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After the LIS (Low-Income Subsidy) has started, if the member receives bills from the Medicare part D plan, they chose with their health insurance company, the full amount should be entered on the medical expense screen, as this is what the member is responsible for.

Example 1: Logan is an applicant and is a Medicare member applying for full coverage Medicaid with income under 150% FPL. Logan chooses a Medicare Part D plan that costs $65.00 per month. Due to Logan choosing a plan that is over the benchmark amount, he would only get credit for the difference on the medical expense screen. Logan would get credit for $65.00- $49.58 (benchmark) = $15.42 as a monthly expense on the medical expense screen.

Example 2: Eric is over 150% FPL and is applying for Medicaid; he is a Medicare member and has Part D coverage. The Medicare Part D plan that Eric chose costs $75.00 per month. For retroactive and application months, enter the full amount of the Medicare Part D premium as a medical expense. If Medicaid passes for all months, before authorizing eligibility, the worker should return to the medical expense screen and update the most recent month reflect the deduction of the current benchmark amount. Eric’s application was approved in July. The Medical Expenses screen should budget the Part D premiums as: April: $75.00 May: $75.00 June: $75.00 July: $75.00 August: $25.42 ($75.00 – 49.58 benchmark)

3045.00.00 GENERAL EARNED INCOME DISREGARD (MED 1 MED 4)

In the eligibility determination, $20 per month of income is disregarded. The income disregard is applied once to the AG's combined total income.15

3046.00.00 SUBSTANTIAL GAINFUL ACTIVITY AMOUNT (MED 1)

Substantial Gainful Activity (SGA) is the limitation on gross earnings that is used to determine categorical eligibility. The amount is $ 1,690 effective January 1, 2026 (effective 1-1-25, $1,620; effective 1-1-24, $1,550; effective 1-1-23, $1,470; effective 1-1-22, $1,350, effective 1-1-21, $1,310; effective 1-1-20, $1,260; effective 1-1-19, $1,220; effective 1-1-18, $1,180; effective 1-1- 17, $1,170; effective 1-1-16, $1,130; 1-1-15, $1,090; 1-1-14, $1,070; $1,040 effective 1-1-13, $1,040; 1-1-12, $1,010; 1-1-10 through 12-31-11 was $1,000; effective 1-1-09, $980; effective 1- 1-08, $940).