POMS Reference

This change was made on Dec 20, 2017. See latest version.
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HI 03030.025: Resource Limits for Subsidy Eligibility

changes
*
  • Effective Dates: 05/18/2017 - Present
  • Effective Dates: 12/20/2017 - Present
  • 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 2017 resource limits for subsidy eligibility
  • B. Policy for 2018 resource limits for subsidy eligibility
  • 1. Individual
  • The two resource limits for an individual in 2017 are $7,390 and $12,320.
  • The two resource limits for an individual in 2018 are $7,560 and $12,600.
  • a. Countable resources are $12,320 or more
  • a. Countable resources are $12,600 or more
  • If countable resources are $12,320.01 or more, the individual is not eligible for any subsidy but can enroll in Part D.
  • 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 $7,390 or less
  • b. Countable resources are $7,560 or less
  • If countable resources are $7,390 or less, the individual can be eligible for a subsidy depending on the amount of countable income.
  • 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 $7,390 but do not exceed $12,320
  • c. Countable resources are greater than $7,560 but do not exceed $12,600
  • If countable resources are $7,390.01 or more but do not exceed $12,320, the individual can be eligible for a subsidy depending on countable income.
  • 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 $7,390 or less in countable resources, as explained in HI 03001.005.
  • * 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: 2017 resource limits for individuals
  • d. Table:2018 resource limits for individuals
  • Individual’s Countable Resources
  • Individual’s Countable Income
  • Amount of the Premium Subsidy
  • $7,390 or less
  • $7,560 or less
  • At or below 135% FPL
  • 100%
  • $7,390.01 to $12,320
  • $7,560.01 to $12,600
  • At or below 135% FPL
  • 100% but less help with co-pays or deductibles
  • $12,320 or less
  • $12,600 or less
  • More than 135% of FPL, but at or below 140%
  • 75%
  • $12,320 or less
  • $12,600 or less
  • More than 140% of FPL but at or below 145%
  • 50%
  • $12,320 or less
  • $12,600 or less
  • More than 145% of FPL but less than 150%
  • 25%
  • $12,320.01 or more
  • $12,600.01 or more
  • Any amount
  • Not eligible for subsidy
  • 2. Married couple
  • The two resource limits for a married couple in 2017 are $11,090 and $24,600. The couple resource limits apply to a married couple who live together whether one or both members apply for the subsidy.
  • 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 $24,600.01 or more
  • a. Countable resources are $25,150.01 or more
  • If countable resources are $24,600.01 or more, the couple is not eligible for any subsidy regardless of countable income, but can enroll in Part D.
  • 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 $11,090 or less
  • b. Countable resources are $11,340 or less
  • If countable resources are $11,090 or less, the couple can be eligible for a subsidy depending on the amount of countable income.
  • 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 $11,090 but do not exceed $24,600
  • c. Countable resources are greater than $11,340 but do not exceed $25,150
  • If countable resources are $11,090.01 or more but do not exceed $24,600, the couple can be eligible for a subsidy depending on countable income.
  • 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 $11,090 or less in countable resources, as explained in HI 03001.005G.
  • * 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: 2017 resource limits for married couples
  • d. Table: 2018 resource limits for married couples
  • Couple’s Countable Resources
  • Couple’s Countable Income
  • Amount of the Premium Subsidy
  • $11,090 or less
  • $11,340 or less
  • At or below 135% FPL
  • 100%
  • $11,090.01 to $24,600
  • $11,340.01 to $25,150
  • At or below 135% FPL
  • 100% but less help with co-pays or deductibles
  • $24,600 or less
  • $25,150 or less
  • More than 135% of FPL, but at or below 140%
  • 75%
  • $24,600 or less
  • $25,150 or less
  • More than 140% of FPL, but at or below 145%
  • 50%
  • $24,600 or less
  • $25,150 or less
  • More than 145% of FPL but less than 150%
  • 25%
  • $24,600.01 or more
  • $25,150.01 or more
  • Any amount
  • Not eligible for subsidy
  • C. Policy for 2015 and 2016 resource limits for subsidy eligibility
  • 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.
  • D. Policy for 2014 resource limits for subsidy eligibility
  • 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.
  • E. Policy for 2013 resource limits for subsidy eligibility
  • 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.
  • F. Policy for 2012 resource limits for subsidy eligibility
  • 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.
  • G. Policy for 2011 resource limits for subsidy eligibility
  • 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.
  • H. Policy for 2009 and 2010 resource limits for subsidy eligibility
  • 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.
  • I. Policy for 2008 resource limits for subsidy eligibility
  • 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.
  • J. Policy for 2007 resource limits for subsidy eligibility
  • 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.
  • K. Policy for 2006 resource limits for subsidy eligibility
  • 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.
  • L. References
  • 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