MAPS sends the application through verification if:

• •

  the application data indicates less income than the agency income data and,

• •

  the difference in the income amounts result in a change from one subsidy category to another.

EXAMPLE: On October 20, 2023, Alex files for Extra Help with a total countable income (application data) for the applicable period of $15,500 (more than 100% and less than 135% on the 2023 FPL table for a family size of one). The agency data from data matching indicates income of $20,000 (more than 135% and less than 140% on the 2023 FPL table for a family size of one).

MAPS will send the application to verification because:

• •

  the application data falls in the 100% premium full subsidy category and,

• •

  the agency data falls in the 75% premium subsidy category.

IMPORTANT: The Inflation Reduction Act of 2022 (IRA) allows for one Extra Help category. Extra Help eligibility determinations on or after January 1, 2024 indicate the individual is either eligible or ineligible for Extra Help.

MAPS does not send the application to verification if:

• •

  the application data and agency data both indicate income within the same subsidy category, and the system determines full or partial subsidy;

  IMPORTANT: 

  Partial subsidy only applies to applications with effective dates before January 1, 2024.

• •

  the application data and agency data both indicate income above the income limit for Extra Help eligibility (the system automatically issues a pre-decisional notice);

• •

  the application data indicates higher income than the agency data;

• •

  the application data indicates lower unearned income than the agency data, but the applicant answered the question about a recent unearned income decrease affirmatively (Question 10 on the SSA-1020-OCR, Application for Help with Medicare Prescription Drug Costs); or

• •

  the application data indicates lower earned income than the agency data, but the applicant answered the question about a recent earned income decrease affirmatively (Question 14 on the SSA-1020-OCR).

EXAMPLE 1: On July 2, 2023, James files for Extra Help with a total countable income (application data) for the applicable period of $19,800 (more than 135% and less than 140% on the 2023 FPL table for a family size of one). The agency data from data matching indicates income of $20,400 (more than 135% and less than 140% on the 2023 FPL table for a family size of one).

MAPS will not send this application to verification because both the application data and the agency data fall within the 75% premium subsidy category.

EXAMPLE 2: On January 16, 2025, Jacqueline files for Extra Help with a total countable income (application data) for the applicable period of $21,900 (more than 135% and less than 140% on the 2025 FPL table for a family size of one). The agency data from data matching indicates income of $23,000 (more than 140% and less than 150% on the 2025 FPL table for a family size of one).

MAPS will not send this application to verification because both the application data and the agency data fall within the 100% premium full subsidy category.

IMPORTANT: Effective January 1, 2024, the (IRA) Act of 2022 increased the income limit for full subsidy from income below 135% of the FPL to income below 150% of the FPL.

The Medicare System Query displays data from the Medicare database. The verification screen clearly identifies income from the RRB, VA, and OPM. The verification screen does not show the specific source of the agency data for the income fields “Other Pensions or Annuities” and “Other Unearned Income.” For information on verifying “Other Unearned Income” or “Other Pension or Annuities” income posted on MAPS verification screen (VRAI), see HI 03035.010D in this section and HI 03035.010G in this section.

For instructions on verifying pension and annuity income, see HI 03035.012.

To obtain detailed agency data, access the Detailed Agency Data (DADS) screen by clicking on the “Query” option on the verification screen.

Contact the applicant after you review the Medicare database. If you make contact with someone other than the applicant, use caution to avoid improper disclosure. When contacting the applicant:

• •

  Discuss the discrepancy between the application data and the agency data. For instructions on if the applicant dies before we process the Extra Help application, see HI 03010.010E.

• •

  Discuss each type of income with a dollar amount posted in either the “Application” or “Agency” data field of the VRAI.

• •

  Obtain the applicant’s explanation for discrepancies between the income amounts posted in the “Application” and “Agency” data fields.

• •

  Accept the explanation and determine that the application data is the correct amount for the application data income if the applicant provides a reasonable explanation for the application data.

• •

  Inform the applicant that we will use the agency data for the Extra Help determination if the applicant agrees with the agency data.

• •

  Inform the applicant that we will use the agency data for the Extra Help determination unless the individual provides evidence to the contrary if the applicant is not able to provide a reasonable explanation for the discrepancy. To offer assistance for evidence and closeout, see HI 03010.040.

• •

  Assist the applicant in determining the actual amount of the excludable work expenses and input the determined amount if the applicant indicates the actual work expenses are higher than the amount automatically posted by MAPS as impairment-related work expenses (IRWE) or blind work expenses (BWE), see HI 03020.030.

When the CS performs verification for earned income:

• •

  Verify with the applicant that the “Stop Work Date” alleged on the application is correct. If it is not correct, input the correct “Stop Work Date” on the appropriate MAPS screens. Based on the “Stop Work Date” MAPS determines the months for countable earnings. An incorrect date results in incorrectly counting the applicant’s earned income, which can result in an erroneous subsidy determination.

• •

  Input the correct “Stop Work Date” on the MAPS Work Stop Date and Work Expenses for Disability (ATWE) screen for initial applications, or the State Agency Work Sampling (SAWS) screen for redeterminations prior to submitting the case for a Medicare Part D Subsidy Determination. If the applicant has ongoing earned income from the filing date, delete the “Stop Work Date” in MAPS.

• •

  Document the determination to revise or delete the “Stop Work Date” when completing the MAPS Report of Contact (DWRC).

On November 6, 2009, the President signed the Worker, Homeownership and Business Assistance Act of 2009 (WHBA), which extends the deadline for receiving a tax credit for purchasing a home under the American Recovery and Reinvestment Act of 2009 (ARRA). WHBA also established a smaller tax credit, up to $6,500, for homebuyers who lived in their principal residence five out of the last eight years and purchased a new principal residence. For purposes of eligibility for the tax credit, these applicants are “deemed” first-time homebuyers.

