19.1 BadgerCare Plus Premiums

Note: Premium policies for BadgerCare Plus Core members are found in the archived PDF version of Chapter 43.

The following individuals must pay a premium to become or remain eligible for BadgerCare Plus unless exempt:

Children in families with income over 200% FPL (under non-MAGI rules) or 201% (under MAGI rules),
Parents, stepparents and caretaker relatives with income over 100% FPL in a BadgerCare Plus Extension that starts on or after April 1, 2014,
Through March 31, 2014, parents, stepparents and caretaker relatives with income over 133% through 200% of the FPL,
Through March 31, 2014, self-employed parents, stepparents and caretaker relatives with income above 200% of the FPL before subtracting the depreciationA federal income tax deduction for the cost of a business asset that gradually loses value through the wear and tear of use. but below 200% of the FPL after subtracting the depreciation.

Note: Effective with BadgerCare Plus Extensions that begin on or after April 1, 2014, parents, stepparents and caretaker relatives with income between 100% and 133% FPL in a BadgerCare Plus Extension will be subject to premiums starting in the seventh calendar month of their Extension. October 2014 is the first month for which premiums will be charged for non-exempt adults in an Extension with income at or below 133% FPL.

If a member’s income changes during their Extension, he or she will only be exempt from premiums if he or she is in the first six calendar months of that Extension, and if his or her income is at or below 133% FPL.

If the member has an increase in income that puts his or her income above 133% FPL, he or she will be subject to premiums, even if he or she is still in the first six calendar months of the Extension.
If the member’s income subsequently decreases to below 133% FPL, he or she will be exempt from premiums as long as he or she is in the first six months of the Extension.
If the member’s income drops below 100% FPL, he or she will be enrolled in regular BadgerCare Plus and is no longer subject to a premium.
If the member’s income drops below 100% FPL, then later increases and the member qualifies for a new Extension, a new six-month premium exemption will begin with the new Extension.
If the member’s income drops below 100% FPL, then later increases and the member does not qualify for a new Extension, the member will be re-enrolled in the previous Extension and the original six-month time frame for exempting premiums will apply.

Example 1: Jane starts a 12-month Extension in June, when her income increases from 90% FPL to 110% FPL. If Jane’s income remains below 133% FPL, she will owe a premium beginning in December, the seventh month of her Extension.

Example 2: Jane starts a 12-month Extension in June, when her income increases from 90% FPL to 110% FPL. On August 5th, she reports she received a raise, and her income goes up to 155% FPL. Jane owes a premium starting in September. If her income stays above 133% FPL through November, she will continue to owe a premium, even though she is in the first six months of her Extension. She will owe a premium, irrespective of whether her income is above or below 133% FPL, for December through May.

Example 3: Joe starts a 12-month Extension in May, when his income increases from 90% FPL to 110% FPL. On June 3rd, he reports he received a raise, and his income goes up to 155% FPL. In July, he will owe a premium. In August, he reports a reduction in hours, bringing his income down to 120% FPL starting in the month of August. He will not owe a premium in August, September or October, but starting with the month of November, his six-month exemption is over, so he will start paying premiums again.

Example 4: Jim starts a 12-month Extension in August, when his income increases from 90% FPL to 140% FPL. He owes a premium. He reports a reduction in hours effective December, which brings his income down to 120% FPL. He will not owe a premium in December or January, but starting in February, his six-month exemption is over, so he will start paying premiums again.

The following individuals are exempt from the requirement to pay a premium:

All pregnant women and pregnant minors,
Pregnant women under age 19 with income at or below 300% of the FPL,
Former Foster Care Youth. (Chapter 11),
Children who have met a BadgerCare Plus deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan., during the remainder of the deductible period,
Children in a BadgerCare Plus Extension,
Children who are not in an Extension but whose parents are in an Extension and paying a premium,
Adult parents and caretakers who are blind or disabled or MAPP Disabled, as determined by the Disability Determination Bureau (DDB) or through the presumptive disability process (MEH, 5.9),
Adults with assistance group income at or below 100% FPL,
All children under age 1 including Continuously Eligible Newborns (Chapter 8.2) ,
American Indian or Alaskan Native Tribal members, the son or daughter of a tribal member, the grandson or granddaughter of a tribal member, or anyone otherwise eligible to receive Indian Health Services.

Note: Persons who are members of families receiving BadgerCare Plus benefits, but who are individually certified for EBD Medicaid, Well Woman Care, Family Planning Only Services or Emergency Services, are not charged a BadgerCare Plus premium.

This page last updated in Release Number: 14-03

Release Date: 09/05/14

Effective Date: 09/05/14