The Basics
Medical Assistance (MA) is a public program that helps pay medical expenses for people with low income. How you may qualify depends on your family’s situation. The rules for qualifying are related to things like whether you have a disability, how much you have in income, how much you have in assets, whether you are pregnant, or if you are a child.
This article focuses on income-based MA, which is a way people under the age of 65 who make $20,783 per year or less can qualify ($43,056 or less for a family of four). Children and pregnant women can get coverage when their family income is $87,360 per year or less for a family of four.
If you qualify, MA will help pay for your visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. Some people worry that if their income goes up, they’ll lose their MA, but if you get MA and your income goes up, you will have options that may let you stay with MA, switch to MinnesotaCare (another public program), or get a private health plan.
If you have a disability, there are additional ways to qualify for MA. Learn more about the different ways of qualifying in DB101's MA overview.
This article is about income-based Medical Assistance (MA) and will help you understand:
- If it is right for you
- Different ways you may qualify for MA if you have a disability
- What services it covers
- How much you will have to pay, and
- How to sign up.
If, after reading this article, you need more help in understanding Medical Assistance (MA), we recommend you talk to trained experts who can help you. Here are some good resources:
- Check out the MNsure website. You can also call them up at 1-855-3-MNSURE (1-855-366-7873).
- Contact a MNsure Assister.
- Visit or call your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn more about health programs for people with disabilities.
- For adults making less than 138% of FPG or less, you can get MA no matter how much you have in assets.
- Children and pregnant women can get MA if they make 280% of FPG or less.
- If you have disability, you may qualify for disability-based MA or MA-EPD if your income is too high for income-based MA.
- If you make between 138% and 200% of FPG and can’t get affordable health coverage through your job, you may qualify for another public program, MinnesotaCare.
- There is a single marketplace called MNsure where you can compare and apply for plans, including Medical Assistance (MA), MinnesotaCare, and private health coverage.
Note: DB101 keeps track of changes to health coverage and related laws. DB101 has been and will continue to be updated to reflect any changes. For news related to health coverage, visit the Minnesota Department of Human Services (DHS).
Learn more
Is it Right for You?
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 (MA) based on your family's income. If you do, it is your best choice and you won’t qualify for other options like MinnesotaCare and subsidized individual coverage. You can see if you qualify for income-based MA at MNsure.
If you don’t qualify for MA, consider other options we will introduce, including MinnesotaCare, Medicare, and private health insurance.
If the Social Security Administration (SSA) or the State Medical Review Team (SMRT) decides you have a disability, you may have additional ways of qualifying for MA, depending on your situation. Read DB101's MA overview and Chat with a Hub expert or visit your local county or tribal human services office.
Income-Based Medical Assistance (MA) Basic Eligibility Requirements
To qualify for income-based Medical Assistance (MA), most people must meet several basic requirements:
-
Be under 65 years old
- You can be 65 or older if you are the parent or caretaker of a child
-
Not be eligible for Medicare
- You can be on Medicare if you are the parent or caretaker of a child or are pregnant
- Be a U.S. citizen or have an immigration status that is eligible for Medical Assistance (MA), and
- Have income below certain limits.
Under Age 65
Income-based Medical Assistance (MA) is usually for people under age 65. However, seniors may qualify for disability-based MA. If you are 65 years old or older and have low income, talk to your local county or tribal human services office.
Exception: If you are 65 or older and are the parent or caretaker of a child, you may be able to get income-based MA.
If you are under 65, continue reading this article.
Not Eligible for Medicare
MA’s eligibility rules are different for most people who are eligible for or enrolled in Medicare. If you are eligible for or getting Medicare, read DB101’s Medicare article or Chat with a Hub expert.
Exception: If you are enrolled in Medicare and are the parent or caretaker of a child or are pregnant, you may be able to get income-based MA.
If you are not on Medicare, keep reading this article.
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 or tribal human services office.
If you are an immigrant who does not qualify for MA, you may qualify for MinnesotaCare, another public program for people with low income. Read DB101’s MinnesotaCare article.
If you are a U.S. citizen or have an immigration status that is eligible for MA, continue reading this article.
Income
Income-based Medical Assistance (MA) is for people with low incomes. These are the two main rules:
- If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($20,783 for an individual; $43,056 for a family of four), you may qualify for income-based Medical Assistance (MA).
