Effective Dates: 10/24/2023 - Present Previous | Next

TN 31 (10-23)

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 their 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 their spouse.

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

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 income.

4. Married couple living together

If the individual is married and living with their spouse at the time they apply 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. (if a married couple separates, see HI 03020.010A.6.)

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 their spouse stopped living together.

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

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 their spouse again.

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

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. (for when an absence is considered temporary, see HI 03020.010C.)

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 they expect to live together in the near future.

D. Policy – Deeming of income

We do not deem another person’s income to an individual filing for or receiving a subsidy. We do not deem the income of parents to children filing for or receiving a subsidy. We do not deem the income of sponsors to a migrant filing for or receiving a subsidy. Deeming is the concept used in SSI that an individual’s income includes a portion of the income 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 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 03020.010C. If the presented facts indicate the absence is not temporary, to determine living together, follow SI 00501.154.

  • •

    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 03030.005 Whose Resources Are 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/0603020010
HI 03020.010 - Whose Income is Counted - 10/24/2023
Batch run: 10/24/2023
Rev:10/24/2023