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 (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.

Different ways to qualify for MA if you have a disability

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 human services agency.

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 human services agency.

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 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.

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:

  1. If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($16,753 for an individual; $34,638 for a family of four), you may qualify for income-based Medical Assistance (MA).
  2. 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 ($70,280 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.

Is income-based MA’s income limit 133% or 138% of FPG?

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.

Health Coverage Income Limits for Your Family

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.

More ways to qualify for MA if you have a disability

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 human services agency.

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 human services agency.

Example

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 human services agency 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.