What You Pay

If you get Medical Assistance for Employed People with Disabilities (MA-EPD), you need to pay a monthly premium and copayments each time you get certain services.

Premiums

The monthly premium for MA-EPD is based on your earned and unearned income and your household size. The higher your income, the higher your premium will be. Your premium will be at least $65. There is no maximum premium. In some cases, it may be cheaper to get an individual plan through MNsure than to pay for MA-EPD. See DB101’s article about Buying Coverage on MNsure to learn more.

Note: Your spouse's income will not be counted when your premium is calculated.

The following rules are effective starting October 1, 2014.

To get MA-EPD, each month you will have to pay:

  1. An amount based on your gross income. The minimum amount will be $65 per month, with a sliding scale for people with gross income at or below 300% of the Federal Poverty Guidelines (FPG). If your income is greater than 300% of FPG, you will have to pay 7.5% of your gross income for coverage.
  2. An additional fee that is equal to 5% of your unearned income. You pay this fee no matter how low your gross income is.

Your total MA-EPD premium will be the combined amount.

Use this tool to check how much you will have to pay each month.

Your MA-EPD Premium Estimate (starting October, 2014):

To get a better idea of whether you qualify for MA-EPD and how much your premium might be, use the MA-EPD Estimator.

Note: If you are an American Indian, you do not have to pay a premium for MA-EPD coverage.

When Can My Premium Change?

The county will review your eligibility and premium for MA-EPD every 6 months:

  • If your income goes up, or if your household size goes down, your premium will go up.
  • If your income drops, or if your household size goes up, your premium will go down.

Be sure to report any changes in income or household size to your local county human services agency within 10 days of when the change occurs.

Billing

You must pay your premium before you get coverage. After you’ve applied, the county will collect the first premium. From then on, the state will send you a bill every month.

You can pay your ongoing monthly premiums:

  • Online by checking account withdrawal or credit card
  • By mail if you send a check or money order with the stub from your premium notice to:
DHS
PO Box 64835
St. Paul, MN 55164-0835

If you mail your payment, make sure you send it early enough so that it arrives by the due date and that you include your portion of the billing statement that shows your customer number. Do not mail cash.

If you have questions about billing, be sure to contact your county human services agency.

If you haven’t paid your premiums

Your MA-EPD will end if you do not pay your premium. However, your MA-EPD coverage may be reinstated if you have “Good Cause” for not paying your premium. Good cause may include a serious illness, hospitalization, or change in income. Paying for other household expenses instead of your premium is not good cause.

To request “Good Cause for Late Payment” write a letter with your name, county case number, the reason for late payment.

Send your letter by fax to 1-651-431-7563 or by mail to:

DHS MA-EPD Good Cause
PO Box 64967
St. Paul, MN 55164-0967

DHS will let you know within 30 days if your request is approved. If it is approved, you will have to repay what you owe over 6 months. If you miss a monthly payment, you will lose your MA-EPD coverage again.

Retroactive Coverage

MA-EPD allows new enrollees to request coverage retroactively. This means that you can ask to have your MA-EPD coverage begin three months before the month you apply. So if you enroll in MA-EPD in April but have unpaid medical bills from the previous three months (January, February, and March), you could pay the MA-EPD premium for those months you have unpaid bills from and have MA-EPD pay for those unpaid bills. So, if you had unpaid bills from January, but not February or March, you could just pay the January premium.

Copayments When You Get Services

Generally, if you are 21 years old or older, you may have to pay small copayments that range from $1 to $3.50 when you use certain medical services that MA covers.

Note: If you are not able to pay a copayment, your medical provider still has to serve you. Providers must take your word that you cannot pay. Providers cannot ask for proof that you cannot pay.

There are some people who do not need to make copayments:

MA-EPD is usually cheaper than MA with a spenddown

Many people who qualify for MA-EPD may also qualify for MA with a spenddown, especially if they are employed, their monthly countable income is above 100% of the Federal Poverty Guidelines ($973) and their assets are below $3,000.

MA-EPD and MA with a spenddown cover the exact same services, but MA-EPD will usually cost you a lot less. With MA with a spenddown, you must pay medical expenses with your own money until all you are left with 75% of FPG ($729) each month for your other expenses. Compared with the amount you would have to “spend down,” MA-EPD’s monthly premium is usually a much smaller percentage of your income.

For an estimate on what your MA-EPD premium or MA spenddown amount would be, use the MA-EPD Estimator.

Example: If you have countable earned income of $1,000 and signed up for MA with a spenddown, you would have to pay the first 271 of your medical bills each month before MA would start paying for your medical expenses. For MA-EPD, you would just pay a $107 monthly premium.