- Any children under 19 or pregnant women in your family may be able to get income-based Medical Assistance (MA) coverage as long as your family’s income is at or under 280% of FPG ($87,360 per year for a family of four). Note: For the purposes of calculating a pregnant woman’s family income, the unborn baby is counted as a family member.
Income-based MA counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based MA eligibility.
There are no limits to how much money or other assets you can have for income-based MA. Other ways to qualify for MA, such as MA-EPD, do have asset limits.
You may see the income limit for income-based MA listed as 133% of the Federal Poverty Guidelines (FPG) in some places. However, when MA counts your income, they’ll knock 5% of FPG off your income if you make more than 133% of FPG. That's why we say that you can make up to 138% of FPG, because it more accurately shows how much income you could have and still get MA.
If you cannot get MA because your income is too high, consider MinnesotaCare or buying an individual plan through MNsure. See DB101’s Health Care Programs section for articles about other options.
| 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 (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
| |
The bottom line: If you meet the four main requirements described here, Medical Assistance (MA) is a great program that you should sign up for. We explain how to sign up later in this article.
If you have a disability, you may qualify for Medical Assistance (MA) in more than one way. When you apply for MA, your application will be checked to see if you qualify for income-based MA. If you do not qualify, your application will be checked to see if you qualify for disability-based MA.
Reasons you might qualify for disability-based MA instead of income-based MA:
- Your income is higher than 138% of FPG. Disability-based MA doesn’t count all of your earned income, so you may make more and still qualify. Furthermore, 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 people getting Medicare, but disability-based Medical Assistance (MA) is. It may even help pay your monthly Medicare premiums.
Reasons you might qualify for income-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 the disability-based MA allows. Disability-based MA has an asset limit, meaning that if you have too much money in the bank or in any other type of account, you do not qualify.
- You make enough money that you would have to make monthly spenddown or premium payments for disability-based MA or MA-EPD.
To learn more, read DB101's MA overview, Chat with a Hub expert, or go to your local county or tribal human services office.
MA and Private Health Coverage
If you qualify for MA, you should sign up for it. Here we will look at what signing up for MA might mean if you have or want private coverage.
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 must get it as well. In that case, if MA decides that the plan your employer offers is cost-effective, 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, Chat with a Hub expert or contact your local county or tribal human services office.
Nadif is a single father living on his own with his daughter. He makes $10 an hour repairing shoes and works 30 hours a week, so he makes a total of about $1,400 a month. Because he works 30 hours a week, his employer offers him and his daughter health insurance, but to get it, he would have to pay a $200 premium each month.
Nadif decides to go to his local county or tribal human services office to see if his family would qualify for Medical Assistance (MA), because the monthly premium for insurance through his job is really expensive. The caseworker looks at his income and explains that he does qualify for income-based MA, because his income is less than 138% of the Federal Poverty Guidelines (FPG) for a family of 2.
Then, the caseworker says, “Because your employer offers you and your daughter insurance, we need to figure out if the insurance is considered cost-effective. If your employer-sponsored insurance is cost-effective, then MA will pay the premiums and other out-of-pocket costs for you and your daughter.”
MA and Individual Plans
If you are eligible for Medical Assistance (MA), then you will not be eligible to get government help paying for a private insurance plan through a tax credit. That means the private insurance plan would be expensive for you. If you qualify for Medical Assistance (MA), it will always be a better option for you than paying for an individual plan.
Learn more
What it Covers
If you get Medical Assistance, it will pay for a broad range of medical services, including all services that the government considers Essential Health Benefits (EHBs). If you’re not sure if a particular service is covered by MA, or if it requires prior authorization, ask your doctor or Chat with a Hub expert.
Here is a list of the main services that MA provides:
- Alcohol and drug treatment
- Chiropractic care
- Dental care (limited for nonpregnant adults)
- Doctor/clinic visits
- Emergency room care (ER)
- Eye exams
- Eyeglasses
- Family planning services
- Hearing aids
- Home care
- Hospice care
- Hospital services (inpatient and outpatient)
- Immunizations and vaccines
- Interpreter services
- Lab and X-rays
- Licensed birth center services
- Medical equipment and supplies
- Medical transportation (access, ambulance and special)
- Mental health care
- Nursing homes and Intermediate Care Facilities for Persons with Developmental Disabilities (ICF-DDs)
- Outpatient surgery
- Podiatry
- Pregnancy related services
- Prescriptions and medication therapy management
- Prosthetics
- Rehabilitative therapy
- Urgent care
- Visits to a clinic or physician for preventive care, including routine physicals
Depending on your circumstances, MA may cover some long-term care services, including nursing homes. If you have specific disability-related needs, you should also see whether you can qualify for disability-based MA. Contact your local county or tribal human services office for more information.
