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Model Medicare Part B premiums net of MSP coverage #7972

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e750e4b
Model Medicare Part B premiums net of MSP coverage
MaxGhenis Apr 10, 2026
a3c0724
Add Part B MSP changelog fragment
MaxGhenis Apr 10, 2026
ae6057e
Fix Medicare Part B baseline regressions
MaxGhenis Apr 10, 2026
9b14095
Format Medicare Part B follow-up files
MaxGhenis Apr 10, 2026
dbeb37f
Fix Medicare Part B compatibility regressions
MaxGhenis Apr 10, 2026
96e9900
Fix Medicare Part B CI regressions
MaxGhenis Apr 10, 2026
b90e3f1
Exclude health premiums from AGI wage deductions
MaxGhenis Apr 27, 2026
d7e8fed
Cover Part B premium legacy input branches
MaxGhenis Apr 27, 2026
acb445e
Cover multiple legacy Part B premium inputs
MaxGhenis Apr 27, 2026
746c887
Simplify legacy Part B premium input collection
MaxGhenis Apr 27, 2026
9a33b52
Merge remote-tracking branch 'upstream/main' into HEAD
MaxGhenis Apr 29, 2026
32960b1
Add historical MSP asset eligibility parameters
MaxGhenis Apr 30, 2026
188d7b1
Backfill historical MSP asset limits
MaxGhenis Apr 30, 2026
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1 change: 1 addition & 0 deletions changelog.d/codex-medicare-partb-msp-clean.fixed.md
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@@ -0,0 +1 @@
Net Medicare Part B premiums in baseline SPM expenses against cycle-free Medicare Savings Program coverage, preserve reported premiums as an audit input, and stop treating reported health insurance premiums as pre-tax wage deductions in federal AGI.
54 changes: 53 additions & 1 deletion policyengine_us/parameters/gov/hhs/medicare/savings_programs/eligibility/asset/applies.yaml
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Expand Up @@ -10,106 +10,158 @@ metadata:
href: https://www.medicare.gov/basics/costs/help/medicare-savings-programs
- title: Medicare Interactive - Medicare Savings Program Income and Asset Limits
href: https://www.medicareinteractive.org/understanding-medicare/cost-saving-programs/medicare-savings-programs-qmb-slmb-qi/medicare-savings-program-income-and-asset-limits
# States that have eliminated the asset test are set to false
# Federal MSP rules apply the asset test by default; states that have
# eliminated it in current law are set to false from 2024.
AL:
0000-01-01: true
2024-01-01: false
AK:
0000-01-01: true
2024-01-01: true
AZ:
0000-01-01: true
2024-01-01: false
AR:
0000-01-01: true
2024-01-01: true
CA:
0000-01-01: true
2024-01-01: false
CO:
0000-01-01: true
2024-01-01: true
CT:
0000-01-01: true
2024-01-01: false
DE:
0000-01-01: true
2024-01-01: false
DC:
0000-01-01: true
2024-01-01: false
FL:
0000-01-01: true
2024-01-01: true
GA:
0000-01-01: true
2024-01-01: true
HI:
0000-01-01: true
2024-01-01: true
ID:
0000-01-01: true
2024-01-01: true
IL:
0000-01-01: true
2024-01-01: true
IN:
0000-01-01: true
2024-01-01: true
IA:
0000-01-01: true
2024-01-01: true
KS:
0000-01-01: true
2024-01-01: true
KY:
0000-01-01: true
2024-01-01: true
LA:
0000-01-01: true
2024-01-01: false
ME:
0000-01-01: true
2024-01-01: true
MD:
0000-01-01: true
2024-01-01: true
MA:
0000-01-01: true
2024-01-01: true
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@daphnehanse11 daphnehanse11 Apr 30, 2026

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MA and ME should not apply the MSP asset test here. Maine's MSP statute says DHHS may not apply an asset test when determining MSP eligibility, and Massachusetts eliminated MSP resource tests for these programs in 2024. With the current true entries, I reproduced a 2025 low-income Medicare enrollee in both MA and ME with $20k in bank assets returning msp_asset_eligible = false, msp_part_b_premium_coverage = 0, and medicare_part_b_premium = 2,220, which overstates SPM MOOP by the standard Part B premium. Please set ME and MA to false from the applicable effective dates and add regression coverage.

