19.3 Premium Limits

Children in an assistance group with income above 201% of the Federal Poverty Level (FPL) will be charged 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 $4,600 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	116%	$0
Rachel	Alan, Rachel, and Hannah	$4,600	214%	$10
Hannah	Alan, Rachel, and Hannah	$4,600	214%	$10
Jacob	Susan, Alan, Aaron, Rachel, Hannah, and Jacob	$7,100	203%	$10

Aaron does not have a premium. Rachel, Hannah, and Jacob each have a $10 premium. Jacob’s Modified Gross Income (MAGI) group has the greatest income, so this group determines the 5% cap. The maximum premium for this group is 5% of $7,100 per month, or $355 per month. Altogether, the household’s monthly premiums are $30. The household will be charged $30 in premiums for their children’s coverage.

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 charged a premium.

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