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Premium decreases must be reviewed, and eligibility redetermined when applicable, when coverage was maintained following a reported change or a timely renewal. Once eligibility is able to be redetermined, premium amounts for months with coverage maintained may need to be refunded. See Process Help Section 12.21.3 Premium Refunds.

Example 1 David and Jenny are married and have a child, Megan. Their household income is 285% of the FPL. Megan is enrolled in BadgerCare Plus with a $68 monthly premium. In June, David had a decrease in work hours. At the end of June, David and Jenny found that this reduction in work hours resulted in the household income decreasing to 235% of the FPL in the month of June. David reports this income change to the agency on July 7. Since this change was reported within 10 days of the household monthly income changing, the lower premium is effective the month in which the change occurs (June). Starting in June, Megan’s monthly premium is $15. David had already paid $68 each for Megan’s June and July premiums, so a refund must be issued. Example 2 Morgan and Taylor are married and have a child, Kelly. Their household income is 285% of the FPL. Kelly is enrolled in BadgerCare Plus with a $68 monthly premium. In June, Morgan has a decrease in work hours. At the end of June, Morgan and Taylor found that this reduction in work hours resulted in the household income decreasing to 235% of the FPL in the month of June. Morgan reports this income change to the agency on July 18. Since this change was reported more than 10 days after the household monthly income changed, the lower premium amount is effective during the month in which it was reported (July). Starting in July, Kelly’s monthly premium is $15. Morgan already paid $68 for Kelly’s July premium, so a refund must be issued. Example 3 Aaron has a child, Emily. Their household income for a group of 2 is 285% of the FPL. Emily is enrolled in BadgerCare Plus with a $68 monthly premium. On September 4, Aaron marries Kathy. Aaron contacts his agency on September 13 to report his marriage to Kathy and add her to his household. Kathy's income must be verified by October 3. Emily’s BadgerCare Plus is maintained for the month of October while eligibility is pending for income verification. On October 3, the income verification is processed. Their household income for a group of 3 is 225% of the FPL. Starting in September, Emily’s monthly premium is $10. Aaron had already paid $68 each for Emily’s September and October premiums, so a refund must be issued. This page last updated in Release Number: 25-04 Release Date: 12/10/2025 Effective Date: 12/10/2025 19.8 Non-Payment Payment of a premium is not a condition of eligibility for BadgerCare Plus. Non-payment of BadgerCare Plus plus premiums will not result in a loss of coverage for BadgerCare Plus. This page last updated in Release Number: 24-01 Release Date: 04/03/2024 Effective Date: 04/01/2024 19.9 Late Payments If a payment is made after adverse action of the benefit month the payment is applied to the next month's premium. Example 1 Alan's daughter Victoria is eligible for BadgerCare Plus, and a $15 premium is charged beginning August 2024. A premium statement is sent to Alan at the end of July with a due date of August 10. Alan does