m,

DEPARTMENT OF
Insurance Affordability Programs (IAPs)
Income and Asset Guidelines
DHS-3461A-ENG 11-18

HUMAN SERVICES

Efective 7/1/18 – 6/30/19 Efective 1/1/19 – 12/31/19

MA Parents, Caretaker
Relative, Children 19–20
Years Old, Adults without MA Children Minnesota Family Advanced Premium
Children 2–18 Years Old MA Pregnant Women MA Infants under Age 2 Planning Program MinnesotaCare Tax Credit
Family 133% FPG 275% FPG 278% FPG 283% FPG 200% FPG 200% FPG 400% FPG
Size Monthly
I Annually Monthly
I Annually Monthly
I Annually Monthly
I Annually Monthly
I Annually Annually Annually

1 $1,345 $16,146 $2,782 $33,385 NA $2,863 $34,356 $2,024 $24,288 $24,280 $48,560

2 $1,824 $21,891 $3,772 $45,265 $3,813 $45,758 $3,881 $46,581 $2,744 $32,928 $32,920 $65,840

3 $2,303 $27,637 $4,762 $57,145 $4,814 $57,768 $4,900 $58,807 $3,464 $41,568 $41,560 $83,120

4 $2,781 $33,383 $5,752 $69,025 $5,814 $69,778 $5,919 $71,033 $4,184 $50,208 $50,200 $100,400

5 $3,260 $39,128 $6,742 $80,905 $6,815 $81,787 $6,938 $83,258 $4,904 $58,848 $58,840 $117,680

6 $3,739 $44,874 $7,732 $92,785 $7,816 $93,797 $7,957 $95,484 $5,624 $67,488 $67,480 $134,960

7 $4,218 $50,619 $8,722 $104,665 $8,817 $105,806 $8,975 $107,709 $6,344 $76,128 $76,120 $152,240

8 $4,697 $56,365 $9,712 $116,545 $9,818 $117,816 $9,994 $119,935 $7,064 $84,768 $84,760 $169,520

Add’l $478 $5,745 $990 $11,880 $1,000 $12,009 $1,018 $12,225 $720 $8,640 $8,640 $17,280

Asset
No Asset Test No Asset Test No Asset Test No Asset Test No Asset Test No Asset Test No Asset Test
Test

Note: “FPG” stands for federal poverty guideline.

Note: Income guidelines are approximations only. Use this chart for general reference only.

Next 
 Efective Efective
7/1/18 – 5/31/19 6/1/19 – 6/30/19 Efective 7/1/18 – 6/30/19
MA Elderly, Blind, MA Elderly, Blind, MA *MA Service Limited *MA *MA Qualifed Working
Disabled (with a Disabled (with a Elderly, Blind, Disabled *MA Qualifed Medicare Medicare Benefciaries Qualifying Individuals Disabled Individuals
spenddown) spenddown (no spenddown) Benefciaries (QMB) (SLMB) (QI) (QWD)
Family 80% FPG 81% FPG 100% FPG 100% FPG 120% FPG 135% FPG 200% FPG
Size Monthly Annually Monthly Annually Monthly Annually Monthly Annually Monthly Annually Monthly Annually Monthly Annually
I I I I I I I
1 $
810 $
9,720 $820 $9,840 $1,012 $12,144 $1,032 $12,384 $1,234 $14,808 $1,386 $16,632 $
2,044 $24,528

2 $
1,098 $
13,176 $1,112 $13,344 $1,372 $16,464 $1,392 $16,704 $1,666 $19,992 $1,872 $22,464 $
2,764 $33,168

3 $
1,386 16,632
$
$1,404 $16,848 $1,732 $20,784 $1,752 $21,024 $2,098 $25,176 $2,358 $28,296 $
3,484 $41,808

4 $
1,674 20,088
$
$1,696 $20,352 $2,092 $25,104 $2,112 $25,344 $2,530 $30,360 $2,844 $34,128 $
4,204 $50,448

5 $
1,962 $
23,544 $1,988 $23,856 $2,452 $29,424 $2,472 $29,664 $2,962 $35,544 $3,330 $39,960 $
4,924 $59,088

