Revision 19-2; Effective June 1, 2019

 

An individual may have to pay a monthly premium as a condition of eligibility. The premium amounts are based on a sliding scale, dependent upon the individual income. The MBI monthly premium amount is determined based on the person's unearned and earned income.

 

M-7100 Post Eligibility — Premium Budgets

Revision 19-2; Effective June 1, 2019

 

There are three steps to find the premium amount.

Reminder: While unearned income is excluded in the income eligibility budget, it is used in the calculation of the premium amount.

Step 1

Unearned Income
The unearned income premium amount is based on unearned income after allowable exemptions and exclusions.

Reminder: Support and maintenance income does not apply to the MBI program.

Find the unearned income premium amount by subtracting the SSI federal benefit rate amount for one person from the person's countable unearned income.

Step 2

Earned Income
Find the earned income premium amount by adding:

  • gross earned income minus mandatory payroll deductions; and
  • any countable earned self-employment income

This calculation results in the net earnings. If the net earnings are equal to or less than 150 percent of the FPL, the monthly premium is $0. If the net earnings exceed 150 percent of the FPL, the MBI person must pay a monthly premium based on the earned income. Compare the net earnings amount to the FPL ranges to find the earned income premium amount.

The chart below uses the 2019 FPL ranges for the earned income premium amounts for example purposes only. Income limits are subject to change annually. See Appendix XXXI, Budget Reference Chart, for current limits.

2019 FPL Ranges Earned Income Premium Amounts
(Example Purposes Only)

Earnings at or below 150% FPL
(less than or equal to $1,562)

$0

Earnings above 150% FPL up to and including 185% FPL
(greater than $1,562 up to and including $1,926)

$20

Earnings above 185% FPL up to and including 200% FPL
(greater than $1,926 up to and including $2,082)

$25

Earnings above 200% FPL up to and including 250% FPL
(greater than 2,082 up to and including $2,603)

$30

Earnings above 250% FPL
(greater than $2,603)

$40

 

Step 3

Add the unearned income premium amount to the earned income premium amount to get the total monthly MBI premium amount.

Total Monthly Premium Limit
The total monthly premium may not exceed $500. If the unearned income premium amount plus the earned income premium amount is greater than or equal to $500, then the total monthly premium is $500.

Examples

Here are three examples using the above policy with the 2019 SSI federal benefit rate and the 2019 FPL ranges for the earned income premium. Income limits are subject to change annually. See Appendix XXXI for current limits.

Example 1

A person has $945 in unearned monthly income. After applying all deductions, the remaining earned income is $1,250.

Step 1: Subtract the SSI federal benefit rate amount for one person from the person's countable unearned income.

Description Amount

Unearned income

$945

SSI federal benefit rate

–$771

Unearned income premium amount

$174

Step 2: Compare the net earned income to the chart showing the FPL ranges to find the earned income premium amount.

Description Amount

Net monthly earnings

$1,250

Earned income premium amount

$0

Step 3: Add the unearned income premium amount to the earned income premium amount to get the total monthly MBI premium amount.

Description Amount

Unearned income premium amount

$174

Earned income premium amount

+$0

Total monthly premium

$174

 

Example 2

A person has $945 in unearned monthly income. After applying all deductions, the remaining earned income is $1,569.

Step 1: Subtract the SSI federal benefit rate amount for one person from the person's countable unearned income.

Description Amount

Unearned income

$945

SSI federal benefit rate

–$771

Unearned income premium amount

$174

Step 2:Compare the net earned income to the chart showing the FPL ranges to find the earned income premium amount.

Description Amount

Net monthly earnings

$1,569

Earned income premium amount

$20

Step 3: Add the unearned income premium amount to the earned income premium amount to get the total monthly MBI premium amount.

Description Amount

Unearned income premium amount

$174

Earned income premium amount

+$20

Total monthly premium

$194

 

Example 3

A person has $1,295 in unearned monthly income. After applying all deductions, the remaining earned income is $1,489.

Step 1: Subtract the SSI federal benefit rate amount for one person from the person's countable unearned income.

Description Amount

Unearned income

$1,295

SSI federal benefit rate

–$771

Unearned income premium amount

$524

Step 2: Compare the net earned income to the chart showing the FPL ranges to find the earned income premium amount.

Description Amount

Net monthly earnings

$1,489

Earned income premium amount

$20

Step 3: Add the unearned income premium amount to the earned income premium amount to get the total monthly MBI premium amount.

Description Amount

Unearned income premium amount

$524

Earned income premium amount

+$20

Total monthly premium

$500*

 

* The total of the unearned income premium amount plus the earned income premium amount is $544. However, the total monthly premium cannot exceed $500.

See Section H-8300, Restitution. Follow current restitution policy for finding underpayments of premium amounts.

See Section H-3500, When to Reconcile. Reconciliation policy for finding overpayments applies only when a report of change was timely but action was untimely. Reconciliation policy for finding overpayments does not apply when the individual reports a change untimely.