17.3 Children Under 19

17.3.1 Deductible Period
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 percent of the FPLFederal Poverty Level for a six-month period.

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.

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, John’s mother and stepfather apply for BadgerCare Plus for themselves, John, and John’s two stepbrothers. The family’s countable income is above 150 percent of the 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 stepbrothers 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 1. John will be covered under BadgerCare Plus 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 a child:

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 percent of the FPL. If a month's income is less than or equal to 150 percent of the FPL, ignore it. If a month's income is more than the income limit (150 percent of the 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 2: John, who is 14 years old, is ineligible for BadgerCare Plus because his assistance group's income is over 150 percent of the FPL, and he is covered under his mother’s employer-sponsored health insurance plan. The household’s size is five. Their income is $366.25 over the 150 percent FPL for a group size of five. John’s six-month deductible amount is $2,197.50. (366.25*6=$2,197.50)

Example 3: Mark, who is 5 years old, 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 and 17-year-old brother whose income is counted because he is expected to be required to file taxes. Mark’s assistance group’s income is $3,026 over the 150 percent FPL for a group size of three. However, because Mark’s brother is not his parent or spouse, his income must be excluded 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: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017