Effective Dates: 4/12/2024 - Present

Identification Number:
HI 03030 TN 20
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Resources
Type:POMS Full Transmittals
Program:All Programs
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. 20, 04/12/2024

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 transmittal updates Extra Help resource limits, incorporates gender inclusive language, and provides new policy to support legislative changes mandated in the Inflation Reduction Act (IRA), Section 11404, which expands Medicare Part D Extra Help (Low Income Subsidy or LIS) full subsidy and ends Extra Help partial subsidy effective January 1, 2024.

Summary of Changes

HI 03030.025 Resource Limits for Subsidy Eligibility

Subsection A

Inserted alert titled IMPORTANT.

Incorporated language to explain the impact of the Inflation Reduction Act (IRA).

Inserted applicable POMS cross references.

In the alert titled NOTE, clarified the figures in this POMS reflect subsidy resource limits without burial expenses.

Subsection B

Updated year and added 2024 resource limits.

In the alert titled NOTE, incorporated language to explain the impact of the Inflation Reduction Act (IRA) and inserted. applicable POMS cross references.

Subsection C

Moved 2023 resource limits from subsection B to subsection C.

HI 03030.025 Resource Limits for Subsidy Eligibility

CITATIONS:

Soc. Sec. Act, §1860D-14(a)(3)(D)

A. Background

To be eligible for a subsidy, an individual or married couple must have countable resources below certain limits prescribed by law.

Every year, the Centers for Medicare and Medicaid Services (CMS) considers changes in the consumer price index and publishes updated subsidy resource limits.

Starting January 1, 2024, all applicants who meet Extra Help eligibility requirements will receive full subsidy (the highest level of subsidy under the Medicare Part D Extra Help Program). The Inflation Reduction Act (IRA) of 2022 increases the resource limits for full subsidy to the high resource levels, eliminates the low resource levels, and eliminates partial subsidy.

For more information about subsidy eligibility requirements or subsidy low and high resource levels, see HI 03001.005. To view subsidy eligibility resource levels for prior years, see HI 03030.025

NOTE: 

The amounts below include the $1,500 individual and $3,000 married couple burial exclusions because the Medicare Application Processing System (MAPS) automatically subtracts $1500 from individual applicants (or $3,000 from married couple applicants), unless applicants report NONE of their resources will be used to pay for funeral or burial expenses. If an individual or couple does NOT expect to use some of their resources for funeral or burial expenses, ADD $1,500 per individual ($3,000 for a married couple) to the below individual or married couple amounts. For information about the Medicare Part D subsidy burial fund exclusion, see HI 03030.020.

B. Policy - 2024 resource limits for subsidy eligibility

1. Individual

The resource limit for an individual in 2024 is $15,720.

a. Countable resources are $15,720 or more

If countable resources are $15,720.01 or more, the individual is not eligible for any subsidy but can enroll in Part D.

b. Countable resources are $15,720 or less

If countable resources are $15,720 or less, the individual can be eligible for a subsidy depending on the amount of countable income.

If an individual's income is less than 150% of the Federal Poverty Level (FPL), the individual will:

  • •

    receive a 100% premium subsidy; and

  • •

    is eligible for $0 co-pays and deductibles, as explained in HI 03001.005.

NOTE: 

Individuals also received 100% if they had an estimated subsidy effective date or coverage start date before January 1, 2024, had income less than 135% of the FPL, and had countable resources below the lower resource limits prescribed by law during the year of their subsidy effective date or coverage start date.

For more information about low and high resource limits see HI 03001.005. To view subsidy eligibility resource levels for prior years, see HI 03030.025.To locate the field in MAPS that captures the estimated effective date, see MS 03206.002E.[21-D]. To locate the coverage start date field in MAPS, see MS 03301.008C. [11-D]. For information about MAPS determination dates, see MS 03206.021.

c. Table: 2024 resource limits for individuals

Individual’s Countable Resources

Individual’s Countable Income

Amount of the Premium Subsidy

$15,720 or less

Below 150% FPL

100%

$15,720 or less

At or above150% of FPL

Not eligible for subsidy (income over allowable LIS limit)

$15,720.01 or more

Any amount

Not eligible for subsidy (resources over allowable LIS limit)

2. Married couple

The resource limit for a married couple in 2024 is $31,360. 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 $31,360 or more

If countable resources are $31,360.01 or more, the couple is not eligible for any subsidy regardless of countable income, but can enroll in Part D.

b. Countable resources are $31,360 or less

If countable resources are $31,360 or less, the couple can be eligible for a subsidy depending on the amount of countable income.

If their income is less than 150% FPL, the couple:

  • •

    receives a 100% premium subsidy; and

  • •

    is eligible for $0 co-pays and deductibles, as explained in HI 03001.005G.

    NOTE: 

    Individuals also received 100% if they had an estimated subsidy effective date or coverage start date before January 1, 2024, had income less than 135% of the FPL, and had countable resources below the lower resource limits prescribed by law during the year of their subsidy effective date or coverage start date.

    For more information about low and high resource limits see HI 03001.005. To view subsidy eligibility resource levels for prior years, see HI 03030.025.To locate the field in MAPS that captures the estimated effective date, see MS 03206.002E.[21-D]. To locate the coverage state date field in MAPS, see MS 03301.008C. [11-D]. For information about MAPS determination dates, see MS 03206.021.

c. Table: 2024 resource limits for married couples

Couple’s Countable Resources

Couple’s Countable Income

Amount of the Premium Subsidy

$31,360 or less

Below 150% FPL

100%

$31,360 or less

At or above 150 FPL%

Not eligible for subsidy (income over allowable LIS limit)

$31,360.01 or more

Any amount

Not eligible for subsidy (resources over allowable LIS limit)

C. Policy - Prior Year resource limits for subsidy eligibility

2023

Individual - $9,090 and $15,160

Married - $13,630 and $30,240

2022

Individual - $8,400 and $14,010

Married - $12,600 and $27,950

2021

Individual - $7,970 and $13,290

Married - $11,960 and $26,520

2020

Individual - $7,860 and $13,110

Married - $11,800 and $26,160

2019

Individual - $7,730 and $12,890

Married - $11,600 and $25,720

2018

Individual - $7,560 and $12,600

Married - $11,340 and $25,150

2017

Individual - $7,390 and $12,320

Married - $11,090 and $24,600

2015 and 2016

Individual - $7,280 and $12,140

Married - $10,930 and $24,250

2014

Individual - $7,160 and $11,940

Married - $10,750 and $23,860

2013

Individual - $7,080 and $11,800

Married - $10,620 and $23,580

2012

Individual - $6,940 and $11,570

Married - $10,410 and $23,120

2011

Individual - $6,680 and $11,140

Married - $10,020 and $22,260

2009 and 2010

Individual - $6,600 and $11,010

Married - $9,910 and $22,010

2008

Individual - $6,290 and $10,490

Married - $9,440 and $20,970

2007

Individual - $6,120 and $10,210

Married - $9,190 and $20,410

2006

Individual - $6,000 and $10,000

Married - $9,000 and $20,000

D. References

HI 03030 TN 20 - Resources - 4/12/2024