• To find general information about health insurance and other types of insurance offered in your state, as well as to learn more about specific insurance companies, agents, or brokers, visit the Wisconsin Office of the Commissioner of Insurance website, or call 800.236.8517 or 606.266.3585.
• For more information and resources on health insurance, visit Triage Cancer's Health Insurance Topics Page.

Marketplace

• For information about options for buying health insurance from private insurance companies, as well as whether you are eligible for marketplace financial assistance, visit HealthCare.gov, or call 800.318.2596.

COBRA

• COBRA provides a way for workers and their families to temporarily maintain their employer-provided health insurance during situations such as job loss or a reduction in hours worked. If you have questions about COBRA, visit the Employee Benefits Security Administration website or call 866.444.3272.

State COBRA

• For information about your state's COBRA law related to maintaining employer-provided health insurance during situations such as job loss or a reduction in hours worked, as well as information about how your state's law works with federal COBRA, visit the Wisconsin Office of the Commissioner of Insurance website, or call 800.236.8517 or 606.266.3585.

Children's Health Insurance

• Visit this site to learn about the Children's Health Insurance Program (CHIP) (800.362.3002), which provides low-cost health coverage to children in families that earn too much money to be eligible for Medicaid.
• Visit InsureKidsNow.gov to learn about free or low-cost health and dental insurance coverage options for kids and teens.

More Insurance Information

• For more information and resources on health insurance, visit Triage Cancer's Health Insurance Topics Page.

• To apply for an Independent Medical Review (an external appeal of a health plan denial) or to file a Consumer Complaint about your health plan, visit the Office of the Commissioner of Insurance website.
• If your health insurance company has denied coverage for your care, you can appeal that decision. The process depends on the type of health insurance that you have. Visit the Health Insurance Appeals module on CancerFinances.org to learn more about appeals.
• If you have private health insurance (e.g., through an employer or the Marketplace), you can also file an external appeal with an entity outside of your insurance company, to see if the insurance company is required to cover your care. The external review process is either handled by the state’s insurance agency or the U.S. Department of Health & Human Services. Visit our Chart of State Laws on Health Insurance Coverage & Navigation to see who runs the external appeals process in your state.

• Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease or ALS. For information about Medicare, to create a personal account where you can view your Medicare information, and to learn about plan options, visit Medicare.gov, or call 800.MEDICARE (800.633.4227)
• Download a copy of Medicare's handbook, “Medicare & You.”
• For help navigating Medicare, contact the State Health Insurance Assistance Program (SHIP), 800.472.1638.
• For more information, visit Triage Cancer's Medicare Topics Page.

• Medicaid provides free or low-cost health coverage to eligible individuals, including people with low-incomes, families, chidlren, pregnant women, the elderly, and people with disabilities. Each state has its own rules for eligibility. Read Triage Cancer's Quick Guide to Medicaid to learn more.
• States have the option to expand Medicaid eligibility to individuals with incomes at or below 138% of the Federal Poverty Level. Visit Triage Cancer's Guide to Medicaid Expansion to see whether your state has expanded Medicaid.
• Visit this site to learn more about Medicaid benefits in your state.

Health Insurance Premium Payment Program (HIPP)

• The HIPP program can help pay your group health insurance premium (e.g., COBRA) if you are eligible for Medicaid. For more information, visit the HIPP program website, or call 800.362.3002.

Early & Periodic Screening, Diagnostic, & Treatment (EPSDT)

• The EPSDT benefit is a Medicaid benefit available to individuals under the age of 21.
• States are required to provide comprehensive services needed to correct and ameliorate health conditions, including:
  • Early: Assess and identify problems early, starting at birth
  • Periodic: Check children’s health at periodic, age-appropriate intervals in comprehensive well-child visits, including health education
  • Screening: Provide physical, dental, mental, developmental, hearing, vision, and other screening or laboratory tests to detect potential problems
  • Diagnosis: Perform diagnostic tests and assessments to follow up when a risk is identified during screening and examinations
  • Treatment: Control, correct, or ameliorate any problems that are found
• States are required to provide any additional health care services that are coverable under the federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan. State Medicaid agencies are required to:
  • Inform all Medicaid-eligible individuals under age 21 that EPSDT services are available and of the need for age-appropriate immunizations;
  • Offer and provide, if requested and necessary, assistance with transportation to medical care.
  • Offer and provide, if requested and necessary, assistance with scheduling appointments for EPSDT visits and services.
• Learn more about your state's program.

