Six Things to Know About Children’s Health Insurance in Wisconsin (WI)

  • September 13, 2016
  • |Quartz
This is a blog post. The information may not be up-to-date. If you have questions, please contact Customer Service
Before you purchase children's health insurance in Madison, Wisconsin, learn about these 6 important things to know.
  1. Children may be on their parent’s health insurance until age 26*.

    Children in WI may remain on a parent’s plan even if they are married, not living with a parent (even if they live outside of Wisconsin), attending school, not financially dependent on their parents and / or are eligible to enroll in their employer’s plan. Essentially, children don’t have to buy their own health insurance until they are 26 years old. However, parents are not required to buy coverage for children who are legal adults.

  2. Children lose this health insurance coverage when they turn 26*. After that, they have 60 days to find an insurance plan. This qualifies as a special enrollment reason, so they can enroll even if it’s not during the open enrollment period.

    Exceptions for an adult child in the national guard or reserve who is called to active duty exist.

  3. If children turn 26 and don’t enroll in a health insurance plan after two continuous months, they may need to pay a penalty.

  4. Young adults may buy catastrophic health insurance plans until age 30 or later if they have a hardship exemption. These plans generally have the lowest cost premiums, but the highest out-of-pocket costs. The good news is that catastrophic plans in Wisconsin are required to cover three primary care visits per year at no cost. They also cover the preventive services required by the Affordable Care Act (ACA). The bad news is that if you buy a catastrophic plan on the Health Insurance Marketplace, you can’t get any subsidies, regardless of your income. Learn more about catastrophic health plans.

  5. You may buy health insurance any time of the year for your dependents if you qualify for BadgerCare. You may qualify for Medicaid or the Children’s Health Insurance Program (CHIP) which is called BadgerCare Plus in WI. BadgerCare Plus is health insurance for individuals, families and children under 19 years of age in WI. The program offers free or low-cost health care coverage to many families in WI who cannot otherwise afford health insurance. In order to qualify, you must have an annual household income (before taxes) that is below the following amounts1 – 
    • Children qualify for BadgerCare Plus up to 300% of the Federal Poverty Level (FPL)
    • Pregnant women qualify for BadgerCare Plus up to 300% of the FPL
    • Other adults (whether or not they have dependent children) qualify up to 100% of FPL

    Table of BadgerCare Plus Federal Poverty Levels

  6. If you earn too much to qualify for BadgerCare Plus, you may still be eligible for other health insurance savings for your children. If you do not qualify for BadgerCare Plus, you are still required to have health insurance coverage for you and your children. The good news is, you may be eligible for premium tax credits and other savings through the Health Insurance Marketplace that may help pay for your child’s health insurance. The Health Insurance Marketplace offers subsidies to those earning less than 400 percent of the FPL.

Unity's customer service representatives are highly trained and are here to help you sort through the information to find the right health insurance for your children in Wisconsin.

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