23-04 Version of 19.3 Premium Limits

Children in an assistance group with income above 201% of the Federal Poverty Level (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 (AG) 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	121%	$0
Rachel	Alan, Rachel, and Hannah	$4,500	217%	$10
Hannah	Alan, Rachel, and Hannah	$4,500	217%	$10
Jacob	Susan, Alan, Aaron, Rachel, Hannah, and Jacob	$7,000	209%	$10

Aaron does not have a premium. Rachel, Hannah, and Jacob each have 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 $30. The household will pay $30 in premiums for their children’s coverage.

Effective January 1, 2024, a child cannot be charged a new or increased premium during their 12-month continuous coverage period, so if an AG’s income increases from at or below 201% to above 201% FPL during their 12-month continuous coverage period, they will not be required to pay a premium.

This page last updated in Release Number: 23-04
Release Date: 12/18/2023
Effective Date: 01/01/2024