What You Pay
Most people who get Medical Assistance (MA) don’t have to pay a monthly premium or spenddown. And with MA, you also don't pay anything when you get medical care or a prescription drug (there are no copayments)!
Private insurance plans always have copayments (the amounts can vary) and some plans have a deductible. 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 Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Monthly Impairment Related Work Expenses (IRWEs) | $ |
 | |
| Your Monthly Countable Income | |
| Your Annual Countable Income | |
| |
| Your Countable Income as a Percent of FPG |
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 100% of FPG to keep MA coverage (100% of FPG is $1,255 for an individual, $1,704 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.
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.
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