19.2 Premium Calculations
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State of Wisconsin
Department of Health Services

Release 24-02
August 22, 2024

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19.2 Premium Calculations

19.2.1 Premium Calculations

Premiums are initially calculated on an individual basis and then a total for the case is determined. The general rules for calculating the premium amounts are explained below.

  1. The minimum monthly premium amount is $10 per child.
  2. The maximum monthly premium for a child with income above 301% up to 306% Federal Poverty Level (FPL) is $97.53.
  3. Each child’s premium amount will be based on their assistance group’s (AG) size and income. Under Modified Adjusted Gross Income (MAGI) rules, it is possible for different children within the same household to have different amounts of income counted and to have 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 AG with the highest income (in terms of dollar amount) in the case (see Section 19.3 Premium Limits).

A child cannot be charged a new or increased premium during their 12-month continuous coverage period, but their premium may be reduced, if applicable. If the premium is lowered, that new amount becomes their premium cap for the rest of the 12-month period. 

This page last updated in Release Number: 24-01
Release Date: 04/03/2024
Effective Date: 04/01/2024

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.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10171