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income. Will’s gross annual income is less than 160% of the FPL for a FTG of one.

Will is determined to be SeniorCare eligible at Level 1 beginning November 1. His 12-month benefit period ends the following October. Will does not pay a deductible or spenddown. He purchases covered prescription drugs at the copayment amounts.

Grace returns home in January. She applies for SeniorCare in February and is determined eligible beginning March 1. Grace’s benefit level is determined based on a FTG of two. Their joint income is between 200% and 240% of the FPL for a FTG of two. Her benefit period ends October 31st, when Will’s benefit period ends.

Since there are eight months in her benefit period, Grace’s deductible amount is prorated. The deductible amount of $850 is multiplied by eight and then divided by 12.

$850 x 8=$6,800/12=$567

Grace’s deductible amount is $567. After she has met her deductible, she purchases covered prescription drugs at the copayment amounts for the remainder of the benefit period. Will’s eligibility and benefit period are not affected. 33.9.3.2 FTG Changes At Level 3 Spouse 2’s spenddown is prorated only if: 1. The income for Spouse 2, based on a FTG of two, is determined to be above 240% of the FPL, and 2. Spouse 2 becomes eligible after Spouse 1’s benefit period has begun, and 3. Spouse 2 was not included in the FTG when the participation level for Spouse 1 was determined. To prorate Spouse 2’s spenddown, the amount of income exceeding 240% FPL is multiplied by the number of months of Spouse 2’s benefit period and divided by 12. The result is equal to the prorated spenddown amount of Spouse 2. Only covered prescription drug costs of Spouse 2 count toward the prorated spenddown. After the spenddown has been met, the deductible for Spouse 2 is prorated (33.9.3.1 FTG CHANGES AT LEVEL 2A AND 2B). Members will get a discount off the retail price for most covered prescription drugs during the deductible period. After the deductible is met, they purchase covered prescription drugs at the copayment amounts for the remainder of the benefit period. Example 7 Tim is married, but his wife Marsha was institutionalized at the time he applied for SeniorCare. Marsha was expected to be out of the home for five months.

Tim applies for SeniorCare in May. Tim’s benefit level is based on a FTG of one. Tim’s gross annual income is less than 160% of the FPL for a FTG of one.

Tim is determined to be SeniorCare eligible beginning June 1. His 12-month benefit period ends the following May. Tim does not pay a deductible or spenddown. He purchases covered prescription drugs at the copayment amounts.

Tim’s wife Marsha returns home in November. She applies for SeniorCare in November and is