We base the resource tolerances on the 2026 resource limits for Part D Extra Help
eligibility, as follows:
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$16,590 for an applicant;
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$33,100 for a married couple
Effective January 1, 2024, The Inflation Reduction Act (IRA) increases the resource
limits for full subsidy to the highest single and married resource limits, eliminates
the low single and married resource limits, and ends partial subsidy eligibility.
For more information about low and high resource limits or to view historical resource
limits see HI 03001.005.
The above resource tolerance amounts include the $1,500 individual and $3,000 married
couple burial exclusions because the Medicare Application Processing System (MAPS)
automatically subtracts $1,500 from individual applicants (or $3000 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
above individual or married couple amounts.
For information about the Medicare Part D subsidy burial fund exclusion, see HI 03030.020.
The sources of agency data used for financial accounts and savings bonds are:
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Internal Revenue Service (IRS)
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Bureau of the Public Debt (BPD)
1. Computing agency data for resources
Data provided by the IRS match does not include the amount of money an applicant has
in his or her financial accounts. The IRS provides data about the interest income
on IRS Form 1099-INT, or dividends and distributions on IRS Form 1099-DIV earned by
the applicant’s financial accounts, but does not provide the account balance. Based
on the interest reported for the account, the subsidy determination system computes
an estimated account balance for the applicant’s financial accounts. The system uses
this estimated account balance as the agency data for financial accounts.
2. Resource verification tolerances for single applicants
The system sends the application to verification if the application data indicates
resources of $16,590 or less and the agency data indicates resources over $16,590.
MAPS will also send applications with an estimated effective date or coverage start
date before January 1, 2024 to verification if the application data indicates resources between
low and high resource limits for individuals ($9,090.01 and $15,160 respectively in
2023) and the agency data indicates resources over the high resource limit for individuals
($15,160 in 2023). 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 more information about low and high resource limits or
to view historical resource limits see HI 03001.005.
EXAMPLE: On the application, an individual alleges they have $500 in cash, $3,500 in his bank
accounts, and $6,000 in savings bonds. The application data for the individual indicates
resources of $10,000. The agency data, derived from data provided by the IRS and BPD,
indicates resources of $17,000. Because application data is under $16,590 and agency
data is over $16,590, the system sends the application to verification.
b. Verification not required
The system does not send the application to verification if:
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the application data and the agency data both indicate resources of $16,590 or less;
or
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the application data indicates resources over $16,590, regardless of the amount of
agency data.
EXAMPLE: On their application, an applicant alleges $500 in cash, $8,000 in bank accounts,
and $12,000 in a retirement account. The application data for the applicant indicates
resources of $20,500. The agency data, derived from data provided by the IRS, indicates
resources of $9,500. Because the application data is over the $16,590 resource limit,
the application does not go to verification. The system issues a pre-decisional notice
to the applicant informing them it appears they are ineligible for Extra Help.
MAPS will also NOT send applications with an estimated effective date or coverage start date before January 1, 2024 to verification if the application data and the agency data both indicate resources between low and high resource limits for
individuals ($9,090.01 and $15,160 respectively in 2023). 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 more information
about low and high resource limits or to view historical resource limits see HI 03001.005.
3. Resource verification tolerances for married couples
The system sends the application to verification if the application data indicates
resources of $33,100 or less and the agency data indicates resources over $33,100.
MAPS will also send applications with an estimated effective date or coverage start
date before January 1, 2024 to verification if the application data indicates resources between
low and high resource limits for married couples ($13,630.01 and $30,240 respectively
in 2023) and the agency data indicates resources over the high resource limit for married couples
($30,240 in 2023).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 more information about low and high resource limits or to
view historical resource limits see HI 03001.005.
b. Verification not required
The system does not send the application to verification if:
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•
the application data and the agency data both indicate resources of $33,100 or less;
or
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•
the application data indicates resources over $33,100, regardless of the amount of
agency data.
MAPS will also NOT send applications with an estimated effective date or coverage start date before January 1, 2024 to verification if the application data and the agency data both indicate resources between low and high resource limits for individuals ($13,630.01
and $30,240 respectively in 2023). 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 more information about low and high resource limits
or to view historical resource limits see HI 03001.005.