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19.3 Premium Limits

Children with assistance group income above 201% of the FPL will be required to pay premiums. The total premium amount for the household is the total of the individually calculated premiums, not to exceed a 5% cap. The cap will be 5% of the income of the assistance group with the highest income (in terms of dollar amount) in the case.


The 5% cap methodology for children with premiums will be effective as soon as one child on the case who is subject to premiums has his or her eligibility determined using MAGI rules.


Example: 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/month as a waitress, and Alan earns $4500/month as a computer analyst. None of the children have income. All four children are eligible for BadgerCare Plus.



MAGI Group Formation

Assistance Group Income Amount


Premium Amount


Susan, Aaron, and Jacob





Alan, Rachel, and Hannah





Alan, Rachel, and Hannah





Susan, Alan, Aaron, Rachel, Hannah, and Jacob





Aaron does not have a premium, Rachel and Hannah have $23 premiums, and Jacob has a premium of $15. In this example, 5% of the income of the assistance group with the highest income is 5% of Jacob’s MAGI group, or 5% of $7000/month, or $350. Altogether, the household’s monthly premiums are $61. The household will pay $61 in premiums for their children’s coverage.





This page last updated in Release Number: 20-02

Release Date: 02/20/2020

Effective Date: 02/01/2020