Identification Number:
HI 03030 TN 14
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Resources
Type:POMS Transmittals
Program:Medicare
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 030 – Eligibility for Subsidized Medicare Prescription Drug Coverage
Subchapter 30 – Resources
Transmittal No. 14, 01/30/2019

Audience

PSC: BA, CA, CS, DS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, CTE, EIE, ERE, FCR, FDE, PETL, RECONE, RECONR;
Subsidy Appeals Unit (SAU): SDR, SDS, SDT;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, DES, EHI, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

HI 03030.025 Resource Limits for Subsidy Eligibility

Section B, updated year and replaced 2018 resource limits with new 2019 Medicare Part D resource limits announced by The Centers for Medicare & Medicaid Services.

Section C, moved existing 2018 resource limits from Section B to Section C.

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 2019 resource limits for subsidy eligibility

1. Individual

The two resource limits for an individual in 2019 are $7,730 and $12,890.

a. Countable resources are $12,890 or more

If countable resources are $12,890.01 or more, the individual is not eligible for any subsidy but can enroll in Part D.

b. Countable resources are $7,730 or less

If countable resources are $7,730 or less, the individual can be eligible for a subsidy depending on the amount of countable income.

c. Countable resources are greater than $7,730 but do not exceed $12,890

If countable resources are $7,730.01 or more but do not exceed $12,890, 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 $7,730 or less in countable resources, as explained in HI 03001.005.

d. Table:2019 resource limits for individuals

Individual’s Countable Resources

Individual’s Countable Income

Amount of the Premium Subsidy

$7,730 or less

At or below 135% FPL

100%

$7,730.01 to $12,890

At or below 135% FPL

100% but less help with co-pays or deductibles

$12,890 or less

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

75%

$12,890 or less

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

50%

$12,890 or less

More than 145% of FPL but less than 150%

25%

$12,890.01 or more

Any amount

Not eligible for subsidy

2. Married couple

The two resource limits for a married couple in 2019 are $11,600 and $25,720. 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 $25,720.01 or more

If countable resources are $25,720.01 or more, the couple is not eligible for any subsidy regardless of countable income, but can enroll in Part D.

b. Countable resources are $11,600 or less

If countable resources are $11,600 or less, the couple can be eligible for a subsidy depending on the amount of countable income.

c. Countable resources are greater than $11,600 but do not exceed $25,720

If countable resources are $11,600.01 or more but do not exceed $25,720, 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 $11,600 or less in countable resources, as explained in HI 03001.005G.

d. Table: 2019 resource limits for married couples

Couple’s Countable Resources

Couple’s Countable Income

Amount of the Premium Subsidy

$11,600 or less

At or below 135% FPL

100%

$11,600.01 to $25,720

At or below 135% FPL

100% but less help with co-pays or deductibles

$25,720 or less

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

75%

$25,720 or less

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

50%

$25,720 or less

More than 145% of FPL but less than 150%

25%

$25,720.01 or more

Any amount

Not eligible for subsidy

C. Policy for 2018 resource limits for subsidy eligibility

1. Individual

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

2. Married couple

The resource limits for a married couple in 2018 are $11,340 and $25,150.

D. 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.

E. 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.

F. 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.

G. 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.

H. 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.

I. 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.

J. 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.

K. 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.

L. 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.

M. 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.

N. References


HI 03030 TN 14 - Resources - 1/30/2019