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The Basics
Many people with disabilities fear that if they return to work and start earning more money, they’ll lose their Medical Assistance (MA) coverage. Medical Assistance for Employed Persons with Disabilities (MA-EPD) means that you don’t have to be afraid of this happening. With MA-EPD, if you have a disability and work, you can earn any level of income, build more assets, and keep your MA coverage. MA-EPD pays for the same services that standard MA covers, including visits to the doctor, hospital stays, medical equipment, home care services, and mental health services.
To qualify for MA-EPD, you must be certified disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT). You also must also be working, paying Medicare and Social Security taxes, and earning at least $65 per month. When you enroll in MA-EPD, you have to pay a monthly premium for your coverage.
This article will help you understand:
- If MA-EPD is right for you
- Different ways you may qualify for MA if you have a disability
- What services it covers
- How much you will have to pay, and
- How to sign up.
If after reading this article, you need more help in understanding MA-EPD, we recommend you talk to trained experts who can help you. Here are some good resources:
- Visit or call your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn more about health programs for people with disabilities.
- If you do not speak English, call the Minnesota Department of Human Services (DHS) Multilingual Referral Line.
- Starting January 1, 2024, MA-EPD doesn't have an asset limit.
- There's no earned income limit.
- You pay a monthly premium that is based on how much income you have.
- You can get it and Medicare at the same time, if you qualify.
- If your MA-EPD premium is high, you may find that MinnesotaCare or individual insurance plans on MNsure cost you less each month.
Disability Hub MN has a great video where people who have MA-EPD describe how it helps them work and keep their MA coverage:
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You can learn about how MA-EPD and other Minnesota benefits can help you get ahead when you work by watching the short video below.
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Note: DB101 keeps track of changes to health coverage and related laws. DB101 has been and will continue to be updated to reflect any changes. For news related to health coverage, visit the Minnesota Department of Human Services (DHS).
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Benefits and Work Estimator
See how a work plan can help your situation.
MA-EPD Estimator
You can work and keep MA. See how MA-EPD can help you when you work.
Medical Assistance (MA): Overview
MA is public health coverage. There are different ways to qualify.
MA-EPD
- The Basics
- Is it Right for You?
- What it Covers
- What You Pay
- How to Sign Up
- FAQs
- Pitfalls
- Next Steps
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Is it Right for You?
Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?
This page looks at whether you might qualify for Medical Assistance for Employed Persons with Disabilities (MA-EPD), and if you do, how you can have MA-EPD and other health coverage at the same time. If you don’t qualify for MA-EPD, you may still qualify for MA based on other rules and you should consider other options we will introduce, including MinnesotaCare, Medicare, and private health insurance.
MA-EPD Basic Eligibility Requirements
To qualify for MA-EPD, you must:
- Be determined blind or disabled by the Social Security Administration or the State Medical Review Team (SMRT)
- Be a U.S. citizen or have an immigration status that is eligible for Medical Assistance (MA), and
- Be working, paying Social Security and Medicare taxes, and earning more than $65 per month. (If you are self-employed, your earnings are your self-employment income minus business expenses and self-employment taxes.)
Note: If you qualify for SSI’s 1619(b) provision, you automatically qualify for MA and do not need to pay a premium. Read more about 1619(b) in DB101’s article about disability-based MA.
Tim has a brain injury. He’s been on disability-based MA for several years and needs the services it pays for.
Tim wants to start working again and has a great opportunity, but the job is part-time and does not come with health insurance. If he takes the job, Tim would be earning too much money to qualify for disability-based MA without a spenddown. What should he do?
Tim should consider MA-EPD. It pays for the same services that MA covers and, unlike MA, MA-EPD has no upper income limit. With MA-EPD, Tim could earn as much as he wants, save up as much as he needed, and still qualify.
Disability Determination
To get MA-EPD, you must be determined disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT). To get a disability determination, you will have to get medical documentation specified by SSA or SMRT.
They’ll say you have a disability if:
- You have a physical or mental impairment or combination of impairments, and
- Your condition has lasted or is expected to last for at least 12 months.
For MA-EPD, SSA’s disability rules related to earned income do not apply.
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.
Some people who qualify for MA-EPD may also qualify for disability-based MA with a spenddown. Usually, MA-EPD premiums are a lot cheaper than paying a spenddown, even though they cover the exact same services. Read more about the differences between MA-EPD and MA with a spenddown later in this article.
Citizenship and Immigration Status
To qualify, you must be a U.S. citizen or have an immigration status that is eligible for MA-EPD. If you are an immigrant and unsure about whether you qualify for MA-EPD, contact your local county or tribal human services office.
