The annual FPL table rates are generally published in the Federal Register and available
for program use in late January (e.g., 01/2026). The Medicare Application Processing
System (MAPS) cannot use the Title II COLA monthly benefit credited (MBC) to determine
subsidy amounts until after publication of the annual FPL table rates. Consequently,
the subsidy determination program uses the MBC effective November (e.g., 11/2025),
until the new table rates are available.
You must use special procedures for Title II beneficiaries whose month of entitlement
is December or later, because these beneficiaries do not have an MBC for November.
For these beneficiaries, MAPS will either:
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•
Deny the application if the resources exceed the current limits: in 2025, $17,600
for a single beneficiary and $35,130 for a couple (systems includes the $1500 per
person for burial expenses); or
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•
Award the application if the income level is 150% or less using prior year’s FPL table
rates.
If neither of the situations in the two prior bulleted items applies to the claimant,
MAPS places the application in “Hold” status, pending receipt of the new FPL table.
Cases in “Hold” status receive the following messages dependent upon the following
actions:
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•
When you click on the “Submit to Subsidy Determination" button on the Development
Worksheet (DWMP) screen, you receive the message "Application is Pending – Awaiting
Federal Poverty Level Table Update."
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•
When you query the current application status, both the “Application Data” and “Status”
sections on the Query (QDIS) screen reflect the message “Awaiting Federal Poverty
Values for the Current Year.”
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•
The “Query Sub Menu” (QSMS) screen reflects the same message as the “Application Data”
and “Status” sections on the QDIS screen “Awaiting Federal Poverty Values for the
Current Year.”