BadgerCare Plus is the Wisconsin Department of Health Services (DHS) program that delivers Medicaid and CHIP coverage to roughly 1.1 million Wisconsinites, including children, parents, pregnant women, and adults without children. Wisconsin is one of 10 states that has not expanded Medicaid under the ACA, yet the state covers adults up to 100% of the Federal Poverty Level through a federal waiver, which means a single adult can keep BadgerCare Plus at an income up to $15,960 in 2026 and a household of four up to $33,000. Losing BadgerCare Plus in 2026 usually follows a renewal that was missed, an income increase, a change in household size, or a data-match problem on your ACCESS account. Because Wisconsin's adult limit is 100% FPL and Marketplace subsidies start at 100% FPL, most Wisconsin adults who lose BadgerCare Plus because of higher income move directly into premium tax credit territory instead of falling into a coverage gap. The 90-day Marketplace SEP for Medicaid loss is the fastest way to make that move before the 2027 Open Enrollment Period begins on November 1, 2026.
Six concrete steps follow in this guide: reading your DHS termination notice, deciding whether to appeal, checking whether you can re-qualify, calculating your 2026 income against subsidy thresholds, applying at healthcare.gov, and covering your children. Wisconsin residents buy Marketplace coverage on the federal platform at healthcare.gov because the state does not run its own exchange. Wisconsin gives you 45 days from the date of the action to request a fair hearing with the Division of Hearings and Appeals, and benefits can continue during the appeal if you ask before the termination date. A qualifying life event such as Medicaid loss lets you enroll outside the usual window, so the sequence matters: appeal and apply at the same time, then cancel the Marketplace plan if the appeal succeeds. The 2026 subsidy cliff at 400% FPL is back after the enhanced premium tax credits expired on January 1, 2026, so your projected 2026 income now determines your cost. Wisconsin navigators at Covering Wisconsin help with every step at no charge.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes Wisconsin residents make after losing BadgerCare Plus in 2026:
- Waiting for the appeal before applying at healthcare.gov. Hearings take weeks, so apply for the Marketplace SEP the day you file, then cancel the plan if the appeal succeeds.
- Missing the 45-day hearing deadline. Wisconsin counts 45 days from the action date, and benefits only continue if you ask before the termination date.
- Reporting last year's income at healthcare.gov. Marketplace subsidies use your projected 2026 income, and a wrong estimate creates a repayment bill at tax time.
- Assuming children lose coverage when a parent does. Children's BadgerCare Plus has income limits near 306% FPL in 2026, so apply for kids even when the adult is terminated.
- Buying a short-term plan to fill the gap. Short-term plans exclude pre-existing conditions and do not qualify as Marketplace coverage, while a subsidized Silver plan usually costs less.
- Skipping free help. Covering Wisconsin navigators and localhelp.healthcare.gov can walk you through the SEP application at no charge.
Wisconsin BadgerCare Plus: Why Losing Coverage Is Different in 2026
Wisconsin is one of 10 non-expansion states, alongside Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming, yet BadgerCare Plus still covers adults without children, which most non-expansion states do not. In 2026 the Wisconsin adult limit is 100% FPL, or $15,960 for one person and $33,000 for four, while expansion states stop at 138% FPL ($22,025 for one person in 2026). Because ACA premium tax credits begin at 100% FPL, a Wisconsin adult who earns slightly above the BadgerCare Plus limit lands in the Marketplace with a subsidy, not in a coverage gap. KFF 2026 state data and the CMS Medicaid eligibility pages at medicaid.gov confirm that Wisconsin's structure differs from the 40 expansion states plus DC. Anyone with income under 100% FPL who was terminated for a paperwork reason should re-apply and appeal first, since that income range is the BadgerCare Plus population. Wisconsin residents can also ask a Covering Wisconsin navigator to compare a re-application, an appeal, and a Marketplace plan side by side before choosing, which prevents duplicate coverage and missed deadlines.
BadgerCare Plus re-application stays open year-round at access.wisconsin.gov, through your county or tribal agency, or by phone at 1-800-362-3002. Children and pregnant women qualify at much higher limits, roughly 306% FPL in 2026, which is about $66,218 for a household of two. Federal H.R. 1 rules from 2025 add work requirements and six-month renewals mainly for ACA expansion adults beginning in 2027, and Wisconsin has not expanded, so confirm with Wisconsin DHS how those changes apply to your case. CHIP funding supports part of the children's side of BadgerCare Plus, so a child's coverage is judged on its own income test. Wisconsin households therefore often hold mixed coverage: a parent in a subsidized Marketplace plan and children in BadgerCare Plus, which is a normal and efficient combination in 2026 when the family income sits between 100% and 306% FPL. Report each person's coverage accurately on the healthcare.gov application so children are not counted twice.
Documents Behind Your Marketplace SEP: Why Each One Matters
Healthcare.gov verifies a Medicaid-loss SEP by checking your termination notice, so the BadgerCare Plus letter with the end date is the single most important document. Income documents matter because premium tax credits use projected 2026 MAGI, and healthcare.gov may ask for pay stubs when your estimate conflicts with data from the IRS or Social Security. Residency proof confirms which county plans you can buy, and immigration documents confirm eligibility for subsidies. Keep every upload receipt, since a data-matching issue at healthcare.gov can suspend subsidies within 90 days. After enrolling, expect Form 1095-A in January 2027, which reports your 2026 premiums and credits for IRS Form 8962 reconciliation at tax time. A credit larger than you earn must be repaid, and the 2026 cliff at 400% FPL has no repayment cap. Wisconsin households that added a job or raise after enrolling should update healthcare.gov within 30 days to avoid that bill. Navigators can also help you estimate how a raise changes the credit before you accept it.
