TN 7 (01-07)

HI 03020.010 Whose Income is Counted

Citations: 20 CFR 418.3310

A. Background

When we determine countable income for the Medicare Part D subsidy, we need to determine if the individual filing for the subsidy is married and lives with his or her spouse. To be eligible for the subsidy, an individual or couple must have countable income below certain limits prescribed by the law. These income eligibility limits are based on the federal poverty levels (FPL), which the Department of Health and Human Services (HHS) issues annually. (See HI 03001.010D. for the current FPLs.)

B. Policy - Whose Income Is Counted

1. Individual is not Married

If the individual is not married at the time the individual applies for a subsidy or in the month that we redetermine subsidy eligibility, we count only the individual’s income to determine eligibility for the subsidy. We do not count the income of relatives who live with the individual and receive one-half support. We do not count the income of non-relatives (roommates).

2. Individual Marries

If an individual’s eligibility for the subsidy has been determined as a single individual, we start counting the spouse’s income in the month after we receive a report the individual married and is living with his or her spouse.

REMINDER: Marriage is a subsidy changing event. (See HI 03050.005B.1. for subsidy changing events)

3. Individual is Married but not Living with Spouse

If the individual is married but separated from his or her spouse at the time the individual applies for a subsidy or in the month we redetermine subsidy eligibility, we count only the individual’s income.

4. Married Couple Living Together

If the individual is married and living with his or her spouse at the time he or she applies for a subsidy or in the month we redetermine subsidy eligibility, we count the income of the individual and the spouse. This is the case whether the individual or both the individual and spouse are applying for or are eligible for the subsidy.

NOTE: A “holding out” couple is not considered married for purposes of determining subsidy eligibility. (See SI 00501.152 for “holding out” couple for SSI purposes.)

5. Marriage Ends

If subsidy eligibility is based on the income of both the individual and the spouse, we stop counting the spouse’s income in the month after we receive a report the marriage ended due to death, divorce, or annulment. (See HI 03020.010A.6. if a married couple separates.)

REMINDER: Death, divorce and annulment are considered subsidy changing events. (See HI 03050.005B.1. for subsidy changing events.)

6. Married Couple Separates

If subsidy eligibility is based on the income of both the individual and the spouse, we stop counting the spouse’s income in the month after we receive a report the individual and his or her spouse stopped living together.

REMINDER: Marital separation is considered a subsidy changing event. (See HI 03050.005B.1 for subsidy changing events.)

7. Married Couple Resumes Living Together

If an individual’s eligibility for the subsidy has been determined as a single individual, we start counting the spouse’s income in the month after we receive a report the individual is living with his or her spouse again.

REMINDER: Resumption of cohabitation is considered subsidy changing events. (See HI 03050.005B.1. for subsidy changing events.)

8. Temporary Absences

If the individual’s subsidy eligibility is based on the income of the individual and the spouse and one of the spouse’s is temporarily away from home, we continue counting the income of both spouses. (See HI 03020.010C. for when an absence is considered temporary.)

C. Policy - Temporary Absences

We consider an absence from the household temporary if:

  • it is due to service in the U.S. Armed Forces; or

  • it is 6 months or less and neither spouse is outside of the United States during this time, and the absence is due to business, employment, or confinement in a hospital, nursing home, mental institution, other medical institution, or a penal institution; or

  • it is based on other circumstances, and it is alleged by the spouses that th