Is it Right for You?
Starting in 2014, almost everyone should be able to get health coverage. In fact, if you don’t have a plan, you may have to pay a tax penalty. The question becomes, which plan is right for you and your family?
This article focuses on whether you will qualify for MA because you have a disability.
However, just because you have a disability does not mean you will qualify for MA by the rules discussed here. You may qualify based on rules discussed in another DB101 MA article, or for Medical Assistance for Employed People with Disabilities (MA-EPD), or you may not qualify for MA at all, depending on your situation.
|Your family size:|
Income limits for your family:
|Income-based MA, adults (138% FPG)|
|Income-based MA, children/pregnant women (280% FPG)|
|Subsidized private plans, reduced fees (250% FPG)|
|Subsidized private plans (400% FPG)|
Medical Assistance (MA) Basic Eligibility Requirements
To qualify for Medical Assistance (MA) by the rules described in this article, you must:
- Have been determined blind or disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)
- Be a U.S. citizen or have an immigration status that is eligible for MA
- Meet certain asset requirements, and
- Meet certain income requirements
Note: If you’re on Minnesota Supplemental Aid (MSA) or SSI’s 1619(a) or 1619(b) provisions, you will automatically qualify for MA. You do not need to worry about the qualifying rules discussed on this page. Read more about 1619(b) in this article’s How to Sign Up page. See the DB101 section on MSA for more details about it.
If you have been determined disabled, but do not meet the asset or income requirements, read DB101’s MA-EPD article.
They’ll say you have a disability if:
- You have a physical or mental impairment or combination of impairments
- Your impairments limit your ability to work, preventing you from earning Substantial Gainful Activity ($1,070 per month, or $1,800 per month if you’re blind), and
- Your condition has lasted or is expected to last for at least 12 months
To get a disability determination, you will have to get medical documentation specified by SSA or SMRT.
Note: If you get Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits due to a disability, or if you are certified disabled by the county for the Development Disability (DD) Waiver, you automatically meet this requirement. If you don’t get SSI or SSDI benefits, you’ll have to be determined disabled by SMRT.
Citizenship and Immigration Status
You must be a U.S. citizen or have an immigration status that is eligible for Medical Assistance (MA). If you are an immigrant and unsure about whether you qualify for MA, contact your local county human services agency.
If you are an immigrant who does not qualify for MA, but you are lawfully present in the United States, you may qualify for MinnesotaCare, another public program for people with low income. Read DB101’s MinnesotaCare article.
If you are an undocumented immigrant, you may qualify for MA coverage for emergencies only. To learn more about this, contact your local county human services agency.
Your assets must be at or below the MA asset limit to qualify due to your disability. The limit is $3,000 for one person ($6,000 for a family of two). The limit increases $200 for each additional family member.
Note: There is no asset limit for MA, but there is an asset limit to qualify based on having a disability. If you are over the asset limit, you can still apply by MA rules that aren’t based on having a disability. To learn more about that, see DB101’s MA article.
For MA, an asset is almost anything you own, including:
- Money in bank accounts
- Vehicles you own (one will not be counted)
- Stocks and bonds
- Real estate other than the home you live in
- Your spouse’s assets, and
- Retirement accounts
There are some assets that MA doesn’t count, including:
- The home you live in
- One car, and
- Household and personal goods including pets, furniture, clothing, jewelry, appliances, tools and other equipment used in the home
Check out the complete list of assets MA doesn’t count.
If you own a home worth $250,000 and you live in it, the value of that home will not be counted toward your MA asset limit, but if you own a home that you rent out, its value may count toward your MA asset limit.
If you own on vehicle, the value of that car won’t count toward the limit, but if you own a second car, its value may count toward the limit.
Medical Assistance (MA) is for people with low incomes. The rules we’re looking at in this article are for low-income people who also have disabilities. If you are in this situation, you may qualify if your countable monthly income is at or below an income limit. If your income is higher than the income limit you may still be eligible if you meet certain additional requirements.
The income limit and how your income is calculated for the rules described in this article are different than the income limit and how your income is calculated for other people who get MA. Read more about those rules in DB101’s MA article.
To see whether your income would qualify for MA due to your disability, MA will look at the number of people in your family, the amount of income your family has, and it will then compare it to the Federal Poverty Guidelines (FPG):
- If you are blind or disabled, according to Social Security or the State Medical Review Team (SMRT), your countable monthly income must be at or below 100% of FPG ($973 for an individual, $1,311 for a family of two).
- If your income is higher than 100% of FPG, you may still be eligible for MA, but you will have to spend some of your own income on your medical bills before MA will start paying. This is called a spenddown.
Note: If your income is over 100% of FPG, you should look into Medical Assistance for Employed People with Disabilities (MA-EPD) and MinnesotaCare, because they are usually much more affordable than getting MA with a spenddown.
In this article, we talk about how there is a limit for how much countable income you can have and still qualify for MA. The confusing thing is that “countable income” is not the same as your total income. For example, if you make $2,000 per month at a job and have no other income and no other deductions, that’s only $957.50 in countable monthly income.
Figuring Out Your Countable Income
This countable income calculation is only for getting MA by disability rules. The rules for qualifying for MA that are discussed in DB101’s MA article are totally different and much less complicated.
Follow these steps to find out your countable income:
Do not include payments you get from SSI, the Minnesota Family Investment Program (MFIP), General Assistance (GA), Minnesota Supplemental Aid (MSA), Section 8 housing, or SNAP. MA doesn’t count income you get from these programs.
