Home > SNAP > Expenses and Deductions > Health Insurance/Medical Expenses > Medical Expenses > Health Insurance Costs

Health Insurance Costs

This is an optional verification.

Allowable health insurance expenses include premiums for health, drug, and hospitalization insurance policies, including those of Medicare and MassHealth.

The following expenses are not allowed:

• The premiums for accident policies, such as those payable in lump sum settlements for death or dismemberment.

• The premiums for income maintenance policies such as those that continue mortgage and loan payments while the beneficiary is disabled.

Verification of Health Insurance Expenses

If the household’s total monthly medical expenses are less than or equal to $190 per month, then the health insurance expenses can be verified via telephonic, DTA Connect, or written self-declaration.  However, it is important to note that anytime a client reports paying Medicare Part A or B, BENDEX must be use to verify the cost the client pays.

If the household’s total monthly medical expenses exceed $190, then the health insurance expenses must be verified with documentary evidence such as:

• BENDEX validation of Medicare Part A or B payments made by the client;

• for Medicare Part D or other prescription drug coverage, a letter or statement from the Social Security Administration or an insurance letter stating how much the client pays for this plan;

• a copy of a health insurance receipt or bill;

• co-payment receipts or bills;

• a bill showing costs the client incurred towards their deductible, including an Explanation of Benefits from the health insurance company; or

• any verification showing type of insurance, amount of premium and the name of the individual covered

Action: DTA Connect – Family Health Insurance

During case maintenance, if a client uses DTA Connect to report private health insurance (or MassHealth) costs and indicates that the insurance plan is a family plan, BEACON will create the Action, DTA Connect – Family Health Insurance, for a FAW to review. BEACON will also pre-fill the Health Insurance page with the Insurer, Type, Amount, Frequency, and Premium Payer (i.e., Self) provided by the client via DTA Connect.  

If you receive the DTA Connect – Family Health Insurance action, you must follow these steps:

1. Attempt to cold call the client two times.

2. If one of the calls is successful, ask the client about the other family members on their health insurance plan. You must determine whether they are part of the SNAP case and, if so, whether they qualify for the medical deduction.

If the family plan includes individuals who are not part of the SNAP case and/or do not qualify for the medical deduction based on age and/or federal disability, you must:

1. divide the monthly premium (provided by the client via DTA Connect) by the total number of family members on the plan;

2. multiply the result of Step A by the number of individuals in the SNAP case who qualify for the medical deduction; and

3. enter the result of step B in the Amount field in the Health Insurance page in BEACON.

3. If the calculated premium makes the household’s total medical expenses less than or equal to $190 per month, you must mark the health insurance costs as verified by self-declaration, recalculate the benefits, and write a detailed narrative.

4. If the calculated premium makes the household’s total medical expenses greater than $190 per month, you must advise the client that verification will be required and send optional VC-1s for proof of the health insurance information and medical costs.

5. If both cold calls are unsuccessful, send an optional VC-1 for the health insurance type. To ensure that the client knows specifically what you are requesting on the VC-1, select Additional Verification for Element and type the following for Document(s) of evidence:

“You reported family health insurance costs on DTA Connect. We need more information about the family plan you are on. Please call us or send us a signed letter listing the other family members on the health insurance plan.”

6. If the client subsequently follows up with the verification, the FAW who receives the Action to review the documents must add them to the BEACON record and recalculate the benefits.

7. If the client does not follow up with verification, the record cannot be updated.

  Last Update:  March 8, 2024