North Dakota Medicaid Income Calculation for Medicare Savings Programs

Gross Income, Not the Direct Deposit

The number-one mistake on Medicare Savings Program applications in North Dakota: reporting the amount that hits the bank account instead of the gross Social Security benefit.

ND Health and Human Services evaluates gross monthly Social Security income — the full benefit before Part B premiums, federal tax withholding, garnishments, or any other deductions are subtracted. The difference between gross and net can be $200 or more per month, and it determines which MSP tier your parent qualifies for or whether they qualify at all.

Where to find the gross amount:

• The current benefit verification letter or the my Social Security account at ssa.gov
• The monthly Social Security benefit statement
• The annual SSA-1099 lists benefits paid in Box 3 and net benefits (Box 3 minus any benefits repaid) in Box 5; use a current monthly statement for the current gross benefit

If your parent's gross benefit is $1,365 per month, the bank deposit might be $1,162.10 after the $202.90 Part B premium is withheld. Reporting $1,162.10 would overstate eligibility; reporting $1,365 gives the state the correct starting figure.

The $20 Unearned Income Disregard

After identifying gross unearned income, North Dakota subtracts a $20 general income disregard per assistance unit per month. This applies to Social Security, private pensions, civil service annuities, and VA pension or disability payments.

Using the example above: $1,365 gross minus the $20 disregard = $1,345 countable income. This is above the $1,330 QMB countable limit but within the SLMB range, so this person may qualify for SLMB. Without knowing about the disregard, they might assume $1,365 puts them over every MSP limit and never apply.

The disregard is applied once to total unearned income, not once per income source. A person receiving $1,200 in Social Security and $150 in a private pension has $1,350 in gross unearned income, minus $20 = $1,330 countable.

Earned Income Gets a Larger Exclusion

If your parent still works — part-time, seasonal, or agricultural — the calculation has additional steps:

1. Apply any remaining portion of the $20 general disregard to earned income (if unearned income is less than $20, the leftover carries over)
2. Subtract a $65 earned income exclusion
3. Subtract 50% of the remaining gross monthly earned income

A parent earning $400/month gross from part-time work, with $1,100 in Social Security: the $20 disregard applies to the Social Security ($1,080 countable unearned). For earned income: $400 minus $65 = $335, then half of $335 = $167.50 countable earned. Total countable income: $1,080 + $167.50 = $1,247.50 — well within QMB range.

What Counts as Income

Spousal Income and Couple Calculations

When both spouses live in the same household, their combined countable income and resources are measured against the couple thresholds ($1,804/month QMB countable income, $14,910 resources). With the full $20 general disregard, the QMB gross unearned-income limit is $1,824/month. If one spouse has Medicare and the other doesn't, both incomes still count — but only the Medicare-enrolled spouse receives MSP benefits.

If spouses are legally separated or live in separate permanent residences, only the applicant's individual income and resources are evaluated against the single-person limits.

An adult child's income is never deemed to a parent for MSP purposes, even when they live in the same household. A joint bank account shared with an adult child is presumed to belong entirely to the parent unless the child provides deposit records proving their contributions.

Running the Calculation Yourself

Before filing, work through the numbers:

1. List every source of gross monthly unearned income
2. Add them up
3. Subtract $20
4. If there's earned income, apply the $65 exclusion and the 50% reduction
5. Add countable unearned + countable earned
6. Compare countable income to the 2026 thresholds: QMB ≤ $1,330 (single), SLMB ≤ $1,596, QI ≤ $1,796. If the full $20 disregard applies to unearned income, the corresponding gross limits are $1,350, $1,616, and $1,816.

The North Dakota Medicare Savings Programs & Extra Help Guide includes a step-by-step income worksheet that walks through this calculation for your parent's specific situation, including the disregards, the earned-income formulas, and the spousal rules — so you know which tier to apply for before the paperwork goes in.

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