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Review the application to determine if the individual has applied for retroactive coverage. If not, contact the individual to determine if they have any unpaid or paid medical expenses that they incurred during that time period.
Explain to the individual that they have the option to use the expenses they incurred and paid during the 3-month period or any expenses they have incurred but which remain unpaid towards meeting spenddown in the retroactive base period, or that they may apply the expenses towards their spenddown liability in the current base period.
Explain the advantages or disadvantages of both options. If the individual chooses to use expenses that were incurred and paid within the 3-month retroactive period towards the current base period, we cannot then use the expenses towards establishing coverage in the retroactive period at a later date.
ACES defaults to a 6-month certification period, however, that may not be the best option for the individual. If possible, talk to the individual to determine their circumstances. Upcoming hospitalizations or other major expenses may make a difference in selecting a base period. If the spenddown amount is high, a 3-month base period may be to the individual's benefit. If the spenddown amount is low and the individual can easily meet it, a 6-month base period would provide medical coverage for a longer period of time.
Excess income
An individual has $30.00 per month in excess income. Spenddown in this example would be $90.00 for a 3-month base period and $180.00 for a 6 month base period.
If the individual has $250.00 in qualifying medical expenses, a 6-month base period would be beneficial to the individual since they would have a longer period of eligibility.
If the same individual has no qualifying medical expenses at the time of application and anticipates no large medical needs, a 3-month base period may be in the individual's best interests. It would enhance the individual's opportunity to meet spenddown and obtain coverage.