Is it Right for You?
Almost everyone should be able to get health coverage. In fact, if you don’t have a plan, you may have to pay a tax penalty. The question is, which plan is right for you and your family?
This article focuses on whether you can qualify for disability-based MA.
Just because you have a disability does not mean you qualify for disability-based MA. You may qualify for income-based MA or Medical Assistance for Employed Persons with Disabilities (MA-EPD), or you may not qualify for MA at all, depending on your situation.
|Your family size:|
Income limits for your family:
|Income-based MA, adults (138% FPG)|
|Income-based MA, children/pregnant women (280% FPG)|
|MinnesotaCare (200% FPG)|
|Subsidized private plans, reduced fees (250% FPG)|
|Subsidized private plans (400% FPG)|
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Note: Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG).
Disability-Based Medical Assistance (MA) Basic Eligibility Requirements
To qualify for disability-based Medical Assistance (MA), you must:
- Have been determined blind or disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)
- Be a U.S. citizen or have an immigration status that is eligible for MA
- Meet certain asset requirements, and
- Meet certain income requirements
Note: If you qualify for SSI’s 1619(b) provision, you automatically qualify for MA. You do not need to worry about the qualifying rules discussed on this page. Read more about 1619(b) in this article’s How to Sign Up page.
If you have been determined disabled, but do not meet the asset or income requirements, read DB101’s MA-EPD article.
They’ll say you have a disability if:
- You have a physical or mental impairment or combination of impairments
- Your impairments limit your ability to work, preventing you from earning Substantial Gainful Activity ($1,130 per month, or $1,820 per month if you’re blind), and
- Your condition has lasted or is expected to last for at least 12 months
To get a disability determination, you will have to get medical documentation specified by SSA or SMRT.
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. If you don’t get SSI or SSDI benefits, you’ll have to be determined disabled by SMRT.
Citizenship and Immigration Status
You must be a U.S. citizen or have an immigration status that is eligible for Medical Assistance (MA). If you are an immigrant and unsure about whether you qualify for MA, contact your local county human services agency.
If you are an immigrant who does not qualify for MA, 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.
Note: There is no asset limit for income-based MA, but there is an asset limit for disability-based MA. If you are over the asset limit, you can still apply for income-based MA. To learn more about that, see DB101’s income-based MA article.
Also, if your disability began before you turned 26, you can open an ABLE account where over time you can save up to $100,000 in assets and not have them counted by any Medical Assistance (MA) program. To learn more, read DB101's ABLE Accounts article.
For disability-based MA, an asset is almost anything you own, including:
- Money in bank accounts
- Vehicles you own (one will not be counted)
- Stocks and bonds
- Real estate other than the home you live in
- Your spouse’s assets, and
- Retirement accounts
There are some assets that MA doesn’t count, including:
- The home you live in
- One car, and
- Household and personal goods including pets, furniture, clothing, jewelry, appliances, tools and other equipment used in the home
Check out the complete list of assets MA doesn’t count.
If you own a home worth $250,000 and you live in it, the value of that home will not be counted toward your disability-based MA asset limit, but if you own a home that you rent out, its value may count toward your MA asset limit.
If you own on vehicle, the value of that car won’t count toward the limit, but if you own a second car, its value may count toward the limit.
For disability-based MA, you may qualify if your countable monthly income is at or below an income limit. If your income is higher than the income limit you may still be eligible if you meet certain additional requirements.
The income limit and how your income is calculated for disability-based MA are different than the income limit and how your income is calculated for income-based MA. Read more about those rules in DB101’s income-based MA article.
To see whether your income would qualify for disability-based MA, MA will look at the number of people in your family, the amount of income your family has, and it will then compare it to the Federal Poverty Guidelines (FPG):
- If you are blind or disabled, according to Social Security or the State Medical Review Team (SMRT), your countable monthly income must be at or below 100% of FPG ($990 for an individual, $1,335 for a family of two).
- If your income is higher than 100% of FPG, you may still be eligible for MA, but you will have to spend some of your own income on your medical bills before MA will start paying. This is called a spenddown.
Note: If your income is over 100% of FPG, you should look into Medical Assistance for Employed Persons with Disabilities (MA-EPD) and MinnesotaCare, because they are usually much more affordable than getting MA with a spenddown.
In this article, we talk about how there is a limit for how much countable income you can have and still qualify for disability-based MA. The confusing thing is that “countable income” is not the same as your total income. For example, if you make $2,000 per month at a job and have no other income and no other deductions, that’s only $957.50 in countable monthly income.
Figuring Out Your Countable Income
This countable income calculation is only for disability-based MA. The rules for qualifying for income-based MA are totally different and much less complicated.
