QQ Medical Insurance Payments

How medical insurance payments are treated depends on the following:

If medical payment is...	And the program is...	Then the treatment is...
Reimbursement received from medical insurance	All programs	Excluded unless it exceeds the actual expense incured. The excess amount is counted as unearned income.
A reimbursement for actual costs paid directly to the health care provider	All programs	Excluded as a vendor payment.
A disbursement from a Health Savings Account (HSA) or Medical Savings Account (MSA)	All programs	Not income. It is the conversion of a resource.
A flat rate insurance policy payment paid directly to the person If the payments have been assigned to someone else, see MA604.B for special handling.	ALTCS SSI-MAO MSP	Counted as unearned income.
	Adult Caretaker Relative Pregnant Woman Child KidsCare	Excluded up to the amount of actual expenses. The excess amount is counted as unearned income.
l Care Insurance payments that are available to the customer but have not been claimed	ALTCS SSI-MAO MSP	Constructively Received

Term	Definition
Flat Rate Policy	Cash from any medical insurance policy, which pays a flat rate benefit to the recipient without regard to the actual charges or expenses incurred (ex., per diem hospitalization or disability insurance, cancer or dismemberment policies or long-term care policies).
Long-Term Care Insurance	Helps cover the cost of assistance with activities of daily living, like bathing and dressing, when you need it, whether at home, in a nursing home, or another facility. NOTE Payments from a long-term care Insurance policy that would be received had they been claimed, are constructively received income. When the benefit is received it may be assigned to a Special Treatment Trust (STT).
Medical Insurance Payments	Payments from Medicare or private medical insurance policies.
Reimbursement for Medical Expenses	Reimbursement received from medical insurance (Medicare and private medical insurance policies).

Income is first obtained through the Federal and State Data Services Hubs. If needed, other proof includes:

Collateral contact with payment source;
Check stub;
Statement from payment source; or
Request for Verification of Long-Term Care Partnership Insurance Policy (DE-243) if payments are being made from a Long-Term Care Partnership Insurance Policy.

Program

Legal Authorities

ALTCS

SSI-MAO

Medicare Savings Program

20 CFR 416.1102 and 1123

AAC R9-22-1909

Adult

Caretaker Relative

Pregnant Woman

Child

KidsCare

42 CFR 435.603

42 CFR 457.10, 300, 301 and 315