State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

19.1 BadgerCare Plus Premiums

Children in families with income over 201 percent of the FPLFederal Poverty Level must pay a premium to become or remain eligible for BadgerCare Plus unless exempt. This includes children who are open for regular BadgerCare Plus (not an extension) but whose parents, caretakers, or siblings are in a BadgerCare Plus extension.

 

Example 1: Roger lives with his son, Sam, and they are open for BadgerCare Plus under an extension. Neither of them have a premium since they are both in an extension. In October, Roger’s other son, Justin, moves into the household. Justin is determined eligible for regular BadgerCare Plus as a child because he does not meet the requirements to be eligible under the extension with Roger and Sam. Roger and Sam continue to be eligible under the extension and do not have a premium. The household income is 230% of the FPL. Justin has a premium of $10.   If Justin’s premium is not paid, he will go into an RRP. Roger and Sam continue to be eligible under the extension.

 

The following children are exempt from the requirement to pay a premium for BadgerCare Plus:

1. Pregnant minors,

2. Former Foster Care Youth (see Chapter 11 Foster Care Medicaid)
3. 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,
4. Children in a BadgerCare Plus extension,
5. All children under age 1 including Continuously Eligible Newborns (see Section  8.2 Continuously Eligible Newborns),
6. 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: 19-01

Release Date: 04/19/2019

Effective Date: 01/01/2019

 

 

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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.

Publication Number: P-10171