - Information on choosing a health care provider, paying for care, filing complaints, coping with chronic illnesses or disabilities, getting the most out of your health care, and additional local and national resources.
 
Information about Wisconsin's new Mental Health Parity laws.

HealthCare.gov -  A web site created by the federal Department of Health and Human Services to provide information to consumers and small employers regarding the Affordable Health Care Act and health care and long-term care insurance information.  It is written in consumer-friendly language.


Paying for Prescription Medication

Prescription MedicationBadgerRX Gold: Prescription discount program for Wisconsin residents.
Coalition of Wisconsin Aging Groups (CWAG): Prescription drug discount program that can save CWAG members money on their prescription needs.

 
Medicare Part D: Medicare prescription drug coverage.
 
NeedyMeds: Web-based information resource for people who need assistance paying for health care. 

Partnership for Prescription Assistance: Offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies.
 
RX Assist: Database of patient assistance programs, as well as practical tools, news, and articles for health care professionals and patients.
 
SeniorCare: Wisconsin's prescription drug assistance program for Wisconsin residents age 65 or older who meet eligibility requirements.