Common Pitfalls

In the past, some people found it impossible to find health coverage that was affordable and met their needs. Now, there should be an option for almost everybody, even if you have a disability. The exact health coverage that will be right for you will depend on things like your family’s income, whether you have access to employer-sponsored coverage, your age, where you live, if you use tobacco products, and whether you have a disability.

If you do not have the option of employer-sponsored coverage, you may be able to get government help through tax credits paying for an individual plan on MNsure. If you cannot afford private individual coverage, your best options will be public programs, like Medical Assistance, MinnesotaCare, or Medicare, if you qualify.

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.

If you have a disability, are working or want to work, and are on disability-based Medical Assistance (MA) with a spenddown, you should look into MA-EPD. MA-EPD pays for the same services that MA with a spenddown covers and in many cases is less expensive.

For estimates on what your MA-EPD premium and your monthly MA spenddown amount might be, use the MA-EPD Estimator.

When you apply for MA-EPD, it is important to give the county everything they need to process your application, including things like your Social Security number, proof of citizenship, pay stubs from the last 30 days and recent bank statements (there may be other things the county requests to figure out your eligibility).

Your eligibility will be reviewed every 12 months. The county will send out a reminder that it is time for your review and will tell you what you need to send them and the date you need to return it. It is important that you return all of the information before the date shown on the letter, or your MA-EPD will be closed and you may have to re-apply.

It is your responsibility to maintain accurate and detailed records. The earnings you report to Social Security and your county or tribal human services office will be verified. Clearly document all communication with both agencies. Make copies of letters and keep records of phone conversations, including the date and time phone calls take place and the name of the individual who was assisting you. These steps can help you avoid pitfalls during the application process and while maintaining eligibility for benefits.

MA-EPD covers many services that private health care plans do not cover. Plus, MA-EPD will pay the premium for your private insurance plan if it is determined cost-effective by the county.

If you’re in that situation and your private premium is higher than what your MA-EPD premium would be, you should definitely enroll in MA-EPD. You’ll get more comprehensive coverage at a lower price.

If you’re eligible for Medicare, you have to keep Medicare Parts A and B to qualify for MA-EPD, even if that means you have to pay the Part B premium yourself. MA-EPD will pay your Part B premium for you if your total income is at or below 200% of the Federal Poverty Guidelines ($2,510 per month for an individual).

If you're on MA-EPD, you should enroll in Medicare Part D. Being on MA-EPD automatically qualifies you for the Part D Low Income Subsidy which means that your only prescription drug costs will be copayments of $1.55 to $11.20 per prescription. You won't have to pay any Part D premiums, deductibles, or coinsurance.

If you're on MA-EPD and you decline Medicare Part D coverage, you will have no prescription drug coverage. MA-EPD will not cover your prescriptions if you’re eligible for Medicare and don't enroll in Part D.