Effective Dates: 01/16/2024 - Present Previous | Next

TN 19 (01-24)

HI 03030.005 Whose Resources Are Counted

CITATIONS:

20 CFR 418.3410

A. Background

When we determine countable resources for the Medicare Part D subsidy, we need to determine if the individual filing for the subsidy is married and lives with their spouse. To be eligible for the subsidy an individual or couple must have countable resources below certain limits prescribed by law. The resource limits are adjusted each year based on the annual percentage increase in the consumer price index and are issued by the Department of Health and Human Services (HHS). (See HI 03030.025 for the current resource limits.)

B. Policy — Whose Resources are 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 we redetermine subsidy eligibility, we count only the individual’s resources to determine eligibility for the subsidy. We do not count the resources of relatives who live with the individual and receive one-half support. We do not count the resources 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 resources in the month after we receive a report the individual married and is living with their 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 their spouse at the time the individual applies for a subsidy or in the month we redetermine subsidy eligibility, we count only the individual’s resources.

4. Married Couple Living Together

If the individual is married and living with their spouse at the time the individual applies for a subsidy or in the month we redetermine eligibility, we count the resources of both the individual and the spouse. This is the case whether the individual or both the individual and spouse apply 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 a “holding out” couple for SSI purposes.)

5. Marriage Ends

If subsidy eligibility is based on the resources of both the individual and the spouse, we stop counting the spouse’s resources the month after we receive a report the marriage ended due to death, divorce, or annulment. (See HI 03020.010A.5. regarding separation.)

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

6. Married Couple Separates

If the subsidy eligibility is based on the resources of both the individual and the spouse, we stop counting the spouse’s resources in the month after we receive a report the individual and their 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 resources in the month after we receive a report the individual is living with their spouse again.

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

8. Temporary Absence

If the individual’s subsidy eligibility is based on the resources of the individual and the spouse and one of the spouse’s is temporarily away from home, we continue counting the resources of both spouses. (See HI 03030.005C. for when an absence is considered temporary.)

C. Policy – Temporary Absence

We consider an absence from the household considered 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 they expect to live together in the near future.

D. Policy – Deeming of Resources

We do not deem another person’s resources to an individual filing for or receiving a subsidy. We do not deem resources of parents to children filing for or receiving a subsidy. We do not deem resources of sponsors to an alien filing for or receiving a subsidy. Deeming is the concept used in SSI that an individual’s resources include a portion of the resources of other people who have a responsibility to provide for their support and maintenance.

E. Procedures - Determining Living Together

When determining living together:

  • •

    absent evidence to the contrary, accept the individual’s allegation of marriage, divorce, annulment, separation and re-cohabitation. Since these are subsidy changing events, the change is effective in the month after we receive the report. Therefore, the actual date of the event is not relevant for subsidy purposes (although it may be needed for Title II purposes).

  • •

    accept an allegation of living together as a married couple without further development. If information is received that indicates the individuals may not be living together in a household, follow SI 00501.154 to determine whether they are living together as a couple.

  • •

    accept the individual’s allegation of temporary absence without further development unless facts are presented that indicate the absence does not meet the requirements in HI 03030.005C. If the presented facts indicate the absence is not temporary, follow SI 00501.154 to determine living together.

  • •

    if it is determined that the absence is not temporary, determine the couple is separated as of the month after we receive a report about the absence.

F. References

SI 00501.154, Determining When Couple Computation Rules Apply

HI 03020.010, Whose Income is Counted

HI 03050.005, Subsidy Changing Events

HI 03050.011, Redeterminations of Eligibility

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603030005
HI 03030.005 - Whose Resources Are Counted - 01/16/2024
Batch run: 01/16/2024
Rev:01/16/2024