Follow these steps to find out your countable income:
Do not include payments you get from SSI, the Minnesota Family Investment Program (MFIP), General Assistance (GA), Minnesota Supplemental Aid (MSA), Section 8 housing, or SNAP. Disability-based MA doesn’t count income you get from these programs.
Step 2: Add up your gross monthly earned income (income from work before taxes are deducted), including wages, tips, bonuses, and self-employment earnings.
Subtract a $65 Earned Income Exclusion.
Then divide the result by two. The result is your countable earned income.
|Minus the $65 Earned Income Exclusion|
|Minus Impairment Related Work Expenses (IRWEs)**|
|Divide by two|
|= Countable Earned Income|
Step 3: Add your countable monthly unearned income to your countable monthly earned income to figure out your total monthly countable income.
|Your Monthly Earned Income||$|
|Your Monthly Unearned Income (not including SSI)||$|
|Your Monthly Countable Income|
|Federal Poverty Guideline|
|Your Countable Income as a Percent of FPG|
If your countable monthly income is less than 100% of FPG, you may qualify for disability-based MA.
If your countable monthly income is more than 100% of FPG, you may have to pay a monthly spenddown. How a spenddown works is explained later in this article.
If you have a disability, your countable income is above 100% of FPG, and you meet all other program requirements, you may be able to get MA with a spenddown. However, a spenddown can be very expensive.
Look at these other health coverage options if you are in this situation:
- People with and without disabilities can get income-based MA it if their total income is up to 138% of FPG. Read DB101’s MA article.
- Medical Assistance for Employed Persons with Disabilities (MA-EPD) is for people with disabilities who work. It has no income limit and its premiums are cheaper than what it would cost to have disability-based MA with a spenddown. Read DB101’s MA-EPD article.
- MinnesotaCare has a 200% of FPG income limit. As with MA-EPD, you pay a monthly premium. Read DB101’s MinnesotaCare article.
MA for Children with Disabilities with Higher Family Income
MA-TEFRA is a way to get MA for children under age 19 with disability determinations from the State Medical Review Team (SMRT) who don’t qualify for income-based MA because their parents have too much income. For eligibility, MA-TEFRA only counts the child’s income, not the parents’ and there is no asset limit. However, parents may have to pay a monthly parental fee. This rule mostly helps families that have income that’s higher than 280% of FPG ($68,040 per year for a family of four). Read more about MA-TEFRA and parental fees.
If you have a disability, you may qualify for Medical Assistance (MA) in more than one way.
Here are some reasons you might not qualify for disability-based Medical Assistance (MA), even if you have a disability:
- Your disability does not meet Social Security’s definition of disability. Disability-based Medical Assistance (MA) is only for people who have disabilities meeting this standard.
- Your assets are greater than disability-based MA's asset limit allows.
- You make enough money that you would have to make monthly spenddown or premium payments for disability-based MA or MA-EPD under disability rules.
Reasons you might qualify for disability-based MA instead of income-based MA:
- Your income is higher than 138% of FPG. Disability-based MA’s eligibility rules don’t count all of your earned income, so you may make more than that and qualify by disability rules. Also, people with disabilities who work and have higher income may qualify through MA-EPD.
- You need certain services for people with disabilities, such as some Home and Community-Based Services (HCBS).
- You also get Medicare. Usually, income-based Medical Assistance (MA) isn’t available to most people getting Medicare, but disability-based Medical Assistance (MA) is. It may even help pay your monthly Medicare premiums.
MA, Employer-Sponsored Coverage, and Medicare
MA and Employer-Sponsored Health Coverage
If you qualify for Medical Assistance (MA), it will always be your best choice. However, if your employer offers health insurance, you are required to get it if the coverage is cost-effective. MA will look at the plan your employer offers to determine whether it is cost-effective and if it is, MA will pay your portion of the monthly premium 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. To learn more about this option, Talk to an Expert or contact your local county human services agency.
Disability-based MA and Medicare
If you are eligible for Medicare Parts A, B, and D, you have to be getting them in order to get complete disability-based MA coverage. Note: You usually cannot get income-based MA if you are get Medicare.
Getting both Medicare and disability-based MA at the same time will help you, because:
- MA will usually pay your Part B premium (and your Part A premium, if you have one) through a Medicare Savings Program or by determining that your Medicare coverage is cost-effective. In some cases it may even pay for Medicare premiums, 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 $1.20 to $7.40.
- Note: If you have MA with a spenddown, you will only automatically get the Low Income Subsidy after you’ve paid your spenddown during one month of the year. Then, you’ll qualify for the rest of the year.
- MA 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.
Depending on your situation, you might get employer-sponsored coverage, MA, 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 will only pay for expenses that it covers and that your other coverage won't pay for.
The Centers for Medicaid and Medicare Services has a helpful pamphlet on Medicare and Other Health Benefits: Your Guide to Who Pays First.