Step 2: Add up your gross monthly earned income (income from work before taxes are deducted), including wages, tips, bonuses, and self-employment earnings.
Subtract a $65 Earned Income Exclusion.
Then divide the result by two. The result is your countable earned income.
|Minus the $65 Earned Income Exclusion|
|Minus Impairment Related Work Expenses (IRWEs)**|
|Divide by two|
|= Countable Earned Income|
Step 3: Add your countable monthly unearned income to your countable monthly earned income to figure out your total monthly countable income.
|Countable Unearned Income|
|Plus Countable Earned Income|
|= Total Countable Income|
|Your Monthly Earned Income||$|
|Your Monthly Unearned Income (not including SSI)||$|
|Your Monthly Countable Income|
|Federal Poverty Guideline|
|Your Countable Income as a Percent of FPG|
If your countable monthly income is less than 100% of FPG, you may qualify for MA by disability rules.
If your countable monthly income is more than 100% of FPG, you may have to pay a monthly spenddown. How a spenddown works is explained later in this article.
If you have a disability, your countable income is above 100% of FPG, and you meet all other program requirements, you may be able to get MA with a spenddown. However, a spenddown can be very expensive.
Starting on January 1, 2014, you may have these other health coverage options if you are in this situation:
- MA is expanding. Now, many people with and without disabilities can get it if their total income is up to 138% of FPG. Read DB101’s MA article.
- Medical Assistance for Employed People with Disabilities (MA-EPD) is for people with disabilities who work. It has no income limit and its premiums are cheaper than what it would cost to have MA with a spenddown. Read DB101’s MA-EPD article.
- MinnesotaCare has a 200% of FPG income limit. As with MA-EPD, you pay a monthly premium. Read DB101’s MinnesotaCare article.
MA for Children with Disabilities with Higher Family Income
MA-TEFRA is a way to get MA for children under age 19 with disability determinations from the State Medical Review Team (SMRT) who don’t qualify for MA because their parents have too much income. For eligibility, MA-TEFRA only counts the child’s income, not the parents’ and there is no asset limit. However, parents may have to pay a monthly parental fee. This rule mostly helps families that have income that’s higher than 280% of FPG ($66,780 per year for a family of 4). Read more about MA-TEFRA and parental fees.
If you have a disability, you may qualify for Medical Assistance (MA) in more than one way.
Here are some reasons you might not qualify for Medical Assistance (MA) by the rules described in this article, even if you have a disability:
- Your disability does not meet Social Security’s definition of disability. Medical Assistance (MA) for people with disabilities is only for people who have disabilities meeting this standard.
- Your assets are greater than the disability rules for MA allow. They have asset limits, meaning that if you have too much money in the bank or in any other type of account, you do not qualify by those rules.
- You make enough money that you would have to make monthly spenddown or premium payments for MA or MA-EPD under disability rules.
Reasons you might qualify for MA under disability rules instead of the rules explained in DB101’s other MA article:
- Your income is higher than 138% of FPG. MA’s eligibility rules for people with disabilities don’t count all of your earned income, so you may make more than that and qualify by disability rules. Also, people with disabilities who work and have higher income may qualify through MA-EPD.
- You need certain services for people with disabilities, such as some Home and Community-Based Services (HCBS).
- You also get Medicare. Usually, Medical Assistance (MA) isn’t available to most people getting Medicare, but Medical Assistance (MA) for people with disabilities is. It may even help pay your monthly Medicare premiums.
MA, Employer-Sponsored Coverage, and Medicare
MA and Employer-Sponsored Health Coverage
If you qualify for Medical Assistance (MA), it will always be your best choice. However, if your employer offers health insurance, you are required to get it if the coverage is cost-effective. MA will look at the plan your employer offers to determine whether it is cost-effective and if it is, MA will pay your portion of the monthly premium for the insurance plan your employer offers. This can give you the best of both worlds – you get coverage for your medical needs from both your employer’s plan and MA at a lower cost to you. To learn more about this option, Talk to an Expert or contact your local county human services agency.
MA and Medicare
- MA will usually pay your Part B premium (and your Part A premium, if you have one) through a Medicare Savings Program or by determining that your Medicare coverage is cost-effective. In some cases it may even pay for Medicare premiums, deductibles, coinsurance, and copayments.
You will automatically be enrolled in a Part D benchmark plan and automatically qualify for the Part D Low Income Subsidy. The Low Income Subsidy means you won’t have to pay a premium for your Part D or any deductibles, including the "donut hole." All you would pay for prescription drugs are Part D’s copayments, which range from $1.20 to $6.35.
- Note: If you have MA with a spenddown, you will only automatically get the Low Income Subsidy after you’ve paid your spenddown during one month of the year. Then, you’ll qualify for the rest of the year.
- MA covers many more services than Medicare, so by having both you’ll have better health care coverage than you would by enrolling in just one or the other.
If you have both public and private health coverage, the private coverage will usually pay for medical expenses first, Medicare second, and Medical Assistance (MA) last.
So, if you get a medical service that is covered by your private coverage, that policy pays for it. If it’s not covered by private health coverage, but is covered by both Medicare and MA, Medicare pays for it. If it’s not covered by your private coverage or Medicare, but MA does cover it, MA pays for it, as long as it’s an approved expense.
The Centers for Medicaid and Medicare Services has a helpful pamphlet on Medicare and Other Health Benefits: Your Guide to Who Pays First.