Sources:

MI:
0000-01-01: true
2024-01-01: true
MN:
0000-01-01: true
2024-01-01: true
MS:
0000-01-01: true
2024-01-01: false
MO:
0000-01-01: true
2024-01-01: true
MT:
0000-01-01: true
2024-01-01: true
NE:
0000-01-01: true
2024-01-01: true
NV:
0000-01-01: true
2024-01-01: true
NH:
0000-01-01: true
2024-01-01: true
NJ:
0000-01-01: true
2024-01-01: true
NM:
0000-01-01: true
2024-01-01: false
NY:
0000-01-01: true
2024-01-01: false
NC:
0000-01-01: true
2024-01-01: true
ND:
0000-01-01: true
2024-01-01: true
OH:
0000-01-01: true
2024-01-01: true
OK:
0000-01-01: true
2024-01-01: true
OR:
0000-01-01: true
2024-01-01: false
PA:
0000-01-01: true
2024-01-01: true
RI:
0000-01-01: true
2024-01-01: true
SC:
0000-01-01: true
2024-01-01: true
SD:
0000-01-01: true
2024-01-01: true
TN:
0000-01-01: true
2024-01-01: true
TX:
0000-01-01: true
2024-01-01: true
UT:
0000-01-01: true
2024-01-01: true
VT:
0000-01-01: true
2024-01-01: false
VA:
0000-01-01: true
2024-01-01: true
WA:
0000-01-01: true
2024-01-01: true
WV:
0000-01-01: true
2024-01-01: true
WI:
0000-01-01: true
2024-01-01: true
WY:
0000-01-01: true
2024-01-01: true
17 changes: 17 additions & 0 deletions policyengine_us/parameters/gov/hhs/medicare/savings_programs/eligibility/asset/couple.yaml
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@@ -1,5 +1,18 @@
description: The Department of Health and Human Services limits resources to this amount for couples under the Medicare Savings Programs.
values:
0000-01-01: 9_910
2011-01-01: 10_020
2012-01-01: 10_410
2013-01-01: 10_620
2014-01-01: 10_750
2015-01-01: 10_930
2017-01-01: 11_090
2018-01-01: 11_340
2019-01-01: 11_600
2020-01-01: 11_800
2021-01-01: 11_960
2022-01-01: 12_600
2023-01-01: 13_630
2024-01-01: 14_130
2025-01-01: 14_470
2026-01-01: 14_910
Expand All @@ -13,3 +26,7 @@ metadata:
href: https://www.medicare.gov/basics/costs/help/medicare-savings-programs
- title: SSA POMS SI 01715.010 - Resource Eligibility
href: https://secure.ssa.gov/apps10/poms.nsf/lnx/0501715010
- title: "CMS SMDL #10-003: 2010 Medicare Savings Program resource standards"
href: https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/smd10003.pdf
- title: Missouri DSS Historical QMB Resource Limits
href: https://dss.mo.gov/fsd/iman/medasst/0865-010-15.html
17 changes: 17 additions & 0 deletions ...yengine_us/parameters/gov/hhs/medicare/savings_programs/eligibility/asset/individual.yaml
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Original file line number Diff line number Diff line change
@@ -1,5 +1,18 @@
description: The Department of Health and Human Services limits resources to this amount for individuals under the Medicare Savings Programs.
values:
0000-01-01: 6_600
2011-01-01: 6_680
2012-01-01: 6_940
2013-01-01: 7_080
2014-01-01: 7_160
2015-01-01: 7_280
2017-01-01: 7_390
2018-01-01: 7_560
2019-01-01: 7_730
2020-01-01: 7_860
2021-01-01: 7_970
2022-01-01: 8_400
2023-01-01: 9_090
2024-01-01: 9_430
2025-01-01: 9_660
2026-01-01: 9_950
Expand All @@ -13,3 +26,7 @@ metadata:
href: https://www.medicare.gov/basics/costs/help/medicare-savings-programs
- title: SSA POMS SI 01715.010 - Resource Eligibility
href: https://secure.ssa.gov/apps10/poms.nsf/lnx/0501715010
- title: "CMS SMDL #10-003: 2010 Medicare Savings Program resource standards"
href: https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/smd10003.pdf
- title: Missouri DSS Historical QMB Resource Limits
href: https://dss.mo.gov/fsd/iman/medasst/0865-010-15.html
4 changes: 2 additions & 2 deletions policyengine_us/parameters/gov/irs/gross_income/pre_tax_contributions.yaml
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Expand Up @@ -4,8 +4,8 @@ values:
# Assumes all are pre-tax.
- traditional_401k_contributions
- traditional_403b_contributions
# Assumes employer for now.
- health_insurance_premiums
# Only explicit pre-tax payroll health premiums reduce taxable wages.
- pre_tax_health_insurance_premiums
# HSA contributions can be either through pre-tax.
- health_savings_account_payroll_contributions
metadata:
Expand Down
2 changes: 1 addition & 1 deletion policyengine_us/tests/policy/baseline/gov/hhs/medicare/costs/medicare_cost.yaml
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Expand Up @@ -71,6 +71,6 @@
is_medicare_eligible: true
medicare_enrolled: true
medicare_quarters_of_coverage: 40
medicare_part_b_premium: 3_000
gross_medicare_part_b_premium: 3_000
output:
medicare_cost: 11_500 # $14,500 spending - $3,000 Part B premium
38 changes: 38 additions & 0 deletions ...engine_us/tests/policy/baseline/gov/hhs/medicare/eligibility/medicare_part_b_premium.yaml
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Expand Up @@ -8,6 +8,8 @@
tax_exempt_interest_income:
2023: 0
is_medicare_eligible: true
msp_income_eligible: false
msp_asset_eligible: false
output:
medicare_part_b_premium: 2_220 # $185 * 12 months

