76. What medical expenses can I claim if I am elderly or disabled?
Any member of your household who is elder (age 60+) or disabled is allowed to claim un-reimbursed medical and health-related expenses as an income deduction. This applies to disabled children as well as adults. And as of June 2022 under a special USDA approved waiver, medical expenses to qualify for the standard medical expenses can be self-declared.
The more expenses you claim, the lower your net countable income. The lower your countable income, the higher the SNAP benefits your household will receive – up to the maximum SNAP amount for your household.
There are two ways SNAP handles un-reimbursed medical expenses can be claimed. 106 C.M.R. § 364.400(C).
- Standard medical deduction of $155: If your out-of-pocket medical expenses are at least $35 a month, you will receive a standard medical deduction of $155 off of your monthly income. You can self-declare your health care expenses that exceed $35/month and get the standard $155deduction.
- Actual medical expenses: If you incur and verify more than $190 per month in medical expenses (the $35 threshold plus the $155 standard deduction), you can claim the actual expenses (minus the $35 threshold) to boost your SNAP benefits.
Example: Esther is 78 years old. She has MassHealth coverage, but the combination of small pharmacy co-pays plus her over-the-counter pain relief and skin treatments adds up to over $35 per month. Esther can self-declare these expenses. Her SNAP benefits will be calculated using a $155 medical expense deduction. If Esther has more than $190/month in out-of-pocket expenses, and if verifying them would boost her monthly SNAP, she should claim and verify her actual expenses.
If you have a large, one-time medical expense during your certification period, you have the option of claiming the expense as a one-time deduction or having it averaged over a number of months. 106 C.M.R.§ 364.440(C). DTA should look for the most advantageous option for averaging the one-time bill.
Example 1: Esther is 70 and applies for SNAP. She receives Social Security for a total of $1,300/month unearned income and is certified for SNAP for 12 months. She is approved for $191 in SNAP. A month later, she reports a one-time unpaid dental bill of $500. DTA should average her bill out over the next 11 months (the rest of her certification period). Averaging the $500 by 11 months ($45/mo), Esther gets the standard medical expense deduction. Her SNAP increases to $261.
Example 2: Esther’s one-time unpaid dental bill is actually $350. $350 over 11 months does not exceed $35 (is only $31). The DTA worker should average her bill out over 10 months in order to give her the $155 standard medical expense deduction, which maximizes her SNAP. (The DTA worker should also ask Esther if she has any other out of pocket medical expenses that she could self-declare to boost her SNAP.)
Scope of allowable health care expenses
- co-pays or premiums for Medicare, Medicare Part D, Medex or other health insurance, and your deductible for Medicare Part D;
- any medical services from doctors, clinics, hospitals, laboratories or other facilities that are not reimbursed by a third party;
- any custodial or attendant care services you need (even if the caregiver is a relative), as well as housekeeping services you pay for;
- costs for childcare even if you are not working, if you need to pay for childcare because of your age or disability;
- dental care, dentures, dental adhesives;
- health treatments by a licensed practitioner, including chiropractic, acupuncture, physical or other therapy
- prescription drugs, including postage costs and any transportation costs to pick them up;
- over-the-counter vitamins and over-the-counter drugs recommended by a licensed health care provider such as aspirin, laxatives, insulin, herbal and homeopathic remedies (no prescription is required);
- eyeglasses, contact lenses/contact saline, hearing aids, batteries, communication equipment for the hearing or visually impaired;
- health-related supplies recommended by a health provider including incontinence supplies, creams and ointments, commodes and walkers;
- cost of a gym membership such as YMCA or health club membership;
- private transportation costs at the current federal mileage rate (as of January of 2023 it is 65.5 cents/mile);
- out-of-pocket parking and tolls, or the monthly cost of taxis, vans, or public transportation needed to get to medical appointments;
- long distance phone calls related to obtaining medical services, or internet if needed for a medical device to function properly;
- veterinary bills, dog food, and other needs for all animals recommended by a medical provider (including trained service animals and therapy and emotional support animals); and
- any other un-reimbursed medical expenses prescribed or recommended by your health care providers. 106 C.M.R. § 364.400(C).
Self-declaration of health care expenses
If you are claiming less than $190/month in medical expenses, you can self-declare these expenses under a special waiver that USDA approved for DTA. You will get the standard medical expense of $155/month.
Verification of higher health care expenses
If you are claiming more than $190/month in medical expenses, you are required to provide proof for your expenses, but only the amount of your medical expenses. if you do not verify expenses above $190, you will still get the $155 standard deduction for any expenses you self-declare.
You are not required to have paid the bill, or show you paid the bill (just that the cost wasn't reimbursed). 106 C.M.R. § 364.450(A). DTA automatically gets proof of any Medicare Part B premiums taken out of your Social Security benefits.
You also do not need to give DTA multiple months of receipts or bills for recurring medical expenses, as long as you have at least one month worth of bills. You can tell DTA in writing or verbally how often you incur the expense.
Example: In addition to her Medicare Part B deductibles of $170.10 per month, Martha pays roughly $40/month for vitamins and buys hearing aid batteries for $15 every 3 months. She gives DTA one pharmacy receipt for her vitamins, and another for her hearing aid batteries. She writes in a note to DTA that she buys vitamins monthly and hearing aid batteries every 3 months. DTA should accept Martha’s self-declaration unless questionable.
If you need to verify your medical expenses to claim more than $190/month in out-of-pocket expenses, the following are examples of proofs you can submit for medical expenses, but you can also submit other items:
- Billing invoices, canceled checks or other proof of your health care bills or insurance premiums (that you paid or you owe).
- An Explanation of Benefits (EOB) health insurance statement showing how much you owe for co-pays or deductibles.
- A Medicare Claim Summary to show the dates of visits to your doctor and laboratory visits, which you can use to claim your transportation costs (You can also verbally self-declare mileage by calling DTA).
- A print-out from your pharmacy showing your co-pays and out-of-pocket payments for drugs. This is also useful to show all your visits to the pharmacy for claiming transportation. DTA does not need to know which medications you take. You can white-out the medication names and dosages from the pharmacy print-out.
- Copies of receipts for things you bought at a pharmacy or health supply store, such as pain relief, recommended vitamins, skin ointments, hearing aid batteries, incontinence supplies. You do not need a prescription from your MD to claim these items.
- A written or oral statement from you with the dates and mileage if you used your car to go to your doctor, physical therapy, pharmacy or other providers. DTA can take verbal confirmation of your health care travel over the phone. DTA will help figure out the mileage. If you have a T-pass that you use for medical trips, show DTA the T-pass and receipt when you bought it.
Sometimes claiming medical expenses does not make a difference in the SNAP math. unless you are already receiving the maximum SNAP grant, or your income is high but your shelter costs are very low. See MLRI's chart for when claiming medical expenses can make a difference, along with other FAQs and screening forms: masslegalservices.org/snap-medical
If your monthly medical expenses have not changed when you do your Interim Report or Recertification, you do not need to re-verify these expenses.
DTA should make “a reasonable prediction” of the amount you “expect to be billed” for medical expenses during the certification period. You do not have to prove you paid your bills, only that you are responsible for the bill. However, you cannot claim a bill that an insurance company or other third party is going to pay or reimburse you for. 106 C.M.R. §§ 364.410(B)(3), 364.420, 364.430.
If DTA says they cannot count a one-time unpaid medical bills for services that happened more than a year ago (and these expenses were not claimed for SNAP before), contact MLRI at firstname.lastname@example.org.
DTA Online Guide
See Appendix G for links to the DTA’s BEACON Online Guide for this section.