TN 13 (12-11)

HI 03030.025 Resource Limits for Subsidy Eligibility

CITATIONS:

Soc. Sec. Act, §1860D-14(a)(3)(D)

A. Background for resource limits for subsidy eligibility

To be eligible for a subsidy, an individual or couple must have countable resources below certain limits prescribed by law that adjust annually based on changes in the consumer price index.

NOTE: If an individual or couple expects to use some of his or her resources for funeral or burial expenses DON’T COUNT $1500 per individual ($3000 for a married couple); the HIGHER resource level applies.

B. Policy for 2018 resource limits for subsidy eligibility

1. Individual

The two resource limits for an individual in 2018 are $7,560 and $12,600.

a. Countable resources are $12,600 or more

If countable resources are $12,600.01 or more, the individual is not eligible for any subsidy but can enroll in Part D.

b. Countable resources are $7,560 or less

If countable resources are $7,560 or less, the individual can be eligible for a subsidy depending on the amount of countable income.

c. Countable resources are greater than $7,560 but do not exceed $12,600

If countable resources are $7,560.01 or more but do not exceed $12,600, the individual can be eligible for a subsidy depending on countable income.

If his or her income is less than 135% of the Federal Poverty Level (FPL), he or she:

  • receives a 100% premium subsidy; and

  • is eligible for less help with co-pays and deductibles than an individual with $7,560 or less in countable resources, as explained in HI 03001.005.

d. Table:2018 resource limits for individuals

Individual’s Countable Resources

Individual’s Countable Income

Amount of the Premium Subsidy

$7,560 or less

At or below 135% FPL

100%

$7,560.01 to $12,600

At or below 135% FPL

100% but less help with co-pays or deductibles

$12,600 or less

More than 135% of FPL, but at or below 140%

75%

$12,600 or less

More than 140% of FPL but at or below 145%

50%

$12,600 or less

More than 145% of FPL but less than 150%

25%

$12,600.01 or more

Any amount

Not eligible for subsidy

2. Married couple

The two resource limits for a married couple in 2018 are $11,340 and $25,150. The couple resource limits apply to a married couple who live together whether one or both members apply for the subsidy.

a. Countable resources are $25,150.01 or more

If countable resources are $25,150.01 or more, the couple is not eligible for any subsidy regardless of countable income, but can enroll in Part D.

b. Countable resources are $11,340 or less

If countable resources are $11,340 or less, the couple can be eligible for a subsidy depending on the amount of countable income.

c. Countable resources are greater than $11,340 but do not exceed $25,150

If countable resources are $11,340.01 or more but do not exceed $25,150, the couple can be eligible for a subsidy depending on countable income.

If their income is less than 135% FPL, the couple:

  • receives a 100% premium subsidy; and

  • is eligible for less help with co-pays and deductibles than the couple who has $11,340 or less in countable resources, as explained in HI 03001.005G.

d. Table: 2018 resource limits for married couples

Couple’s Countable Resources

Couple’s Countable Income

Amount of the Premium Subsidy

$11,340 or less

At or below 135% FPL

100%

$11,340.01 to $25,150

At or below 135% FPL

100% but less help with co-pays or deductibles

$25,150 or less

More than 135% of FPL, but at or below 140%

75%

$25,150 or less

More than 140% of FPL, but at or below 145%

50%

$25,150 or less

More than 145% of FPL but less than 150%

25%

$25,150.01 or more

Any amount

Not eligible for subsidy

C. Policy for 2017 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2017 are $7,390 and $12,320.

2. Married couple

The resource limits for a married couple in 2017 are $11,090 and $24,600.

D. Policy for 2015 and 2016 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2015 and 2016 are $7,280 and $12,140.

2. Married couple

The resource limits for a married couple in 2015 and 2016 are $10,930 and $24,250.

E. Policy for 2014 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2014 are $7,160 and $11,940.

2. Married couple

The resource limits for a married couple in 2014 are $10,750 and $23,860.

F. Policy for 2013 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2013 are $7,080 and $11,800.

2. Married couple

The resource limits for a married couple in 2013 are $10,620 and $23,580.

G. Policy for 2012 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2012 are $6,940 and $11,570.

2. Married couple

The resource limits for a married couple in 2012 are $10,410 and $23,120.

H. Policy for 2011 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2011 are $6,680 and $11,140.

2. Married couple

The resource limits for a married couple in 2011 are $10,020 and $22,260.

I. Policy for 2009 and 2010 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2009 and 2010 are $6,600 and $11,010.

2. Married couple

The resource limits for a married couple in 2009 and 2010 are $9,910 and $22,010.

J. Policy for 2008 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2008 are $6,290 and $10,490.

2. Married couple

The resource limits for a married couple in 2008 are $9,440 and $20,970.

K. Policy for 2007 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2007 are $6,120 and $10,210.

2. Married couple

The resource limits for a married couple in 2007 are $9,190 and $20,410.

L. Policy for 2006 resource limits for subsidy eligibility

1. Individual

The resource limits for an individual in 2006 are $6,000 and $10,000.

2. Married couple

The resource limits for a married couple in 2006 are $9,000 and $20,000.

M. References

  • HI 03001.005 Medicare Part D Extra Help (Low-Income Subsidy or LIS)

  • HI 03020.055 Income Limits for Subsidy Eligibility

  • DHHS Poverty Guidelines and Federal Register References


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0603030025
HI 03030.025 - Resource Limits for Subsidy Eligibility - 12/20/2017
Batch run: 12/20/2017
Rev:12/20/2017