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After a spouse has met their deductible, they purchase covered prescription drugs at the co-payment amounts for the remainder of the benefit period. Example 4 Bob and Bernice’s joint income is $1,000 more than 240% of the FPL for a FTG of two. Bernice applies in December and is determined eligible for SeniorCare effective January 1. Bob does not apply because he is not yet 65 years old. Only Bernice’s covered prescription drug costs are applied toward the spenddown amount of $1,000. Bernice meets the spenddown requirement in April. She then begins purchasing covered prescription drugs that count toward her $850 deductible. In June, she has $100 left before she will meet her deductible. In May, Bob turns 65 and is determined eligible for SeniorCare. His eligibility begin date is June 1. His benefit period ends December 31, when Bernice’s ends. Since Bernice has already met the spenddown requirement, Bob will begin participating at Level 2b. His deductible will be prorated. Since there are seven months in his benefit period, $850 is multiplied by seven and the total is divided by 12. $850 x 7 = $5,950/12 = $496 Bob’s deductible is $496. After he meets the $496 deductible by purchasing covered prescription drugs, he purchases covered prescription drugs at copayment amounts for the remainder of his benefit period. Bernice’s eligibility and benefit period are not affected. Once she meets her deductible by purchasing another $100 in covered prescription drugs, she purchases covered prescription drugs at the copayment amounts for the remainder of her benefit period. 33.9.3 FTG Changes When a married SeniorCare participant applies after Spouse 1’s benefit period has begun, and Spouse 2 was not included in the FTG when the participation level for Spouse 1 was determined: 1. The gross annual income test for Spouse 2 is based on a FTG of two, and 2. Gross annual income for Spouse 2 is determined prospectively beginning with the month Spouse 2’s request is received, and 3. The eligibility and benefit period for Spouse 1 is not affected, unless they choose to reapply. Example 5 Jim is a SeniorCare participant from September through August. Because he was not married and living with a spouse when he applied, Jim’s benefit level was based on a FTG of one.

In January, Jim marries Helen. Helen applies for SeniorCare in February. Jim’s eligibility is not redetermined when Helen applies.

Helen’s participation level is determined based on a FTG of two. Income is estimated for Helen prospectively for the 12-month period beginning in February.

Helen’s benefit period begins in March, if she met all eligibility requirements in February. Helen’s benefit period ends in August, when Jim’s benefit period ends. 33.9.3.1 FTG Changes at Level 2a and 2b Spouse’s 2 deductible is prorated (33.9.3.1 FTG CHANGES AT LEVEL 2A AND 2B) when income for Spouse 2, based on a FTG of two, is determined to be above 160% but less than or equal to 240% of the FPL and Spouse 2 is added to the case after Spouse 1’s benefit period has begun. Example 6 Will is married, but he and his wife Grace were separated at the time he applied for SeniorCare.

Will applies for SeniorCare in October. Will’s benefit level is based on a FTG of one, using only his