If you are an immigrant who does not qualify for MA-EPD, 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 or tribal human services office.
MA-EPD doesn't have an asset limit anymore. (The limit was removed on January 1, 2024.) That means you can work more, earn more, and don't have to worry about losing your coverage if you save up money!
MA-EPD, Private Health Coverage, and Medicare
Here we will look at what signing up for Medical Assistance for Employed Persons with Disabilities (MA-EPD) might mean if you also have private coverage or Medicare.
MA-EPD and Employer-Sponsored Health Coverage
If you sign up for MA-EPD and your employer offers health insurance, you are required to get it as well. In that case, if MA-EPD determines that the plan your employer offers is “cost-effective,” MA-EPD will pay your portion of the monthly premium, copayments, and deductibles 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. On the other hand, if MA-EPD’s premium is higher than what it would cost you to get coverage through your employer, it may make more sense for you not to sign up for MA-EPD.
To learn more about this option, Chat with a Hub expert or contact your local county or tribal human services office.
MA-EPD and Medicare
If you are eligible for Medicare Parts A, B, and D, you have to be getting them in order to get complete MA-EPD coverage. This will help you, because:
- If your total income is at or below 200% of the Federal Poverty Guidelines ($2,510/month for an individual), MA-EPD will pay your Part B premium (and your Part A premium, if you have one). In some cases it may even pay for Medicare, 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. All you would pay for prescription drugs are Part D’s copayments, which range from $1.55 to $11.20.
- MA-EPD 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.
To learn more, read DB101’s detailed information on Medicare Savings Programs for Parts A and B and the Part D Low Income Subsidy.
Depending on your situation, you might get employer-sponsored coverage, MA-EPD, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.
The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.
Generally speaking, MA-EPD will only pay for expenses that it covers and that your other coverage won't pay for.
How Medicare works with other insurance shows how it works when you have Medicare and other coverage.
MA-EPD is just one option for people with disabilities who work. Depending on your situation, other ways for you to get health coverage could include:
- Employer-sponsored coverage, if your employer offers it
- MinnesotaCare if your income is at or below 200% of the Federal Poverty Guidelines (FPG)
- Individual plans on MNsure, which the government may help you pay for. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
Depending on your situation, these options may be better for you. Read more about them in DB101’s Health Programs section.
Learn more
Benefits and Work Estimator
See how a work plan can help your situation.
MA-EPD Estimator
You can work and keep MA. See how MA-EPD can help you when you work.
Medical Assistance (MA): Overview
MA is public health coverage. There are different ways to qualify.
MA-EPD
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What it Covers
Medical Assistance for Employed Persons with Disabilities (MA-EPD) generally covers the same services as standard Medical Assistance. If you get MA-EPD, it will pay for a broad range of medical services, including all services that the government considers Essential Health Benefits (EHBs). If you’re not sure if a particular service is covered by MA-EPD, or if it requires prior authorization, ask your doctor or Chat with a Hub expert.
Here is a list of the main services that MA-EPD provides:
- Alcohol and drug treatment
- Chiropractic care
- Dental care (limited for adults who are not pregnant)
- Doctor/clinic visits
- Emergency room care (ER)
- Eye exams
- Eyeglasses
- Family planning services
- Hearing aids
- Home care
- Hospice care
- Hospital services (inpatient and outpatient)
- Immunizations and vaccines
- Interpreter services
- Lab and X-ray
- Licensed birth center services
- Medical equipment and supplies
- Medical transportation (access, ambulance, and special)
- Mental health care
- Nursing homes and ICF-DD facilities
- Outpatient surgery
- Personal Care Assistant (PCA) services
- Podiatry
- Pregnancy-related services
- Prescriptions and Medication Therapy Management
- Private-duty nursing
- Prosthetics
- Rehabilitative therapy
- Urgent care
- Visits to a clinic or physician for preventive care, including routine physicals
Depending on your circumstances, MA-EPD may cover some long-term care services, including nursing homes. If you have specific disability-related needs, contact your local county or tribal human services office for more information.
More Services through MA-Waiver Programs
People on MA-EPD may also be eligible for MA-Waiver programs. These programs pay for additional services that help people live in their own homes instead of an institution, like a hospital or nursing facility. To apply for an MA-Waiver program, talk to your local county or tribal human services office.
To learn more, read DB101’s article about MA-Waivers.
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Benefits and Work Estimator
See how a work plan can help your situation.
MA-EPD Estimator
You can work and keep MA. See how MA-EPD can help you when you work.
Medical Assistance (MA): Overview
MA is public health coverage. There are different ways to qualify.
