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17.4 Meeting the Deductible The BadgerCare Plus member or group meets the deductible by incurring medical or remedial costs that equal the dollar amount of the deductible. The countable costs are added together. When they are equal to or greater than the amount of the deductible, the pregnant woman or child under 19 can be certified for BadgerCare Plus through the end of the deductible period. Note The deductible is built on an individual basis. To meet the deductible, the member and their parents in the BadgerCare Plus group must incur medical bills equal to the deductible amount. The parent’s medical expenses may be used for meeting the deductible of more than one child at a time, but deductible-based eligibility is not extended to other children or members of the original assistance group. Medical expenses of siblings may not be used for a child's deductible. If an expense was applied to a prior deductible but did not result in BadgerCare Plus certification, it can be applied to a later deductible, as long as it still meets the criteria listed in SECTION 17.4.1 WHEN EXPENSES CAN BE COUNTED TOWARD A DEDUCTIBLE. 17.4.1 When Expenses Can Be Counted Toward a Deductible To be counted toward the deductible, a medical or remedial expense must meet all of the following conditions: 1. Be incurred by the member, their spouse (if applicable), or, if the member is younger than 19 years old, their parents.

Expenses may also be counted if incurred for someone the member is legally responsible for if that person's bills could be counted toward the member's deductible. The medical bill may be used even if the person is no longer living or no longer in the current BadgerCare Plus group. Example 1 Sally's spouse, Michael, died in April. In September, Sally requests that a medical bill incurred for Michael be used toward her deductible. Sally is still legally responsible for the bill. The bill can be used to meet the deductible as long as it did not result in a BadgerCare Plus certification in an earlier period.

Example 2 Jenny’s children, Sam and Olivia, each have a $1000 deductible. Jenny has a medical bill for $1000. This bill can be used to meet both Sam’s $1000 deductible and Olivia’s $1000 deductible at the same time. 2. Meet the Definition of Medical or Remedial expense described in SECTION 17.4.2 COUNTABLE EXPENSES. 3. Meet one of the following four conditions: a. Still be owed to the medical service provider sometime during the current deductible period. Expenses which have been "deferred” by the provider are considered a countable cost still owed to the provider and can be used to meet a BadgerCare Plus deductible. i. The deferred charge should be viewed as an incurred expense that remains an unpaid obligation for the member. ii. If only a portion of the deferred charge was used to meet a prior deductible, any remaining balance can be used to meet future deductibles.