Learn more
What You Pay
Most people who get Medical Assistance (MA) don’t have to pay a monthly premium. And with MA, you also don't pay anything when you get medical care or a prescription drug (there are no copayments)!
Dahlia is on MA and never has to pay a monthly premium. One chilly day in early November, she feels sick and bundles herself up to go to the doctor. When she gets there, the doctor tells Dahlia that she has a bad cold and prescribes her a medication.
As she leaves, Dahlia asks if she owes anything for the visit or the prescription. The receptionist tells her that MA covered everything and that Dahlia doesn't have to pay anything.
Retroactive Coverage
MA allows new enrollees to request 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.
Compared to Private Insurance
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.
Learn more
How to Sign Up
You should sign up for Medical Assistance (MA) at your county or tribal human services office if you:
- Are 65 years old or older
- Get Supplemental Security Income (SSI) benefits, or
- Have Medicare coverage.
If you are not in one of those situations, there are three ways to apply for health coverage:
- Online using MNsure, a one-stop shop where you can learn about your public and private coverage options.
- In person at your local county or tribal human services office.
- Filling out a paper application and faxing it in to 1-651-431-7750 or mailing it to the address listed on the form.
No matter how you apply, it is important to know that if you are not eligible for MA, you may be able to get MinnesotaCare or private insurance subsidized by the government.
How Your Application Is Reviewed for Eligibility
-
Your application will be reviewed to see if you qualify for income-based MA.
- If you do qualify, MNsure will let you know and you can sign up.
- If you do not qualify, your application will be reviewed to see if you might qualify for disability-based MA. If so, you will be contacted for additional information to complete your application. To learn more about this process, see DB101’s disability-based MA article.
- If there is no way you can qualify for MA, MNsure will display your other options, which could be MinnesotaCare or a private insurance plan, depending on your situation. For more information about these, see DB101’s articles about MinnesotaCare and Buying Health Coverage on MNsure.
Staying on MA
Usually, once you are approved for Medical Assistance (MA), you will continue to get it for 12 months. If your income, immigration status, residency, or household size changes, update your information on MNsure or let your county or tribal human services office know. When you report your changes, the eligibility system will tell you whether you will continue getting MA or if you have new health coverage options. There should always be at least one health coverage option for your family.
If you need help applying for health coverage, try the following options:
- Check out the MNsure website. You can also call them up at 1-855-3-MNSURE (1-855-366-7873).
- Contact a MNsure Assister.
- Visit or call your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn more about health programs for people with disabilities.
- If you do not speak English, call the Minnesota Department of Human Services (DHS) Multilingual Referral Line.
Learn more
Frequently Asked Questions
I have been getting MA because I have a disability. Will my MA change?
No. You can continue to get the Medical Assistance (MA) benefits you currently get.
To qualify for MA, is there a limit on the amount of assets my family can have?
It depends on how you qualified for Medical Assistance (MA). Income-based MA has no asset limit. However, some people with disabilities and seniors may qualify for disability-based MA or MA-EPD, which do have asset limits. If there's an asset limit, you must approve the use of the Account Validation Service (AVS) so that MA can make sure your assets are below the limit.
DB101's MA overview compares the different ways of qualifying.
This is really confusing. Where can I get help?
- MNsure has a lot of great information about your options. You can also call MNsure at 1-855-3-MNSURE (1-855-366-7873).
- Contact a MNsure Assister.
- If you have a disability, Chat with a Hub expert to learn if you have additional options.
- If you do not speak English, call the Minnesota Department of Human Services (DHS) Multilingual Referral Line.
- Minnesota has detailed information about the implementation of health care reform.
Where can I sign up?
You should sign up for Medical Assistance (MA) at your county or tribal human services office if you:
- Are 65 years old or older
- Get Supplemental Security Income (SSI) benefits, or
- Have Medicare coverage.
If you are not in one of those situations, there are three ways to apply for health coverage:
- Online using MNsure.
- In person at your local county or tribal human services office.
