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.

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.

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, 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.