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1223 (07/2026) Chapter 8: Examples • Chapter 8: Examples Example 4: Burt applies for Medicare Savings Program benefits on 9/20/18 and requests retroactive benefits. During the interview, Burt reports receiving $1,100 SSB and has been receiving $600 each quarter (Jan, April, July, Oct) since 2003 from a third-party trust with no restrictions. Burt provides all necessary information on 9/24/18. The countable income is calculated as follows: • June – August: $1,100 SSB + $180 trust income ($600 ÷ 3 - $20 monthly exclusion) = $1,280 • September and ongoing: $1,100 SSB + $180 trust income ($600 ÷ 3 - $20 monthly exclusion) = $1,280 Example 5: Burt applies for Medicare Savings Program benefits on 9/20/18 and requests retroactive benefits. During the interview, Burt reports receiving $1,100 SSB and will start receiving $600 each quarter (Jan, April, July, Oct) from a third-party trust with no restrictions starting in July 2018. Burt provides all necessary information on 9/24/18. Countable income is calculated as follows: • June: $1,100 SSB • July – August: $1,100 SSB + $180 trust income ($600 ÷ 3 - $20 monthly exclusion) = $1,280 • September and ongoing: $1,100 SSB + $180 trust income ($600 ÷ 3 - $20 monthly exclusion) = $1,280 OSIPM Countable periodic income when calculating service liability Example 1: Maude applies for OSIPM and services in August 2018. During the interview Maude reports receiving $1,800 SSB and an annual payment of $1,200 in royalties from a cookbook she published 10 years ago. Maude receives these payments each January. The countable income is calculated as follows: • For eligibility purposes:
August and ongoing: $1,800 SSB + $90 trust income ($1,200 ÷ 12 - $10 monthly exclusion) = $1,890 • Countable income used in liability calculation:
August - December: $1,800 SSB
January and ongoing: $1,800 SSB + $100 ($1,200 ÷ 12) = $1,900 (SSA COLA not included)