17-01 Version of 19.2 Premium Calculations
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State of Wisconsin
Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

This page last updated in Release Number: 17-01
Release Date: 04/11/2017
Effective Date: 04/11/2017

19.2 Premium Calculations

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  1. 19.2.1 Premium Calculations
    1. 19.2.1.1 Premiums for Children
    2. 19.2.1.2 Premiums for Adults

 

19.2.1 Premium Calculations

Premiums for children are initially calculated on an individual basis and then a total for the case is determined, while premiums for adults in extensions are based on a percentage of the adult’s assistance group income. The general rules for calculating the premium amounts are explained below for children and adults.

19.2.1.1 Premiums for Children

  1. The minimum monthly premium amount for children is $10 per person.
  2. The maximum monthly premium for a child with income above 301% up to 306% FPL is $97.53.
  3. Each child’s premium amount will be based on their AG’s size and income. Under MAGI rules, it is possible for different children within the same household to have different amounts of income counted and to have a different AG sizes. For this reason, each child’s AG is evaluated separately to determine that AG’s income and group size, which is the basis for determining the FPL percentage of that child’s income. That FPL percentage, in turn, will determine whether a child potentially owes a premium and the amount of the premium.
  4. The premium for the BadgerCare Plus group is the total of the individually calculated premiums combined, not to exceed 5% cap.

  5. The cap will be 5% of the income of the assistance group with the highest income (in terms of dollar amount) in the case (see Section 19.3 Premium Limits).

19.2.1.2 Premiums for Adults

  1. For non-pregnant, non-disabled parents and caretaker relatives in BadgerCare Plus extensions with a family income between 100% and 133% of the FPL, the premiums will be equal to 2% of countable income.
  2. For non-pregnant, non-disabled parents and caretaker relatives in BadgerCare Plus extensions with a family income above 133% of the FPL, premiums will be calculated based on a sliding scale, ranging from 3% of countable income for individuals above 133% of the FPL to 9.5% of countable income for individuals at or above 300% of the FPL.
  3. Premiums for adults in extensions will be calculated based on actual income and rounded to the nearest dollar. See 48.1 for premium ranges based on family size and income. When a child is pulled into an adult’s extension, the child does not owe a premium.
  4. Adults in an extension who are married filing jointly, or who are married but not filing taxes, will have a combined premium. Adults in an extension who are married filing separately or are non-marital co-parents will have premiums calculated on an individual basis.

 

Note: Pregnant minors are not charged a premium.

 

 

 

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017

The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171