For Medicare Part D Extra Help purposes, consider the first-time homebuyer’s and deemed first-time homebuyer’s tax credit as countable unearned income. By law, we do not exclude the first-time homebuyer’s tax credit or the deemed first-time homebuyer’s tax credit when we determine eligibility for Medicare Part D Extra Help.

When verifying the $250 economic recovery payment:

• •

  Verify income for Medicare Part D Extra Help applications filed May 2009 through December 2010. If the applicant reports other income on the application, ask if the applicant received a $250 payment based on the ARRA of 2009.

• •

  Exclude one-time ARRA payments of $250 from income to determine Medicare Part D Extra Help eligibility.

• •

  Inform the applicant not to report ARRA payment as income on the application for Medicare Part D Extra Help. If the applicant reported funds as income, the field office (FO) must correct the applicant’s income on the verification screen accordingly.

• •

  The Making Work Pay Tax Credit provides working applicants a reduction in the amount of income tax withholding deducted from their pay checks. This tax credit increases the applicant’s take home pay but does not increase the applicant’s gross wages.

• •

  For purposes of determining eligibility for Medicare Part D Extra Help, the increase in take home pay is not countable as income. This includes situations where the applicant has an increase in take home pay from multiple employers.

• •

  Applicants with very low wages may not receive their full tax credit through an increase in take home pay. Self-employed applicants do not receive this tax credit in take home pay. These applicants can get the tax credit as part of a tax refund when the individuals file their income tax return. If the applicant receives a tax credit in their tax refund, exclude it from income for Medicare Part D Extra Help.

• •

  You do not need to take special action because the increase in take home pay does not affect the computation of countable earned income, based on the applicant’s gross wages.

See Also:

• •

  HI 03020.050 for more information on the one-time $250 payment, the $25 per week unemployment compensation increase, and the Making Work Pay Tax Credit.

• •

  HI 03030.020 for information on the resource exclusions for the one-time $250 payment and the Making Work Pay Tax Credit.

• •

  HI 03035.020 for resource verification.

ARRA establishes the Filipino Veterans Equity Compensation Fund (FVECF) that provides a one-time payment for veterans who served in the Philippine armed forces during World War II. Only a small number of applicants will receive this payment, however, some veterans who file for Medicare Part D Extra Help may require verification via MAPS.

Eligible veterans who are citizens of the United States (U.S.) may receive a one-time payment of $15,000. Eligible veterans who are non-U.S. citizens may receive a one-time payment of $9,000. A veteran’s surviving spouse may receive the one-time payment only if the veteran filed for but did not receive the payment prior to death.

When verifying receipt of FVECF:

• •

  Exclude the one-time FVECF payment from income to determine Medicare Part D Extra Help eligibility received by the veteran or the surviving spouse.

• •

  Accept the Medicare Part D Extra Help applicant’s allegation about the receipt of this special payment and the amount of the payment.

• •

  Inform the Medicare Part D Extra Help applicant not to report the FVECF payment as income on the application for Medicare Part D Extra Help. If the applicant incorrectly reported funds as income, the FO must correct the applicant’s income on the verification screen accordingly.

• •

  If the applicant incorrectly reported funds, correct the income amounts on the income verification screen as income and document the verification on the (DWRC) screen.

For more information about income exclusions for Medicare Part D Extra Help, see HI 03020.050.

For more information about resource exclusions for Medicare Part D Extra Help, see HI 03030.020.

When verifying income for Medicare Part D Extra Help applications filed May 1, 2008 through December 31, 2009, and the applicant reports other income on the application:

• •

  Ask the applicant if a payment was received based on the Economic Stimulus Act of 2008. Explain to the applicant not to report the stimulus payment as income on the application for the Extra Help; and

• •

  If the applicant incorrectly reported funds as income, the FO must correct the applicant’s income on the verification screen accordingly.

Document the verification determination following procedures in HI 03035.007.

Use the DWRC screen to document:

• •

  verified income amounts;

• •

  types of evidence reviewed;

• •

  FO determination (Resolved or Failure to Cooperate); and

• •

  dates and types of contacts made.

REMINDER: Do not photocopy evidence for the file because you must record all documentation on the verification screens.

Input the verification determination as follows:

1. 1. 

   Select “None,” “Application,” “Agency,” or “New Amount” on the VRAI screen to indicate the correct amount of income for each type of income under consideration.

2. 2. 

   If the applicant reports income not already on the application, input that in the appropriate field.

3. 3. 

   When all income issues are resolved and there are no items marked “Not Verified,” go to the “Issue Resolution” section, select the “Resolved” button, and click on “Submit to Subsidy Determination.”

4. 4. 

   If you made two unsuccessful attempts to contact the applicant by phone and the applicant does not respond to the Evidence Request Notice within the 15-day closeout period, input “failure to cooperate” and click on “submit to subsidy determination.” For additional information on evidence and closeout, see HI 03010.040.

If you select an application for verification that has “Other Unearned Income” reported and the DADS screen has no corresponding detailed agency data, query the MAPS Current Agency Data screen to see if the undocumented unearned income lists as “Unemployment (OCSE).”

If there is a report of “Unemployment (OCSE)” on the MAPS Current Agency Data screen, develop and document the unemployment income following the procedures in HI 03035.010E in this section.

If the applicant’s other unearned income remains unexplained, develop and document the remaining unearned income following the procedures in HI 03035.010, in this section.

REMINDER: The unexplained “Other Unearned Income” could be the amount of garnished Title II benefits (see HI 03035.010F in this section). For instructions on verifying annuity income, see HI 03035.012.