6 $
2,250 $
27,000 $2,280 $27,360 $2,812 $33,744 $2,832 $33,984 $3,394 $40,728 $3,816 $45,792 $
5,644 $67,728

7 $
2,538 $
30,456 $2,572 $30,864 $3,172 $38,064 $3,192 $38,304 $3,826 $45,912 $4,302 $51,624 $
6,364 $76,368

8 $
2,826 $
33,912 $2,864 $34,368 $3,532 $42,384 $3,552 $42,624 $4,258 $51,096 $4,788 $57,456 $
7,084 $85,008

Add’l $
288 $
3,456 $292 $3,504 $360 $4,320 $360 $4,320 $432 $5,184 $486 $5,832 720
$
$8,640

Asset • $3,000 for a single • $3,000 for a single • $3,000 for a single • $10,000 for a single • $10,000 for a single • $10,000 for a single • $4,000 for a single
Test person person person person person person person
• $6,000 for household • $6,000 for household • $6,000 for household • $18,000 for household • $18,000 for household • $18,000 for household • $6,000 for household
of two, plus $200 for of two, plus $200 for of two, plus $200 for of two of two of two of two
each dependent each dependent each dependent

ADA1 (2-18)

MA for Employed Person with Disabilities (MA‑EPD)

To qualify for MA-EPD, you must:
For accessible formats of this information or assistance with
• Be certifed disabled by the Social Security Administration (SSA) or the State Medical Review Team additional equal access to human services, write to
(SMRT)
• Have monthly earnings of more than $65 (there is no upper income limit)
DHS.info@state.mn.us, call 651-431-2670 or 800-657-3739,
• Be employed and have Social Security and Medicare (FICA) taxes withheld or paid from earned income or use your preferred relay service.
• Meet the MA-EPD asset limit of $20,000 per enrollee
• Pay a premium and an unearned income obligation, if required

* A $20 disregard is included in each amount listed.

Note: Income and asset guidelines are approximations only. Use this chart for general reference only.
 m,
DEPARTMENT OF
Insurance Affordability Programs (IAPs)
Income and Asset Guidelines
DHS-3461A-ENG 7-18

HUMAN SERVICES

Effective 7/1/18 – 6/30/19 Effective 1/1/18 – 12/31/18

MA Parents, Caretaker
Relative, Children 19–20 Years MA Children
Prog. Old, Adults without Children 2–18 Years Old MA Pregnant Women MA Infants under Age 2 MinnesotaCare Advanced Premium Tax Credit

Family 133% FPG 275% FPG 278% FPG 283% FPG 200% FPG 400% FPG
Size Monthly
I Annually Monthly
I Annually Monthly
I Annually Monthly
I Annually Annually Annually

1 $
1,345 $
16,146 $
2,782 $
33,385 NA $
2,863 $
34,356 $
24,120 48,240
$

2 $
1,824 $
21,891 $
3,772 $
45,265 $
3,813 $
45,758 $
3,881 $
46,581 $
32,480 64,960
$

3 $
2,303 $
27,637 $
4,762 $
57,145 $
4,814 $
57,768 $
4,900 $
58,807 $
40,840 81,680
$

4 $
2,781 $
33,383 $
5,752 $
69,025 $
5,814 $
69,778 $
5,919 $
71,033 $
49,200 98,400
$

5 $
3,260 $
39,128 $
6,742 $
80,905 $
6,815 $
81,787 $
6,938 $
83,258 $
57,560 $
115,120

6 $
3,739 $
44,874 $
7,732 $
92,785 $
7,816 $
93,797 $
7,957 $
95,484 $
65,920 $
131,840

7 $
4,218 $
50,619 $
8,722 104,665
$ $
8,817 105,806
$ $
8,975 107,709
$ $
74,280 $
148,560

8 $
4,697 $
56,365 $
9,712 116,545
$ $
9,818 117,816
$ $
9,994 119,935
$ $
82,640 $
165,280

Add’l 478
$
5,745
$
990
$ $
11,880 $
1000 $
12,009 $
1018 $
12,225 $
8,360 16,720
$

Asset
No Asset Test No Asset Test No Asset Test No Asset Test No Asset Test No Asset Test
Test

Note: “FPG” stands for federal poverty guidline.

