Revision 21-2; Effective June 1, 2021
A person may have to pay a monthly premium as a condition of eligibility. The premium amounts are based on a sliding scale, dependent upon the person's income. The MBI monthly premium amount is determined based on the person's unearned and earned income.
Revision 25-1; Effective March 1, 2025
There are three steps to calculate the premium amount.
Note: While unearned income is excluded in the income eligibility budget, it is used in the calculation of the premium amount.
Step 1
The unearned income premium amount is based on unearned income after allowable exemptions and exclusions.
Note: Support and maintenance does not apply to the Medicaid Buy-In (MBI) program.
Find the unearned income premium amount by subtracting the Supplemental Security Income (SSI) federal benefit rate amount for one person from the person's countable unearned income.
Step 2
Find the earned income premium amount by adding:
This calculation results in the net earnings. If the net earnings are equal to or less than 150% of the federal poverty level (FPL), the monthly premium is $0. If the net earnings exceed 150% of the FPL, the person must pay a monthly premium based on the earned income amount. Compare the net earnings amount to the FPL ranges to find the earned income premium amount.
The 2024 FPL ranges for the earned income premium amounts are listed in the chart below. Income limits are subject to change annually.
| 2024 FPL Range | Earned Income Premium Amount |
|---|---|
| Earnings at or below 150% FPL (less than or equal to $1,883) | $0 |
| Earnings above 150% FPL up to and including 185% FPL (greater than $1,883 up to and including $2,322) | $20 |
| Earnings above 185% FPL up to and including 200% FPL (greater than $2,322 up to and including $2,510) | $25 |
| Earnings above 200% FPL up to and including 250% FPL (greater than $2,510 up to and including $3,138) | $30 |
| Earnings above 250% FPL (greater than $3,138) | $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
Below are three examples for calculating the MBI premium.
Example 1
A person has $998 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 | $998 |
| SSI federal benefit rate | – $967 |
| Unearned income premium amount | $31 |
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 | $31 |
| Earned income premium amount | + $0 |
| Total monthly premium | $31 |
Example 2
A person has $998 in monthly unearned income and $1,915 in monthly earned income after applying all deductions.
Step 1: Subtract the SSI federal benefit rate amount from the person's countable unearned income.
| Description | Amount |
|---|---|
| Unearned income | $998 |
| SSI federal benefit rate | – $967 |
| Unearned income premium amount | $31 |
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 | $1,915 |
| 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 | $31 |
| Earned income premium amount | +$20 |
| Total monthly premium | $51 |
Example 3
A person has $1,500 in monthly unearned income and $1,889 in monthly earned income after applying all deductions.
Step 1: Subtract the SSI federal benefit rate amount from the person's countable unearned income.
| Description | Amount |
|---|---|
| Unearned income | $1,524 |
| SSI federal benefit rate | – $967 |
| Unearned income premium amount | $557 |
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 | $1,889 |
| 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 | $557 |
| Earned income premium amount | +$20 |
| Total monthly premium | $577* |
* The total of the unearned income premium amount plus the earned income premium amount is $577. However, the total monthly premium cannot exceed $500.
Related Policy
Budget Reference Chart, Appendix XXXI