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What You Pay
If you get Medical Assistance for Employed Persons with Disabilities (MA-EPD), you need to pay a monthly premium. However, you don't have to pay any copayments or other fees when you get medical care or a prescription drug!
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 $35. 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.
To get MA-EPD, each month you will have to pay:
- An amount based on your gross income. The minimum amount will be $35 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.
- An additional fee that is equal to 0.5% 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 estimate how much you will have to pay each month.
Are you married? | |
If you are married, is your spouse applying for or already on MA-EPD? | |
How many children do you have under age 21 that live with you? | |
Household Size for Premium Estimate: | |
Individual FPG | $15,060 |
FPG delta | $5,380 |
Monthly FPG for this family: | |
How much monthly gross income do you get from each of the following sources? | |
Earnings from all jobs (leave out spouse's income) | $ |
SSDI | $ |
Unemployment Compensation | $ |
Child Support Payments | $ |
Alimony | $ |
Other unearned income | $ |
Gross Unearned Income | |
Total Income: | |
Percent of FPG | |
F(i) | |
F(ii) | |
F(iii) | |
F(iv) | |
F(v) | |
F(vi) | |
Premium Percentage | |
G(i) | |
G(ii) | |
$35 | |
Sliding Fee Premium: | |
0.005 | |
Unearned Income Obligation: | |
Total Premium: |
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 12 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 or tribal human services office within 30 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:
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 or tribal human services office.
If You Can't Pay Your Premium
Tell your county worker right away if you can't pay your MA-EPD premium because of something out of your control, like:
- You lose your job
- You go on medical leave from your job
- You had an unexpected serious physical or mental illness and you can't work
- A natural disaster causes you to lose your belongings or be out of work
- Your income changed unexpectedly
In situations like these, you can ask the Department of Human Services (DHS) if any of your premiums can be waived, so that you don’t have to pay. This is called “requesting a Good Cause” for not paying your premium.
Or you may qualify for a lower premium and up to four months of MA-EPD eligibility without working through a Job Loss Extension or Medical Leave Extension.
To request a Good Cause:
- Fill in the MA-EPD Good Cause Request Form
-
Send the form:
- Online, by pressing the “Submit” button at the end of the form, or
-
By printing it and either faxing it to 1-651-431-7563 or mailing it to:
DHS MA-EPD Good Cause
P.O. Box 64967
St. Paul MN, 55164-0967
Good Cause does not include:
- Your initial premium. You won't get MA-EPD coverage until your first premium is paid. You can't ask to pay your initial premium late, or not pay it at all.
- Paying other household expenses instead of your MA-EPD premium. If you do not pay your premium because you had other bills, your MA-EPD will end because of non-payment. You can pay your premium to get MA-EPD back. You might have to apply again.
If you have any questions or need help, Chat with a Hub expert.
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.
Many people who qualify for MA-EPD may also qualify for disability-based MA with a spenddown, especially if they are employed, their monthly countable income is above 100% of the Federal Poverty Guidelines ($1,255) and their assets are below $3,000.
MA-EPD and disability-based MA with a spenddown cover the exact same services, but MA-EPD will usually cost you less. With MA with a spenddown, you must pay medical expenses with your own money until all you are left with 100% of FPG ($1,255 each month for your other expenses if you are single). Compared with the amount you would have to “spend down,” MA-EPD’s monthly premium is usually a smaller portion 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 $1,455 and no unearned income, when you sign up for MA with a spenddown, you have to pay the first $200 of your medical bills each month before MA starts paying for your medical expenses. With MA-EPD, you would just pay a $158 monthly premium.
Learn more
Benefits and Work Estimator
See how a work plan can help your situation.
MA-EPD Estimator
You can work and keep MA. See how MA-EPD can help you when you work.
Medical Assistance (MA): Overview
MA is public health coverage. There are different ways to qualify.
MA-EPD
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How to Sign Up
The only way you can apply for Medical Assistance for Employed Persons with Disabilities (MA-EPD) is by filling out the Minnesota Health Care Programs Application for Certain Populations and taking it or mailing it to your local county or tribal human services office. You cannot sign up online.
Note: You should only use this application if you think you might qualify for MA-EPD. If you are not sure whether you qualify for MA-EPD, Chat with a Hub expert.
How Your Application is Reviewed for Eligibility
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Your application will be reviewed to see if you qualify for income-based Medical Assistance (MA).
- If you do qualify, you’ll start getting MA coverage.
- If you do not qualify, your application will be reviewed to see if you might qualify based on disability-based MA or MA-EPD.
- If there is no way you can qualify for MA or MA-EPD, your county worker will tell you to apply for health coverage on MNsure.