Frequently Asked Questions
What is the SEP window after losing BadgerCare Plus in Wisconsin in 2026?
The Marketplace Special Enrollment Period for Medicaid or CHIP loss runs 90 days after your BadgerCare Plus coverage ends, and you can start up to 60 days before it ends. For example, if coverage ends October 31, 2026, the window runs September 1, 2026 through January 29, 2027, per healthcare.gov. Wisconsin residents apply on the federal platform at healthcare.gov because the state has no exchange of its own. Coverage generally starts the first of the month after you pick a plan, so selecting a plan before your end date avoids a gap. Check the date on your DHS notice and apply early, since the 2027 Open Enrollment Period begins November 1, 2026 and ends January 15, 2027.
How do I document losing BadgerCare Plus for a Marketplace SEP?
Upload your BadgerCare Plus termination notice to healthcare.gov, which shows the coverage end date and the program name. If you lost the letter, log in to your ACCESS account at access.wisconsin.gov and print the notice history, or call BadgerCare Plus Member Services at 1-800-362-3002 for a copy. Healthcare.gov normally lets you attest to the loss first and then asks for proof within 30 days, so submit the document quickly. Also gather pay stubs for your projected 2026 income, Social Security numbers, and proof of Wisconsin residency. Keep screenshots of every upload, because a missing document can cancel your subsidy or your SEP approval.
What if I miss the SEP window after losing BadgerCare Plus?
Missing the 90-day SEP means you generally wait until the ACA Open Enrollment Period, which runs November 1, 2026 through January 15, 2027 for 2027 coverage, with no protection for the gap in between. Another qualifying life event, such as a job change with new coverage, marriage, a birth, or a move, can open a new SEP. Re-applying for BadgerCare Plus never has a deadline, so if your income is at or under 100% FPL in 2026 ($15,960 for one person) you can apply any day. Children can also apply for BadgerCare Plus year-round. A gap in coverage means you pay medical bills in full, so apply as early as possible.
Can I get retroactive coverage after losing BadgerCare Plus?
Marketplace coverage is not retroactive: a plan chosen under the Medicaid-loss SEP starts the first of the month after you select it, so choosing before your end date prevents a gap. BadgerCare Plus can sometimes cover medical bills from the months before your application when you were eligible, under federal Medicaid retroactive coverage rules, but federal H.R. 1 changes shorten those periods starting in 2027 for some groups, so confirm the current rule with Wisconsin DHS. If your appeal succeeds, DHS must restore coverage back to the termination date, which means the Marketplace plan and BadgerCare Plus should not overlap. Cancel the Marketplace plan promptly if the hearing decision restores your coverage.
What is the difference between COBRA and the Marketplace for a Wisconsin Medicaid loss?
COBRA only applies if you also lose job-based coverage, and it costs 102% of the full premium, typically $400 to $900/mo for one person in 2026. Losing BadgerCare Plus alone does not trigger COBRA. The Marketplace SEP offers premium tax credits that can drop the 2026 cost to $0 to $300/mo for incomes between 100% and 400% FPL, which is $15,960 to $63,840 for one person. COBRA keeps your exact doctors and a met deductible, but an employer plan or a subsidized Marketplace Silver plan nearly always costs less. Wisconsin state continuation under Wis. Stat. 632.897 can extend some fully insured group plans in addition to federal COBRA.
What Wisconsin-specific rules apply after losing BadgerCare Plus?
Wisconsin covers adults up to 100% FPL ($15,960 for one person in 2026) without the ACA Medicaid expansion, so re-qualifying has a stricter income line than in expansion states. You have 45 days from the action date to request a fair hearing with the Division of Hearings and Appeals, and benefits continue if you ask before termination. Wisconsin has no state exchange, so you apply at healthcare.gov. Apply, report changes, and renew through ACCESS at access.wisconsin.gov, and call 1-800-362-3002 for help. Free Marketplace help is available from Covering Wisconsin navigators and at localhelp.healthcare.gov.
Do I qualify for BadgerCare Plus after this loss, based on household size?
Wisconsin adults qualify for BadgerCare Plus at or under 100% FPL, which in 2026 is $15,960 for one person, $21,640 for two, $27,320 for three, and $33,000 for four. Children and pregnant women qualify at higher limits, about 306% FPL in 2026. Income is measured with MAGI, so count wages, self-employment profit, and unemployment pay for everyone in your tax household. The household-size table on this page lists 2026 limits for sizes 1 through 8. If your income is above 100% FPL but under 400% FPL ($63,840 for one person in 2026), a subsidized Marketplace plan is usually the better path.
What happens to my children's coverage if I lose BadgerCare Plus?
Children's BadgerCare Plus is evaluated separately from yours, with income limits near 306% FPL in 2026, so your children often stay covered or re-qualify even when you do not. CHIP funding supports part of that coverage in Wisconsin. Apply for your children at access.wisconsin.gov year-round, with no SEP deadline. If your children are denied, the Marketplace SEP covers them too, and the 2026 subsidy is calculated for the whole household. Keep your children's coverage active during an appeal, and ask a Covering Wisconsin navigator to check whether the whole family is on the best mix of programs.
