211.13 MEAD Premium Requirements SR 13-35 Dated 10/13 |
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No premium payment is required for individuals with net income less than 150% of the Federal Poverty Guidelines (FPG). Individuals with net income equal to or greater than 150% and less than or equal to 450% of the FPG are required to pay a premium.
SSI payments are counted when determining the MEAD premium amount.
Income Ranges by Percentage of FPG
Income Range of FPG |
Premium Amount |
< 150% |
None |
> 150% and < 200% |
Not more than 7.5% of 150% of the FPG |
> 200% and < 250% |
Not more than 7.5% of 200% of the FPG |
> 250% and < 300% |
Not more than 7.5% of 250% of the FPG |
> 300% and < 350% |
Not more than 7.5% of 300% of the FPG |
> 350% and < 400% |
Not more than 7.5% of 350% of the FPG |
> 400% and < 450% |
Not more than 7.5% of 400% of the FPG |
Exception: Premiums for recipients with annual adjusted gross income over $75,000 are equal to 7.5% of the recipient's net income.
The amount of any health insurance premium payments, including Medicare premiums, paid by a participant for the participant or the participant's spouse or dependent children, are deducted from the participant's MEAD premium.
Premium Payment Schedules
Premium payments are processed through the Office of Medicaid Business & Policy (OMBP).
. The first premium payment is due on the first day of the month following the month in which eligibility is determined, with no premium due the month of application. Premiums for retroactive periods are due at the same time that the first premium payment is due.
EXAMPLE 1 - No Retroactive Coverage Requested
The applicant applies for MEAD in February and is determined eligible in March. There is no premium due for February. The premiums for March and April are due on April 1st .
EXAMPLE 2 - Retroactive Coverage Requested
The applicant applies for MEAD on June 1st and requests retroactive coverage for March, April and May. Eligibility is determined in August. There is no premium due for June. The premium for the 3 retroactive periods and the payment for July, August, and September are due September 1st.
. Subsequent payments are due on the first day of the month and applied to the current month.
. No payment is due for the last partial month of coverage for the 6-month period of unemployment.
Non-payment of premiums can result in termination of MEAD coverage.
References: He-C 5003, He-W 841.03, RSA 167:3-i, RSA 167:3-c,XII, RSA 167:6,IX, 42 CFR 435.914, 42 USC 1396a(a)(10)(A)(ii)(XV)