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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. |
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). |
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.
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 |