BadgerCare Income Limits
BadgerCare is a healthcare program for low-income Wisconsin residents. It is important to know the income limits for BadgerCare so you can see if you are eligible.
BadgerCare Plus is a health insurance program for low-income adults in Wisconsin. It is run as an 1115 waiver and combines funding from both federal Title XIX (Medicaid) and Title XXI (State Children’s Health Insurance) programs. It is unique in that it received federal approval to use an enrollment “trigger” to ensure the program stays within its budgeted amount. In order to qualify for BadgerCare Plus, you must be a resident of Wisconsin and have a countable family income below the poverty level. You must also meet citizenship, age, and disability requirements. Those who receive BadgerCare Plus must pay a monthly premium based on your income.
Annual Household Income Limits
| Household Size* | Maximum Income Level (Per Year) |
|---|---|
| 1 | $43,740 |
| 2 | $59,160 |
| 3 | $74,580 |
| 4 | $90,000 |
| 5 | $105,420 |
| 6 | $120,840 |
| 7 | $136,260 |
| 8 | $151,680 |
*For households with more than eight people, add $15,420 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.
Families whose countable family income is less than or equal to 185% of the FPL will have to pay a zero-dollar monthly premium. Families with income below 200% of the FPL will be required to pay a monthly premium that is calculated as 3% of their countable family income after certain deductions. The BadgerCare reform waiver also includes more comprehensive benefits for childless adults compared to the previous waiver. This includes benefits such as vision, dental, hearing, and mental health services. The waiver also provides preventive care, such as screenings for diabetes, blood pressure, and depression.
What are BadgerCare Plus Premiums?
BadgerCare Plus is a state-sponsored health insurance program for Wisconsin children and families. It also provides health coverage for pregnant women, parents, and caretakers up to 300% of the federal poverty level. In addition to providing health coverage, BadgerCare offers other benefits such as checkups, shots (immunizations), and prenatal care. It also covers dental and vision services, mental health, and substance abuse treatment. It covers prescriptions, lab tests, and x-rays. Families pay a premium, called a copay, for certain services. Copays vary from service to service, ranging from $0.50 to $3.00. The maximum monthly copay is capped at 5% of family income.
If a family member’s employer offers a family health insurance plan that is cost-effective and more comprehensive than BadgerCare Plus or MAPP, they may choose to enroll in the BadgerCare Health Insurance Premium Payment (HIPP) program. HIPP requires the family to pay between 40-80% of their monthly employer-offered insurance costs, but BadgerCare pays the rest for all other family members, including the enrolled child in the family’s BadgerCare Plus or MAPP case.
The new BadgerCare Reform waiver decreases BadgerCare Plus eligibility levels to 100% of the FPL for childless adults and shifts current autoconverts into the Marketplace as of April 1, 2014. Individuals with incomes up to 100-138% FPL are eligible for tax credits to help them purchase coverage through the Marketplace.
