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.
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