What You Pay

Most people who get Medical Assistance (MA) don’t have to pay a monthly premium or spenddown. If you are covered by MA, you only have to make payments when you need medical care.

Payments When You Get Services

Generally, if you are 21 years old or older, you may have to pay a small $3.20 monthly deductible and small copayments that range from $1 to $3 when you use certain medical services that MA covers.

Note: If you are not able to pay a copay or deductible, your medical provider still has to serve you. Providers must take your word that you cannot pay. Providers cannot ask for proof that you cannot pay.

There are some people who do not need to make copayments:

Compared to Private Insurance

MA’s deductible and copayments are much lower than the copayments required by private insurance plans. For example, many private insurance plans can have annual deductibles that require you to pay thousands of dollars before the plan will cover most services and even after the deductible is paid, many private insurance plans require $50 or more in copayments for services.

Medical Assistance (MA) with a Spenddown

Some people who qualify for disability-based MA and have countable income that is higher than 100% of the Federal Poverty Guidelines (FPG) may have to pay a spenddown each month.

Your Countable Income:

A spenddown is like a deductible: you have to pay some of your medical expenses each month before MA will start paying for the rest. If your medical bills don’t reach the spenddown amount in a particular month, you don’t have to pay the whole spenddown for that month.

If you have disability-based MA with a spenddown, you have to “spend down” until your countable income is down to 80% of FPG to keep MA coverage (80% of FPG is $810 for an individual, $1,098 for a family of two).

Note: MA with a spenddown is often very expensive. In many cases, it is more affordable to pay a monthly premium and get Medical Assistance for Employed Persons with Disabilities (MA-EPD), MinnesotaCare, or even a private individual insurance plan through MNsure. Before you get MA with a spenddown, look into those other options in DB101’s Health Programs section.

Example

Thomas has a $400 monthly spenddown. In April, he has $700 in medical expenses. Thomas is responsible for paying the first $400 and MA will pay the remaining $300.

In May, Thomas has only $50 in medical bills. He has to pay that $50 himself, but he doesn’t have to pay the whole $400 spenddown amount for May. MA will not pay for any medical expenses in May.

Retroactive Coverage

MA allows new enrollees to ask for coverage retroactively. This means that you can ask to have your MA coverage begin three months before the month you apply. So if you enroll in MA in April but have unpaid medical bills from the previous three months (January, February, and March), you could have MA pay for those unpaid bills.