- Filling out a paper application and faxing it in to 1-651-431-7750 or mailing it to the address listed on the form.
What’s the difference between MA and MinnesotaCare?
Both Medical Assistance (MA) and MinnesotaCare are public health coverage programs:
- Income-based MA is for people with income that’s 138% of the Federal Poverty Guidelines (FPG) or less, which is $20,783 per year for an individual ($43,056 for a family of four). The income limits are higher for pregnant women and children and are calculated differently for disability-based MA.
-
MinnesotaCare is similar to MA, but you have to pay a monthly premium for it. It is for people who:
- Have income at or below 200% of FPG ($30,120 per year for an individual; $62,400 for a family of four), and
- Can’t get affordable health coverage through MA, Medicare, or their jobs.
Isn’t MA just for people with disabilities?
No. Income-based Medical Assistance (MA) is available to many people. To get income-based MA, most people must:
-
Be under 65 years old
- You can be 65 or older if you are the parent or caretaker of a child
-
Not be eligible for Medicare
- You can be on Medicare if you are the parent or caretaker of a child or are pregnant
- Be a U.S. citizen or have an immigration status that is eligible for Medical Assistance (MA), and
- Have income below certain limits.
There are additional ways to get MA if you have a disability or are a senior. Learn more about the different ways of qualifying in DB101's MA overview or Chat with a Hub expert.
What is the most money I can make and still get MA? Why have I seen different amounts listed in different articles?
You and your family can usually get income-based Medical Assistance (MA) if your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($20,783 for an individual; $43,056 for a family of four).
Any children under 19 or pregnant women in your family can get income-based Medical Assistance (MA) coverage as long as your family’s income is at or below 280% of FPG ($87,360 per year for a family of four). For the purposes of calculating a pregnant woman’s family income, the unborn baby is counted as a family member.
Income-based MA counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based MA eligibility.
You may see the income limit for MA listed as 133% of FPG in some places. However, when MA counts your income, they’ll knock 5% of FPG off your income if you make more than 133% of FPG. That's why we say you can make up to 138% of FPG, because it more accurately shows how much income you could have and still get income-based MA.
Note: The income limits may be different if you have a disability. Learn more about the different rules for qualifying in DB101's MA overview.
| 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 (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
| |
If my job offers me health coverage, am I allowed to sign up for MA?
Yes. If your family’s income is low enough for you to qualify for Medical Assistance (MA), you may do so even if your job offers insurance. If you are in this situation, you must tell your county or tribal human services office about the insurance your employer offers. If your employer-sponsored plan is considered cost-effective, MA will pay your portion of the private plan’s monthly premium. If you have questions about this, Chat with a Hub expert.
Note: If your job offers you affordable insurance, you cannot get MinnesotaCare or get subsidies for purchasing an individual health plan through MNsure.
I'm an immigrant. Can I get MA?
- Undocumented immigrants and some noncitizens who have legal immigration status do not qualify for full MA coverage. However, if their income is below 200% of the Federal Poverty Guidelines (FPG), they may qualify for MinnesotaCare, a different public program.
- Immigrants who have been legal residents for 5 years or longer and some other noncitizens with legal immigration status qualify for all of the same programs that citizens can get.
Does it matter how I qualify for MA?
In most cases, no. The actual medical coverage you get from MA will basically be the same, no matter how you qualified. Generally speaking, the big difference is that people with disabilities have extra ways to qualify and if you have a disability and start working, you can earn more while still getting MA coverage.
DB101 has four articles about different ways to get MA:
- DB101's MA overview compares the different ways of qualifying.
- The income-based MA article explains the most common way to qualify, which does not require you to have a disability.
- The disability-based MA explains a common way that people with disabilities who have low incomes can qualify.
- The MA-EPD article explains a way that people with disabilities can get MA coverage by paying a premium, no matter how high their income.
If you are not sure how you qualified for MA, you can ask your local county or tribal human services office.
I make too much money for MA, but not enough to afford private coverage. What are my options?
If you make more than the income limit for Medical Assistance (MA) and cannot get coverage through your or a family member’s job, use MNsure to see what other options you may have.
If your family’s income is more than 138% of the Federal Poverty Guidelines (FPG), but at or below 200% of FPG ($30,120 per year for an individual; $62,400 for a family of four) and you can’t get affordable health coverage through your job, you may qualify for another public program called MinnesotaCare. You can read about it in DB101’s MinnesotaCare article.