If you need help applying for MA-EPD, try the following options:
- Visit or call your local county or tribal human services office.
- Chat with a Hub expert.
- If you do not speak English, call the Minnesota Department of Human Services (DHS) Multilingual Referral Line.
Staying on MA-EPD
Usually, once you are approved for MA-EPD, you will need to verify your income every 12 months. At any time, if your income, immigration status, residency, or household size changes, the best way to update your information is by letting your county or tribal human services office know within 30 days. When you report your changes, they’ll tell you whether you will continue getting MA, if your premium will change, or if you have new health coverage options. There should always be at least one health coverage option for your family.
Job Loss
To be on MA-EPD, you must be employed. But if you lose your job through no fault of your own, you can keep your MA-EPD coverage for up to four months while you look for a new job. You still have to pay your premium and you have to give your county or tribal human services office office a letter from your employer stating that you lost your job through no fault of your own.
If you quit your job or get fired, you would not get those four months of coverage. You would lose your coverage at the end of the month.
Note: When your income goes down, you may become eligible for MA without a premium, MinnesotaCare with a low premium, or an individual insurance plan. Read more about these options in DB101’s Health Programs section.
Medical Leave
If you can’t work because of your medical condition, you can stay on MA-EPD for up to four months. You must provide a signed note from your doctor stating that you are unable to work because of your medical condition, and the date that you’re expected to be able to return to work.
Learn more
Benefits and Work Estimator
See how a work plan can help your situation.
MA-EPD Estimator
You can work and keep MA. See how MA-EPD can help you when you work.
Medical Assistance (MA): Overview
MA is public health coverage. There are different ways to qualify.
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Frequently Asked Questions
This is really confusing. Where can I get help?
- Visit or call your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn if you have additional options.
- If you do not speak English, call the Minnesota Department of Human Services (DHS) Multilingual Referral Line.
- Minnesota has detailed information about the changes happening with health care reform.
Where can I sign up?
The only way you can apply for Medical Assistance for Employed Persons with Disabilities (MA-EPD) is by filling out the Minnesota Health Care Programs Application for Certain Populations and taking it or mailing it to your local county or tribal human services office. You cannot sign up online.
Note: You should only use this application if you think you might qualify for MA-EPD. If you are not sure whether you qualify for MA-EPD, Chat with a Hub expert.
I have been getting MA-EPD. Will my MA-EPD change?
No. You can continue to get the MA-EPD benefits you currently receive.
Who is eligible for MA-EPD?
To qualify for MA-EPD, you must:
- Be a Minnesota resident who is working or self-employed, paying Social Security and Medicare taxes, and earning more than $65 per month. (If you are self-employed, your earnings are your self-employment income minus business expenses and self-employment taxes.)
- Be certified disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT).
- Not be eligible for standard Medical Assistance (MA) without a spenddown, and you must not be living in a long-term care facility for more than 30 days.
Is MA-EPD coverage free?
No. You must pay a monthly premium based on your income and household size. As your income goes up, or as your household size goes down, your premium will go up. There is a $35 minimum premium for the program. For an estimate of what your MA-EPD premium would be, use the MA-EPD Estimator.
Does MA-EPD cover the same services as standard MA?
Yes. MA-EPD pays for the same services that standard MA pays for, including doctor visits, medical equipment, and Personal Care Assistant (PCA) services. See the complete list of services covered by MA-EPD.
What is the difference between MA, MA with a spenddown, and MA-EPD?
MA: You may qualify for income-based MA or disability-based MA, depending on your situation. You also qualify for MA if you qualify for SSI’s 1619(b) provision.
MA with a spenddown: You "spend down" your income by paying the first part of your medical costs. The amount you are responsible to pay before disability-based MA starts paying is the difference between your countable income and the "income standard." The income standard is 100% of the Federal Poverty Guidelines (FPG) ($1,255 for an individual, $1,704 for a family of two). Note: Usually, if you qualify, MA-EPD will be a better option than MA with a spenddown.
Medical Assistance for Employed Persons with Disabilities (MA-EPD): You pay a monthly premium based on your income and household size. Generally, if you are certified disabled by the Social Security Administration or the State Medical Review Team (SMRT) and are working you will qualify for MA-EPD.
DB101's MA overview compares these different ways of qualifying for MA.
Am I better off with MA-EPD or standard MA with a spenddown?
Usually, MA-EPD is a better deal, because you will end up paying less than you would with MA with a spenddown, while getting the exact same services.
If you have a lot of old, unpaid medical bills, you should talk to your county or tribal human services office to find out if you would be better off with MA-EPD or MA with a spenddown until the bills are paid.