Children's Health Insurance

• Visit this site to learn about the Children's Health Insurance Program (CHIP) (800.362.3002), which provides low-cost health coverage to children in families that earn too much money to be eligible for Medicaid.
• Visit InsureKidsNow.gov to learn about free or low-cost health and dental insurance coverage options for kids and teens.

In-Home Support Services (IHSS)

• Visit this site for information about a Medicaid program that helps seniors and people with disabilities to stay in their homes, by providing in-home caregiving services, such as help with activities of daily living, household chores, grocery shopping, etc. Some states allow family members to get paid as caregivers.

More Medicaid Resources

• For more information, visit Triage Cancer Medicaid Topics Page.

• For a list of Hill-Burton Federally Funded Health Centers that are obligated to provide free or reduced-cost health care, visit the Health Resources & Services Administration (HRSA) website.
• Federally Qualified Health Centers (FQHC) are community-based health care providers that provide primary care services in underserved areas. To search for an FQHC in your state, use the Find a Health Center tool on the HRSA website.
• To find a community clinic in your area: screenings and services in your area, visit the National Association of Free & Charitable Clinics website.
• The National Breast & Cervical Cancer Treatment Program (NBCCEDP) provides breast and cervical cancer screenings and diagnostic services to women who have low incomes and are uninsured or underinsured. For more information about screenings and services in your area, use the CDC search tool.
• The Breast & Cervical Cancer Treatment Program (BCCTP) provides cancer treatment benefits to eligible low-income individuals diagnosed with breast and/or cervical cancer.

Women's Health & Cancer Rights Act (WHCRA)

• WHCRA provides protections for individuals who have had a mastectomy. For more information, visit the Employee Benefits Security Administration website.

Privacy

• HIPAA sets rules about health information privacy. To learn more, read this document on sharing health information with family members and friends.
• For more information about HIPAA and to file a HIPAA complaint, visit the Department of Health & Human Services website.
• To learn about making educated disclosure decisions, visit Triage Cancer's Quick Guide to Disclosure, Privacy, & Medical Certification Forms.

State Clinical Trials Law

• Wis. Stat. 632.87(6) – Coverage of Clinical Trials
• Who must cover the costs? Insurance policies, plans, or contracts
• What must be covered? Routine patient care that is administered to an insured in a cancer clinical trial satisfying the criteria that it would be covered under the policy, plan, or contract if the insured were not enrolled in a cancer clinical trial. This coverage applies for clinical trials of any phase but is subject to the terms and conditions of the underlying plan or policy.
• Requirements for Coverage: The trial must be designed and the treatment intended to improve the health outcomes of the patient; it may not be designed exclusively to test toxicity or disease pathophysiology. The trial must also do one of the following: (a) Tests how to administer a health care service, item, or drug for the treatment of cancer, (b) Test responses to a health care service, item, or drug for the treatment of cancer, (c) Compare the effectiveness of health care services, items, or drugs for the treatment of cancer with that of other health care services, items, or drugs for the treatment of cancer, or (d) Study new uses of health care services, items, or drugs for the treatment of cancer.
• Qualifying Trials: The trial must be approved by one of the following: (1) NIH, or one of its cooperative groups or centers, under the federal department of health and human services, (2) The FDA, (3) The U.S. Dept. of Defense; or (4) the U.S. Dept. of Veterans Affairs.

(Current as of 08/2022)

More Health Insurance Resources

• For more information and resources on health insurance, visit Triage Cancer's Health Insurance Topics Page.