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.

Alternatives for employed people with disabilities

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:

Depending on your situation, these options may be better for you. Read more about them in DB101’s Health Programs section.

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)
  • Meet certain asset requirements, 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.

Example

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 to $20,000 in assets, 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.

MA-EPD vs. MA with a spenddown

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 human services agency.

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 human services agency.

Assets

If you are 21 years old or older, to qualify for MA-EPD, your assets must be at or below $20,000. There is no asset limit if you’re under 21 or if you’re pregnant.

Note: There is no asset limit for MinnesotaCare and there is no asset limit for income-based MA, but there is a limit for MA-EPD. If you are over the limit, you can still apply for income-based MA, MinnesotaCare, or government help paying for a private insurance plan on MNsure. To learn more about these options, see DB101’s Health Programs section.

For MA-EPD, an asset is almost anything you own, including:

  • Cash
  • Money in bank accounts
  • Any vehicles, except for one car
  • Stocks and bonds
  • Real estate other than the home you live in

There are some assets that MA-EPD doesn’t count, including:

  • The home you live in
  • The car you drive to work or to medical appointments
  • Household and personal goods including pets, furniture, clothing, jewelry, appliances, tools and other equipment used in the home
  • Income in the month of receipt
    • Example: If you earn $4,000 in October, that income is not counted as an asset in October
  • Medical expense accounts set up through an employer
  • Your spouse’s assets and your spouse’s share of jointly held assets, and
  • Retirement accounts.

Also, if your disability began before you turned 26, you can open an ABLE account where you can save up to $15,000 each year and not have it counted by MA-EPD. Learn more about ABLE accounts.

Example

You could own a house, a car, have $100,000 in a retirement account, and another $19,000 in a bank account and still qualify for MA-EPD.

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 human services agency.

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 ($2,023/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, including the "donut hole." All you would pay for prescription drugs are Part D’s copayments, which range from $1.25 to $8.50.
  • 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.

Who pays when you have more than one health coverage

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.

Medicare and Other Health Benefits: Your Guide to Who Pays First shows how it works when you have Medicare and other coverage.