22-01 Version of 19.3 Premium Limits

Children in an assistance group with income above 201% of the FPL are required to pay premiums. The total premium for the household is the total of the individual premiums for all children in the household, not to exceed a 5% cap. The cap is 5% of the income of the assistance group with the highest income (in terms of dollar amount) in the case.

Example 1

Susan and Alan are non-marital co-parents caring for four children: Susan’s son, Aaron (15); Alan’s daughters Rachel (12) and Hannah (11); and Susan and Alan’s son Jacob (9). Alan claims Rachel and Hannah as his two tax dependents, while Susan claims Aaron and Jacob. Susan earns $2,500 per month as a waitress, and Alan earns $4,500 per month as a computer analyst. None of the children have income. All four children are eligible for BadgerCare Plus.

Child	MAGI Group Formation	Assistance Group Income Amount	FPL	Premium Amount
Aaron	Susan, Aaron, and Jacob	$2,500	130%	$0
Rachel	Alan, Rachel, and Hannah	$4,500	234%	$15
Hannah	Alan, Rachel, and Hannah	$4,500	234%	$15
Jacob	Susan, Alan, Aaron, Rachel, Hannah, and Jacob	$7,000	226%	$10

Aaron does not have a premium, Rachel and Hannah have $15 premiums, and Jacob has a $10 premium. Jacob’s MAGI group has the greatest income, so this group determines the 5% cap. The maximum premium for this group is 5% of $7,000 per month, or $350 per month. Altogether, the household’s monthly premiums are $40. The household will pay $40 in premiums for their children’s coverage.

This page last updated in Release Number: 22-01
Release Date: 04/04/2022
Effective Date: 04/04/2022