Medicaid Eligibility in Wisconsin: Income Limits & How to Apply
Medicaid Eligibility in Wisconsin
Wisconsin has not formally expanded Medicaid under the ACA, but through a federal waiver, BadgerCare Plus covers adults with household income up to 100% of the federal poverty level (FPL). This is approximately $15,650 per year for an individual or $32,150 per year for a family of four in 2026.
Wisconsin's unique approach: While not a formal expansion state, BadgerCare Plus covers childless adults up to 100% FPL. Adults earning between 100-138% FPL are directed to the ACA marketplace where they qualify for subsidies. This means there is no coverage gap in Wisconsin.
BadgerCare Plus in Wisconsin covers:
- Adults aged 19-64 with income up to 100% FPL
- Children in families with income up to 300% FPL
- Pregnant women with income up to 300% FPL
- Seniors and people with disabilities who meet income and asset requirements
About BadgerCare Plus
In Wisconsin, BadgerCare Plus provides essential health coverage to many residents. You may qualify if your household income is at or below 100% of the Federal Poverty Level (FPL) as a childless adult, parent, or caretaker. For example, a single adult with a monthly income of up to $1,330, a two-person household up to $1,803, or a family of four up to $2,750 could be eligible. Children and pregnant individuals have higher income limits, up to 300% FPL. For a pregnant individual or child in a one-person household, this means a monthly income up to $3,990. Currently, about 1.33 million Wisconsin residents are enrolled in Medicaid or CHIP, demonstrating it's a widely used and crucial program. There is no asset limit for BadgerCare Plus, which can be a significant advantage.
If your income is slightly above the BadgerCare Plus threshold, you'll likely transition to the HealthCare.gov marketplace for subsidized coverage. Wisconsin has a seamless transition, as marketplace subsidies begin where BadgerCare Plus eligibility ends. With a benchmark Silver plan costing around $527 per month, subsidies can significantly reduce your monthly premium, making coverage much more affordable. It's important to remember that income changes can shift your eligibility between BadgerCare Plus and the marketplace, so reporting any changes promptly is crucial. If you lost BadgerCare Plus coverage during the recent "unwinding" period, you can reapply at any time if your circumstances change.
BadgerCare Plus offers comprehensive benefits, including primary and acute care services, physician visits, inpatient and outpatient hospital care, pharmacy, non-emergency medical transportation, and vision and dental care. Generally, there are no cost-sharing requirements for most BadgerCare Plus members, though some children with higher incomes and individuals on transitional medical assistance may have monthly premiums. Wisconsin also has unique waiver programs like Family Care and IRIS (Include, Respect, I Self-Direct), which provide home and community-based services for eligible elderly and adults with disabilities, allowing them to receive care in their homes instead of institutions.
Be aware that processing delays can occur, so submitting all required documentation accurately and on time is essential. During the recent unwinding of continuous Medicaid coverage, many people in Wisconsin had to redetermine their eligibility. Make sure your contact information is always up-to-date with the state to receive important notices about your coverage. You can update your information through the ACCESS website or MyAccess app. Your concrete action step is to visit ACCESS.wi.gov to apply for benefits or update your information.
Wisconsin Medicaid Income Limits 2026
The following table shows the key income thresholds for Wisconsin in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 100% FPL column, you qualify for BadgerCare Plus. If your income is between 100% and 400% FPL, you qualify for ACA marketplace subsidies.
Wisconsin's average benchmark premium of $527/month is near the national midpoint. For residents earning between 100-400% FPL, premium tax credits offset most of this cost.
Marketplace Insurance in Wisconsin
Wisconsin residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Wisconsin costs approximately $527/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Wisconsin might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Wisconsin uses the federal marketplace at HealthCare.gov for ACA enrollment. When you apply, the system automatically checks your Medicaid eligibility — if you qualify, your application is forwarded to the state Medicaid agency.
Since expanding Medicaid, Wisconsin has enrolled hundreds of thousands of adults in BadgerCare Plus. Residents whose income fluctuates around the 138% FPL threshold can move between Medicaid and subsidized marketplace coverage as their circumstances change.
How to Apply for BadgerCare Plus
- Apply online through HealthCare.gov. The system will automatically check your Medicaid eligibility based on your income and household size.
- Apply directly through your state's Medicaid agency. You can apply year-round — there is no enrollment period for Medicaid.
- Call the Medicaid hotline for Wisconsin to get help with your application or check your eligibility over the phone.
- Visit in person at your local Department of Social Services or county human services office.
To complete your application, you'll need income documentation (pay stubs, tax returns), a Wisconsin address for residency verification, Social Security numbers for household members, and information about existing coverage.
Calculate Your Subsidy in Wisconsin
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Wisconsin.
Check Your Eligibility →Frequently Asked Questions
Who qualifies for BadgerCare Plus?
Wisconsin has not expanded Medicaid, so there is no standard income limit for adults. Traditional Medicaid covers specific groups (children, pregnant women, disabled, very low-income parents). Income limits for these groups vary. Children are generally covered up to 200-300% FPL through CHIP.
Is Medicaid expanded in Wisconsin?
Wisconsin has not formally expanded Medicaid but covers adults up to 100% FPL through BadgerCare Plus under a federal waiver. There is no coverage gap because adults above 100% FPL can access marketplace subsidies.
Am I eligible for health insurance subsidies in Wisconsin?
Yes. Wisconsin residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the name of Wisconsin's Medicaid program?
Wisconsin's Medicaid program is known as BadgerCare Plus. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and certain other qualifying groups.
What should I do if my BadgerCare Plus coverage is ending?
If your BadgerCare Plus coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
What's the difference between Medicaid and marketplace insurance in Wisconsin?
Medicaid (BadgerCare Plus) is free or near-free with no premiums or deductibles. Marketplace plans in Wisconsin average $527/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.
Medicaid Eligibility in Nearby States
- Iowa Medicaid Eligibility — Expansion state
- Illinois Medicaid Eligibility — Expansion state
- Michigan Medicaid Eligibility — Expansion state
- Minnesota Medicaid Eligibility — Expansion state