If your family’s income is greater than 200% of FPG and your job doesn’t offer health coverage, read DB101’s Buying Health Coverage on MNsure article.
Learn more
Common Pitfalls
Thinking you can’t get MA or MinnesotaCare because you have too much money in the bank
It used to be that MA and MinnesotaCare had limits on how much your family could have in assets, including things like your money in the bank, the value of your cars, or other investments. They don’t anymore.
No matter how much your family has in assets, you can get MA or MinnesotaCare if you meet other program requirements and your income is at or below 138% of the Federal Poverty Guidelines (FPG) for MA or at or below 200% of FPG for MinnesotaCare.
| 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 (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
| |
Thinking you don’t qualify because you didn’t in the past
The eligibility rules for Medical Assistance (MA) and MinnesotaCare are different than they used to be:
- They no longer have asset limits
- Income-based MA has a much higher income limit than it did before 2014
- MinnesotaCare doesn’t require you to have been uninsured for months prior to your application
These are just a few of the big changes. If you applied for one of these programs in the past and were rejected, try again, because these programs are accepting many more people than they used to.
Not getting health coverage because you think it will be too expensive
In the past, some people found it impossible to find health coverage that was affordable and met their needs. Now, there should be an option for almost everybody, even if you have a disability. The exact health coverage that will be right for you will depend on things like your family’s income, whether you have access to employer-sponsored coverage, your age, where you live, if you use tobacco products, and whether you have a disability.
If you do not have the option of employer-sponsored coverage, you may be able to get government help through tax credits paying for an individual plan on MNsure. If you cannot afford private individual coverage, your best options will be public programs, like Medical Assistance, MinnesotaCare, or Medicare, if you qualify.
Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.
Not going back to work because you fear losing your coverage
In the past, people feared that if they got a job while on public health coverage, like Medical Assistance (MA) or MinnesotaCare, they’d lose that coverage, because they would no longer have low enough income to qualify.
Now, if you lose one health coverage option, there should be another one you can get. If you lose your current coverage, you should either become eligible for employer-sponsored coverage, another public coverage program, or private individual coverage. And, if you can’t afford the individual coverage, the government may help you pay for it through tax credits.
The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage.
Not enrolling in MA because you have private coverage
It’s not always obvious, but there are times when you should consider having both private coverage and Medical Assistance (MA). For example, there may be services you need that MA covers but your private plan doesn’t.
If you enroll in MA and you also have cost-effective private coverage, the state will pay the premium for your private policy for you.
Not looking into how to get MA as a person with a disability
If you have a disability, there are additional ways to qualify for MA. You may be able to earn more money without losing your MA coverage or get additional services, like Home and Community-Based Services (HCBS). Learn more about the different ways of qualifying in DB101's MA overview.
Learn more
Next Steps
Learn more about Medical Assistance (MA)
To learn more about health coverage:
- Visit the Minnesota Department of Human Services (DHS) website for general information on Minnesota health care programs.
- MNsure has a lot of information about Medical Assistance (MA). You can also call MNsure at 1-855-3-MNSURE (1-855-366-7873).
- Contact a MNsure Assister.
- If you have a disability, Chat with a Hub expert to learn if you have additional MA options.
- Minnesota has detailed information about the implementation of health care reform.
Apply for Medical Assistance (MA)
You should sign up for Medical Assistance (MA) at your county or tribal human services office if you:
- Are 65 years old or older
- Get Supplemental Security Income (SSI) benefits, or
- Have Medicare coverage.
If you are not in one of those situations, there are three ways to apply for health coverage:
- Online using MNsure.
- In person at your local county or tribal human services office.
- Filling out a paper application and faxing it in to 1-651-431-7750 or mailing it to the address listed on the form.
Learn About Work and Benefits - Chat with a Hub expert!
When you have questions or need help, use Chat with a Hub expert. This feature connects you to a DB101 Expert using live chat, phone, or secure email. Anything you talk about is private.
- Understand your current benefits
- Get help using DB101.org
- Connect to resources
- Plan next steps
Free Legal Help
The Minnesota Disability Law Center (MDLC) provides free assistance to people with civil legal issues related to their disability. Call the MDLC Intake Line at 1-612-334-5970 (Twin Cities metro area), 1-800-292-4150 (Greater Minnesota), or 1-612-332-4668 (TTY).
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