QQ Medical Insurance Payments

 

 

Revised 08/31/2017

Policy

How medical insurance payments are treated depends on the following:

If medical payment is...

And the program is...

Then the treatment is...

Reimbursement received from medical insurance

All programs

Excluded unless it exceeds the actual incurred expense.  The excess amount is counted as unearned income.

A reimbursement for actual costs paid directly to the health care provider

All programs

Excluded as a vendor payment.

A disbursement from a Health Savings Account (HSA) or Medical Savings Account (MSA)

All programs

Not income. It is the conversion of a resource.

A flat rate insurance policy payment paid directly to the person

If the payments have been assigned to someone else, see MA604.B for special handling.

·         ALTCS

·         SSI-MAO

·         MSP

Counted as unearned income.

·         Adult

·         Caretaker Relative

·         Pregnant Woman

·         Child

·         KidsCare

Excluded up to the amount of actual expenses.  The excess amount is counted as unearned income.

 

Definitions

Term

Definition

Medical Insurance Payments

Payments from Medicare or private medical insurance policies.

Reimbursement for Medical Expenses

Reimbursement received from medical insurance (Medicare and private medical insurance policies).

Flat Rate Policy

Cash from any medical insurance policy, which pays a flat rate benefit to the recipient without regard to the actual charges or expenses incurred (ex., per diem hospitalization or disability insurance, cancer or dismemberment policies or long term care policies).

 

Proof

Income is first obtained through the Federal and State Data Services Hubs.  If needed, other proof includes:

·         Collateral contact with payment source;

·         Check stub;

·         Statement from payment source; or

·         Request for Verification of Long Term Care Partnership Insurance Policy (DE-243) if payments are being made from a Long Term Care Partnership Insurance Policy.

 

Legal Authority

This requirement applies to the following programs:

Program

Legal Authorities

ALTCS

SSI-MAO

Medicare Savings Program

20 CFR 416.1102 and 1123

AAC R9-22-1909

Adult

Caretaker Relative

Pregnant Woman

Child

KidsCare

42 CFR 435.603

42 CFR 457.10, 300, 301 and 315