Not getting health coverage because you think it will be too expensive

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.

Paying a spenddown for MA coverage when MA-EPD would be cheaper

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.

Example

Bill lives alone, gets $600/month in Social Security Disability Insurance (SSDI), and makes $1,000/month at a job. His MA spenddown is about $225/month, so he has to pay the first $225 of his medical bills each month before MA starts paying. His prescription medications alone cost more than that! With this same income, his MA-EPD premium would be just $49/month and he'd save a lot of money by switching.

Not giving the county what they need to keep you on MA-EPD

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 six 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.

Not keeping complete earnings records

It is your responsibility to maintain accurate and detailed records. The earnings you report to Social Security and your county human services agency 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.

Not enrolling in MA-EPD because you have private coverage

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.

Not enrolling in or dropping Medicare

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 ($2,082 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 $1.25 to $8.50 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.