For estimates on MA-EPD premiums and MA monthly spenddown amounts, use the MA-EPD Estimator.
What is the MA-EPD income limit?
You must work and earn at least $65 a month to qualify for MA-EPD. But there is no upper income limit. This is one of the great advantages of MA-EPD: you could earn tens of thousands of dollars per month and still qualify for the program.
The more you earn, the higher your monthly premium will be.
Does MA-EPD have an asset limit?
No! Starting January 1, 2024, MA-EPD doesn't have an asset limit.
I have private health coverage. Is there any reason I should consider MA-EPD?
Yes. There are a couple of reasons why you might want both private coverage and MA-EPD:
- MA-EPD may cover services that your private coverage doesn’t (e.g., transportation, home care, medical equipment).
- If the county determines that your private coverage is cost-effective, MA-EPD will actually pay your private premiums, copayments and deductibles. If this is the case and your MA-EPD premium is less than your private premium, there is no reason not to keep both forms of coverage. You’d pay less and get more comprehensive coverage.
I have Medicare. Why should I consider MA-EPD?
It depends on your situation and the services you need. In some situations, it makes sense to enroll in both.
MA-EPD covers a lot of services that Medicare doesn’t and you might reduce the amount you have to pay in coinsurance, deductibles, and copayments by enrolling in both programs as opposed to just Medicare.
If you are eligible for Medicare, you have to keep it in order to enroll in MA-EPD. The state will pay your Medicare Part B premium for you if your total income is less than 200% of the Federal Poverty Guidelines ($2,510 per month for an individual).
Does it matter how I qualify for MA?
In most cases, no. The actual medical coverage you get from MA will basically be the same, no matter how you qualified. Generally speaking, the big difference is that people with disabilities have extra ways to qualify and if you have a disability and start working, you can earn more while still getting MA coverage.
DB101 has four articles about different ways to get MA:
- DB101's MA overview compares the different ways of qualifying.
- The income-based MA article explains the most common way to qualify, which does not require you to have a disability.
- The disability-based MA explains a common way that people with disabilities who have low incomes can qualify.
- The MA-EPD article explains a way that people with disabilities can get MA coverage by paying a premium, no matter how high their income.
If you are not sure how you qualified for MA, you can ask your local county or tribal human services office.
Learn more
Benefits and Work Estimator
See how a work plan can help your situation.
MA-EPD Estimator
You can work and keep MA. See how MA-EPD can help you when you work.
Medical Assistance (MA): Overview
MA is public health coverage. There are different ways to qualify.
Try It
Common Pitfalls
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.
Bill lives alone, gets $1,000/month in Social Security Disability Insurance (SSDI), and makes $1,400/month at a job. His MA spenddown is about $413/month, so he has to pay the first $413 of his medical bills each month before MA starts paying. With this same income, his MA-EPD premium would be just $105/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 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.
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 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.
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 ($2,510 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.
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Benefits and Work Estimator
See how a work plan can help your situation.
MA-EPD Estimator
You can work and keep MA. See how MA-EPD can help you when you work.
Medical Assistance (MA): Overview
MA is public health coverage. There are different ways to qualify.
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Next Steps
Learn more about MA-EPD
To learn more about MA-EPD:
- Visit your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn if you have additional MA options.
- Visit the Minnesota Department of Human Services (DHS) website for general information on Minnesota health care programs.
- Minnesota has detailed information about the changes happening with health care reform.
Apply for MA-EPD
To apply, fill out the Minnesota Health Care Programs Application for Certain Populations and take it or mail it to your local county or tribal human services office. You cannot sign up online.
Note: You should only use this application if you think you might qualify for MA-EPD. If you are not sure whether you qualify for MA-EPD, Chat with a Hub expert.
Learn About Work and Benefits - Chat with a Hub expert!
When you have questions or need help, use Chat with a Hub expert. This feature connects you to a DB101 Expert using live chat, phone, or secure email. Anything you talk about is private.
- Understand your current benefits
- Get help using DB101.org
- Connect to resources
- Plan next steps
Free Legal Help
The Minnesota Disability Law Center (MDLC) provides free assistance to people with civil legal issues related to their disability. Call the MDLC Intake Line at 1-612-334-5970 (Twin Cities metro area), 1-800-292-4150 (Greater Minnesota), or 1-612-332-4668 (TTY).
Find Local Services
You can use MinnesotaHelp.info to find social services near you, from benefits applications to job counseling. |
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Benefits and Work Estimator
See how a work plan can help your situation.
MA-EPD Estimator
You can work and keep MA. See how MA-EPD can help you when you work.
Medical Assistance (MA): Overview
MA is public health coverage. There are different ways to qualify.