Note: Income guidelines are approximations only. Use this chart for general reference only.

Next 
 Effective 7/1/18 – 6/30/19
MA Elderly, Blind, MA *MA Service Limited *MA Qualifed Working
Disabled (with a Elderly, Blind, Disabled *MA Qualifed Medicare Medicare Benefciaries *MA Disabled Individuals Minnesota Family
spenddown) (no spenddown) Benefciaries (QMB) (SLMB) Qualifying Individuals (QI) (QWD) Planning Program

Family 80% FPG 100% FPG 100% FPG 120% FPG 135% FPG 200% FPG 200% FPG
Size Monthly I Annually Monthly I Annually Monthly I Annually Monthly I Annually Monthly I Annually Monthly I Annually Monthly I Annually

1 $
810 9,720
$ $
1,012 12,144
$ $
1,032 12,384
$ $
1,234 14,808
$
1,386
$
16,632
$ $
2,044 24,528
$
2,024
$
24,288
$

2 $
1,098 13,176
$ $
1,372 16,464
$ $
1,392 16,704
$ $
1,666 19,992
$
1,872
$
22,464
$ $
2,764 33,168
$
2,744
$
32,928
$

3 $
1,386 16,632
$ $
1,732 20,784
$ $
1,752 21,024
$ $
2,098 25,176
$
2,358
$
28,296
$ $
3,484 41,808
$
3,464
$
41,568
$

4 $
1,674 20,088
$ $
2,092 25,104
$ $
2,112 25,344
$ $
2,530 30,360
$
2,844
$
34,128
$ $
4,204 50,448
$
4,184
$
50,208
$

5 $
1,962 23,544
$ $
2,452 29,424
$ $
2,472 29,664
$ $
2,962 35,544
$
3,330
$
39,960
$ $
4,924 59,088
$
4,904
$
58,848
$

6 $
2,250 27,000
$ $
2,812 33,744
$ $
2,832 33,984
$ $
3,394 40,728
$
3,816
$
45,792
$ $
5,644 67,728
$
5,624
$
67,488
$

7 $
2,538 30,456
$ $
3,172 38,064
$ $
3,192 38,304
$ $
3,826 45,912
$
4,302
$
51,624
$ $
6,364 76,368
$
6,344
$
76,128
$

8 $
2,826 33,912
$ $
3,532 42,384
$ $
3,552 42,624
$ $
4,258 51,096
$
4,788
$
57,456
$ $
7,084 85,008
$
7,064
$
84,768
$

Add’l $
288 3,456
$
360
$
4,320
$
360
$
4,320
$
432
$
5,184
$
486
$
5,832
$
720
$
8,640
$ $
720 8,640
$

Asset • $3,000 for a single • $3,000 for a single • $10,000 for a single • $10,000 for a single • $10,000 for a single • $4,000 for a single None
Test person person person person person person
• $6,000 for household of • $6,000 for household of • $18,000 for household • $18,000 for household • $18,000 for household • $6,000 for household
two, plus $200 for each two, plus $200 for each of two of two of two of two
dependent dependent

ADA1 (12-12)

MA for Employed Person with Disabilities (MA‑EPD)

To qualify for MA-EPD, you must:
For accessible formats of this publication or assistance with additional
• Be certifed disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT) equal access to human services, write to DHS.info@state.mn.us, call
• Have monthly earnings of more than $65 (there is no upper income limit) 651-431-2670 or 800-657-3739, or use your preferred relay service.
• Be employed and have Social Security and Medicare (FICA) taxes withheld or paid from earned income
• Meet the MA-EPD asset limit of $20,000 per enrollee
• Pay a premium and an unearned income obligation, if required

* A $20 disregard is included in each amount listed.

Note: Income and asset guidelines are approximations only. Use this chart for general reference only.