Article: Casey Schwarz Medicare Watch
Each year, the Department of Health and Human Services (HHS) updates the federal poverty guidelines, which are then used to determine eligibility for programs including Medicaid, the Low Income Subsidy for Part D (LIS), and Medicare Savings Programs.
The 2019 guidelines for the 48 contiguous states and DC* are:
- $12,490 for a household of 1
- $16,910 for a household of 2
- $25,750 for a household of 4
These amounts are established by federal law, which requires the Secretary of HHS to update them based on the Consumer Price Index for All Urban Consumers (CPI-U). The CPI-U is a measure of inflation, or the amount that the cost of certain goods and services has increased over time. The previous poverty guideline amounts are multiplied by the CPI-U number, then rounded and adjusted for family size.
Some government programs that rely on the guidelines to determine eligibility use the numbers directly, while other programs use a percentage multiplier. For example, the income limit for LIS, which is also called Extra Help, is 138% of the federal poverty guideline.
Various programs also have specific rules about how income is counted. For example, for Medicare Savings Program applications, earned income is calculated at about 50%, so if a person’s income is largely from wages, they might seem to be over the income limit for a program but actually qualify. If you or a friend or family member believe that you might be eligible for a federal program or assistance, or your income is close to the limits for those programs, Medicare Rights encourages you to learn more and apply.
*The guidelines for Alaska and Hawaii are different, and published in a separate chart. In Puerto Rico and other outlying jurisdictions, Federal programs may use the contiguous states and DC guidelines or the office that administers the program can use a different procedure.