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.
The more expenses you are able to verify, 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 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 from your monthly income. You only need to give DTA proof of at least $35/month expenses.
- Actual medical expenses: If you incur more than $190 per month in medical expenses (that’s the $35 threshold plus the $155 standard deduction), you can claim the actual expenses (minus the $35 threshold). You will need to give DTA proof of your actual medical/health expenses to claim a higher deduction.
For 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 add up to $35 per month. Her SNAP benefits will be calculated using a $155 medical expense deduction. If Esther verified more than $190/month in out-of-pocket expenses ($155 plus $35 threshold), she should claim actual, verifiable expenses that exceed the standard.
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 the remaining months in your certification period. 106 C.M.R.§ 364.440(C). The most advantageous option depends on the circumstances.
For example: Suppose Esther also reports a one-time unpaid hospital bill of $960 and she just applied for SNAP benefits. Because she is elderly, she will be certified for 24 months. The amount of the bill averaged over 24 months would be $40. Esther also reports she now has only $15/month in other health care expenses each month because MassHealth now covers some of her over-the-counter medications. The $15/month alone would not get her a standard deduction, but if DTA averages out and includes the value of the unpaid hospital bill), her medical expenses exceed $35 and she gets the standard medical expense deduction.
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 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 child care if you need to pay for child care due to your age or illness
- 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) – and a written prescription is not required;
- eyeglasses, contact lenses, hearing aids, batteries, communication equipment for the hearing or visually impaired;
- health-related supplies recommended by a health provider including incontinent supplies, creams and ointments, commodes and walkers;
- private transportation costs at the current federal mileage rate (as of January 2018 it is 54.5 cents/mile) as well as out-of-pocket parking and tolls, or the monthly cost of taxis, vans, or public transportation needed to get to medical appointments;
Note: Mileage can be verbally self-declared by telling a DTA worker over the phone or in person.
- veterinary bills, dog food, and other needs for trained service animals; and
- any other un-reimbursed medical expenses prescribed or recommended by your health care providers. 106 C.M.R. § 364.400(C).
Proof of medical/health care expenses
You are only required to provide proof of the amount of your medical expenses. You are not required to show you paid the bill. 106 C.M.R. § 364.450(A). You are not required to get a prescription or statement from your MD or health provider. Appendix C contains an FAQ and Medical Expense screening form.
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 useful in showing the dates of visits to your doctor and laboratory visits, which you can use to claim your transportation costs.
- 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. You need not show DTA exactly which drugs you take—you can white-out the names of the medications from the pharmacy print-out.
- Copies of receipts for things you bought at a pharmacy or health supply store, like incontinence supplies, aspirins, vitamins, skin ointments, hearing aid batteries. Again, you should not need to get a prescription or statement from your MD about these items. DTA should accept that you bought these items because you and your doctor agreed you needed them.
- A written 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 help you figure out the mileage using MapQuest. If you have a T-pass that you use for medical trips, show DTA the T-pass and receipt when you bought it.
- Medical expenses are one of the most under-claimed income deductions. DTA workers are supposed to ask about your medical expenses and help you get verifications. Be sure to tell DTA about all health and medical-related expenses of any household member who is elder or disabled.
- Sometimes claiming medical expenses does not make a difference in the SNAP math. This is true when the household is already receiving the maximum grant or if the household has low shelter costs and higher income. MLRI has a chart to show when claiming medical expenses matters the most.
- If your monthly medical expenses are the same at recertification, you do not need to re-verify these expenses. You can check off “No Change” on your Interim Report or Recertification form.
- DTA should make “a reasonable prediction” of the amount you “expect to be billed” for medical expenses during the certification period. You do not need to provide 12 months of bills. You do not have to prove you paid your bills, only that you 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 you are an SSI recipient getting Bay State CAP benefits, you can switch to regular SNAP if your benefits would be higher due to medical expenses or higher shelter costs. See What is Bay State CAP for SSI recipients?
DTA Policy Guidance:
- DTA’s SNAP Medical Expense Brochure (revised Aug. 2015).
- DTA SNAP Medical Deductions Job Aid instructing workers how to handle medical expense deduction, when to request verification and how to average expenses.
- Standard medical deduction increased to $155. Ops Memo 2014-16 (Feb 2014)
- Over-the-counter and service animals, dietary supplements: Reminder on scope of allowable medical expenses including dental bills, drug plan premiums and delivery fees, and costs of service animals. Guidance confirms SNAP household does NOT need a prescription to claim over-the-counter drugs. Dietary supplements like Ensure can be claimed as medical expenses, but food you need for a special diet is not allowable expense. Transitions Feb 2015, Hotline Q &A. Clarification to this guidance: Food you need for a special diet is not an allowable expense. For example, you can buy Ensure with SNAP, but you cannot claim it as a medical expense.
- Transportation Costs: IRS mileage rate for private vehicles 54.5 cents/mile for 2017. Ops Bulletin 2016-3 (Jan 29, 2016). Self-declaration of transportation expenses acceptable, worker can use MapQuest to determine the door-to-door mileage. Transitions Hotline Q&A (Aug. 2008). Sample transportation cost calculations included in Transitions Training Corner (February 2015).
- Medical expenses must be verified initially, but can be self-declared at recertification if there are no changes or the amount would not exceed the standard medical deduction; must be verified if the expense is questionable. Transitions Training Corner (February 2015).
- Averaging One Time Medical Bills: Household has option to average large one-time (non-recurring) bills over 12 months or 24 month cert period for higher deduction, or deduct bill for one month; workers should explain advantages and disadvantages for clients to make informed choice. DTA Transitions Hotline Q &A (August 2012)
- Re-verifying Medical Expenses: Medical expenses that have not changed do not need to be re-verified at recertification; recert form lists household member claiming medical expenses, type and amount previously claimed. DTA Transitions Mailbox (August 2015), F.O. Memo 2010-3 (Jan. 22, 2010).
- Verifying Over the Counter: Workers instructed to not burden elder/disabled households with excessive verifications; receipts of over-the-counter purchases for drugs and health supplies are sufficient without requiring statement from health care provider that they are prescribed. Ops Bulletin 2015-2 (July 30, 2015), DTA Transitions Mailbox (August 2015), DTA Transitions FYI (Jan. 2010)
- Expenses incurred still count: Medical bills need only be “incurred”—not necessarily paid—to claim for medical deduction (as long as not reimbursable by third party); Transitions Mailbox (August 2015)
- Nutrition supplements, special diets, dental care, drug plans, service animals: Dental and monthly drug plan premiums qualify. Maintenance costs of trained service animals allowed, but not therapeutic pets (e.g., cats); nutrition supplements prescribed by M.D. cannot be claimed, nor can other special diets. Transitions Hotline (February 2015). F.O. Memo 2009-10 (Feb. 20, 2009).