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 medical expenses usually covered by Medicaid but that exceed limitations on amount, duration, or scope of services customarily covered (more than $500 of psychiatric services in a year or hospice care of more than 210 days); and  medical expenses usually covered by Medicaid deducted in chronological order.

Health Insurance Premiums 7.4.2

Health insurance premiums can be counted toward a group's spend-down deductible as the premium costs are incurred. They can only be projected over the entire budget period if the applicant/recipient is institutionalized. Premiums paid prior to the prospective budget period may not be applied to the prospective spend-down deductible (unlike outstanding medical bills prior to the budget period which can be applied.)

Medicare Part B Premiums 7.4.3

Medicare Part B premiums paid in a retroactive budget period are considered similarly to other health insurance premiums and are deducted from the spend-down deductible amount. The recipient who has been certified for a retroactive eligibility period will not receive a lump sum reimbursement for Part B premiums paid during the retroactive months.

Medicare Part B premiums to be paid during the prospective budget period are an exception to the deduction of health insurance premiums from the spend-down deductible. Medicare Part B premiums are paid by the Department after Medicaid eligibility is determined and certified, and SSA provides lump sum reimbursement for Medicaid recipients who paid Part B premiums out-of-pocket while awaiting the Medicaid program to begin paying the premiums. Therefore, deduct from the spend-down deductible only Medicare Part B premiums paid in months of the prospective budget period when the applicant/recipient is not eligible for MA.

Example Ms. Muriel is 69-years-old and appli $75 which results in a spend-down d Muriel has $250 in outstanding med pocket each month for transportation es for MA benefi eductible of $45 cal bills not cover o and from doct um. s on December 1 for the six-mont d by her Medica r appointments. 2. Her monthly excess income is prospective budget period. Ms. e. She also pays $40 out-of- Ms. Muriel also pays $20 per month for her Medicare Part B premi Prospective Budget Period Amount Total to Date Not allowable Before December Doctor bill $250 $250 Medicare premiums paid before December December Medicare B $20 $270 transportation $40 $310 January Medicare B $20 $330 transportation $40 $370