BadgerCare Plus is Wisconsin’s main Medicaid health insurance program, covering about one million residents who meet income and residency rules. It serves children, pregnant women, parents and caretaker relatives, and childless adults ages 19 through 64. Income limits run from 100% of the federal poverty level for adults up to 306% FPL for children and pregnant women, and there is no asset test. Most members pay nothing beyond small prescription copays.
Who Qualifies by Group
BadgerCare Plus sorts applicants into four eligibility groups, each with its own income ceiling tied to the federal poverty level. The limits below took effect February 1, 2026, and run through January 31, 2027.1Wisconsin Department of Health Services. BadgerCare Plus Federal Poverty Level Guidelines
- Childless adults ages 19 through 64: household income at or below 100% FPL.
- Parents and caretaker relatives: household income at or below 100% FPL, and you must live with a dependent child under 18 (or under 19 if still in high school).
- Children ages 0 through 18: household income at or below 306% FPL. Children in families above 200% FPL may owe a monthly premium.
- Pregnant women: household income at or below 306% FPL.
In dollar terms, 100% FPL for 2026 is roughly $1,330 per month for one person, $1,803 for two, and $2,750 for a family of four. The 306% ceiling for a family of four is $8,415 per month. So a four-person household earning up to $8,415 could still qualify for children’s coverage, while a single adult without children would need to stay at or below $1,330. The adult thresholds track Wisconsin Statutes 49.471.2Wisconsin State Legislature. Wisconsin Statutes 49.471 – BadgerCare Plus
Household size generally includes you, your spouse, and any tax dependents living with you. BadgerCare Plus counts most taxable income: wages, net self-employment earnings, Social Security benefits, unemployment compensation, pensions, and tribal per-capita gaming payments. It does not count child support, SSI, veterans benefits, workers compensation, or gifts.3Wisconsin Department of Health Services. BadgerCare Plus Enrollment and Benefits Handbook There is no asset or resource test. Owning a home, a car, or holding money in a savings account will not disqualify you.
What’s Covered and What It Costs
BadgerCare Plus covers a broad set of medical services: primary and preventive care, immunizations, lab work, emergency room visits and inpatient hospital care, prenatal and delivery care, mental health and substance abuse treatment, prescription drugs and qualifying over-the-counter drugs, dental care, and vision exams and eyeglasses.4Wisconsin Department of Health Services. BadgerCare Plus – Covered Services and Copays Vision coverage generally includes one pair of eyeglasses per 12 months without prior authorization; anti-glare coating, sunglasses, and spare glasses are not covered.
Prescription copays are the main out-of-pocket cost. Generic drugs run $1, brand-name drugs $3, and over-the-counter medications and diabetic supplies $0.50 per prescription, with a $12 cap per member per provider per calendar month.5ForwardHealth. BadgerCare Plus and Medicaid – Pharmacy Reimbursement Copayment Total monthly copays across all services can never exceed 5% of your gross monthly income.
Most members pay no monthly premium. Two groups do: children over age one in households above 200% FPL (children under one and tribal-member children are exempt), and transitional medical assistance recipients whose income exceeds 133% FPL during the transitional period. Households between 100% and 133% FPL are exempt from premiums for the first six months of transitional eligibility.6ForwardHealth. Populations Eligible for BadgerCare Plus Childless adults and parents at or below 100% FPL owe no premium.
The Employer Insurance Catch
If you are a parent or caretaker with household income above 133% FPL and your employer offers health insurance whose premium is at or below 9.5% of your family’s income, you generally cannot enroll in BadgerCare Plus without a qualifying good-cause reason. Dropping that affordable employer coverage to switch to BadgerCare Plus will disqualify you. Quitting a job where you had coverage may trigger a three-month waiting period before enrollment.7Wisconsin Department of Health Services. BadgerCare Plus and Employer Health Insurance P-10177
This restriction does not apply to childless adults or to children’s coverage. If your employer later raises your premium share above 9.5% of your income or changes the plan, the restriction may stop applying. Call your local agency before you make any change to employer coverage, because the timing affects what you qualify for.
How to Apply
Before you start, pull together a Social Security number for each applicant (the number itself; you do not need to produce the card), a full month of recent pay stubs for every working household member, the most recent federal tax return or bookkeeping records if anyone is self-employed, information on any other income like Social Security, unemployment, or pensions, and details of any current health insurance. Non-applicants in your household are not required to provide an SSN. Citizenship is usually confirmed through an automated match with the Social Security Administration; if that fails, you may be asked for a passport, birth certificate, or naturalization documents.8Wisconsin Department of Health Services. BadgerCare Plus Handbook – 9.9 Mandatory Verification Items
You can apply three ways:
- Online at access.wi.gov, which is the fastest route and lets you apply for other benefit programs at the same time.9Wisconsin Department of Health Services. ForwardHealth – Apply for Benefits
- By phone through Member Services at 800-362-3002, which can also connect you with your local agency.10Wisconsin Department of Health Services. BadgerCare Plus Contacts
- By mail or fax using Form F-10182, the standard application packet.11Wisconsin Department of Health Services. BadgerCare Plus Application Packet F-10182
The state has 30 calendar days to process your application and issue a decision. If day 30 lands on a weekend or holiday, the deadline moves to the next business day.12Wisconsin Department of Health Services. BadgerCare Plus Handbook – 25.7 Application Processing Period
Keeping Coverage: Reporting Changes and Renewals
Once enrolled, you must report income changes, but only when your household’s total monthly income crosses a defined FPL threshold such as 50%, 100%, 133%, 200%, or 306%. The report is due by the 10th of the month after the change. Routine raises and small fluctuations that stay inside your current bracket do not need to be reported.13Wisconsin Department of Health Services. BadgerCare Plus Handbook – 27.3 Income Change Reporting Requirements If you are unsure, update your ACCESS account or call Member Services.
Eligibility is renewed each year. About two months before your renewal date, the agency checks the information already on file. If you still qualify, you will get a letter saying your benefits renewed automatically with no action needed. If more information is required, a renewal packet arrives roughly two weeks before your renewal month with a deadline and instructions. You can renew online, by mail, by phone, or in person.14Wisconsin Department of Health Services. ForwardHealth – Health Care Renewals
Missing your renewal month ends your benefits. You can still submit a late renewal for up to three months, though you may have a coverage gap in the meantime. After four months, you have to start over with a new application.
If You’re Denied
A denial notice, or a notice reducing or ending benefits, will list a deadline and appeal instructions. You have 45 days from the effective date of the action to request a fair hearing. Miss the deadline and your appeal is typically dismissed.15Wisconsin Department of Health Services. Medicaid/BadgerCare Plus Fair Hearing Information Start by calling your local agency; many problems get resolved there. If you still disagree, send a written request to the Department of Administration, Division of Hearings and Appeals, PO Box 7875, Madison, WI 53707-7875, or call 608-266-7709. Include your name, mailing address, a description of the problem, your local agency’s name, your Social Security number, and your BadgerCare Plus ID number.
A Note on Estate Recovery
Wisconsin’s estate recovery program can recoup the cost of certain benefits from a deceased member’s estate, but for most BadgerCare Plus members it never comes into play. Recovery applies to nursing home residents of any age for benefits paid during that stay, and to members age 55 or older who receive long-term care services in the community or through programs like Family Care or IRIS. Members 55 or older who live in the community and do not receive long-term care services are not subject to recovery.16Wisconsin Department of Health Services. Wisconsin Estate Recovery Program Handbook Working-age adults and families using BadgerCare Plus for regular medical care are not affected. The rules matter if you or a relative is heading into long-term care.