17.3 Children Under 19

17.3.2 Calculating the Deductible Amount

The deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. amount for a child under 19 is the amount of countable income above 150% FPL for a 6 month period.

Under MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules, to meet the deductible, the child or his or her parents included in the child’s BadgerCare Plus group must incur medical bills equal to the deductible amount. Deductible-based eligibility is not extended to other children or members of the original assistance group. The parents’ medical expenses may be used for meeting the deductible of more than one child are a time.

Under non-MAGIApply to households whose eligibility is determined using BadgerCare Plus relationship rules (prior to March 31, 2014) to budget income for a household prior to transitioning to MAGI BadgerCare Plus budgeting rules. rules, to meet the deductible, the child or other family members included in the BadgerCare Plus group must incur medical bills equal to the deductible amount. Once the deductible is met, the child and all other children under 19 in the BadgerCare Plus group will be covered under the Standard plan without a premium, for the remainder of the deductible period.

17.3.1 Deductible Period

The child under 19 can choose to begin the BadgerCare Plus deductible period as early as three months prior to the month of application and as late as the month of applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process..

Example 1: On November 1, 2014 John’s mother and step-father apply for BadgerCare Plus for themselves, John and John’s two step-brothers. The family’s countable income is above 150% FPL. John’s mother has employer sponsored insurance that covers her and John. John is ineligible for BadgerCare Plus due to the insurance access. John’s step-brothers are eligible for BadgerCare Plus with a premium. Because the health insurance does not cover all of John’s medical expenses, in December John’s mother requests a deductible for John. The deductible period is December through May. John has medical bills that will meet the deductible as of January 1st. John will be covered under the standard plan with no premium from January through May.

The BadgerCare Plus deductible period for a child can include a month in which, if he or she had applied, he or she would have been ineligible for a non-financial reason other than health insurance access or coverage. Although excess income is still calculated over a six month period, the child can only be certified for BadgerCare Plus during the dates when he or she met all non-financial criteria other than health insurance access or coverage.

A new deductible period can be established at any time before the current deductible has been met.

17.3.2 Calculating the Deductible Amount

To calculate the dollar amount of the BadgerCare Plus deductible for children under age 19 under non-MAGIApply to households whose eligibility is determined using BadgerCare Plus relationship rules (prior to March 31, 2014) to budget income for a household prior to transitioning to MAGI BadgerCare Plus budgeting rules. rules.

Determine the BadgerCare Plus deductible period.
Find the BadgerCare Plus group's total countable income for each month in the deductible period.
Compare the total income of each month with 150% FPL. If a month's income is less than or equal to 150% FPL, ignore it. If a month's income is more than the income limit (150% FPL), find the excess income by subtracting the income limit from the income of that month. The child could choose to drop the deductible for months his or her income decreases and the child is eligible to enroll in BadgerCare Plus. If the child chooses to drop the deductible, the 6-month deductible period is interrupted and the deductible lapses. If the income later increases to above 150%, the child would need to start a new deductible period.
Add together the excess income of the months in the deductible period. The result is the child’s BadgerCare Plus deductible amount.

To calculate the dollar amount of the BadgerCare Plus deductible for a child under MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules:

Determine the BadgerCare Plus deductible period.
Find the child’s assistance group's total countable income for each month in the deductible period.
If the assistance group’s total countable income includes the income of someone other than the child, the child’s parents, or, if married, the child’s spouse, subtract the income of that person, but do not change the group size of the AG.
Compare the total income of each month with 150% FPL. If a month's income is less than or equal to 150% FPL, ignore it. If a month's income is more than the income limit (150% FPL), find the excess income by subtracting the income limit from the income of that month. The child could choose to drop the deductible for months his or her income decreases so that the child is eligible to enroll in BadgerCare Plus.
Add together the excess income of the months in the deductible period. The result is the child’s BadgerCare Plus deductible amount.

Example 1: John, age 14, is ineligible for BadgerCare Plus because his assistance group's income is over 150% of the FPL and he is covered under his mother’s employer sponsored health insurance plan. The household’s size is 5. Their income is $3466.25 per month, which is $366.25 over the 150% FPL for a group size of 5. John’s six month deductible amount is $2197.50. (366.25*6=2197.50)

Example 2: Mark, age 5, is ineligible for BadgerCare Plus because his assistance group's income is over 306% of the FPL. The household is made up of Mark’s mother, who earns $4,000/month and his brother, age 17, who earns $1,500/month and whose income is counted because he is expected to be required to file taxes. Mark’s assistance group’s income is $5,500 per month, which is $3,026 over the 150% FPL for a group size of 3. However, because Mark’s brother is not his parent or spouse, we must exclude his income from the deductible calculation. This reduces the excess income to $1,526. John’s six month deductible amount is $9,156 ($1,526*6=$9,126).

This page last updated in Release Number: 14-02

Release Date: 05/14/14

Effective Date: 04/01/14