Expand All @@ -21,6 +23,8 @@
tax_exempt_interest_income:
2023: 0
is_medicare_eligible: true
msp_income_eligible: false
msp_asset_eligible: false
output:
medicare_part_b_premium: 4_440 # $370 * 12 months

Expand All @@ -34,6 +38,8 @@
tax_exempt_interest_income:
2023: 0
is_medicare_eligible: true
msp_income_eligible: false
msp_asset_eligible: false
output:
medicare_part_b_premium: 7_546.8 # $628.90 * 12 months

Expand All @@ -47,6 +53,8 @@
tax_exempt_interest_income:
2023: 0
is_medicare_eligible: true
msp_income_eligible: false
msp_asset_eligible: false
output:
medicare_part_b_premium: 3_108 # $259 * 12 months

Expand All @@ -60,6 +68,8 @@
tax_exempt_interest_income:
2023: 0
is_medicare_eligible: true
msp_income_eligible: false
msp_asset_eligible: false
output:
medicare_part_b_premium: 2_220 # $185 * 12 months

Expand All @@ -73,5 +83,33 @@
tax_exempt_interest_income:
2023: 0
is_medicare_eligible: true
msp_income_eligible: false
msp_asset_eligible: false
output:
medicare_part_b_premium: 7_546.8 # $628.90 * 12 months

- name: MSP coverage fully offsets standard Part B premium
period: 2025
input:
age: 65
is_medicare_eligible: true
medicare_enrolled: true
gross_medicare_part_b_premium: 2_220
base_part_b_premium: 2_220
msp_income_eligible: true
msp_asset_eligible: true
output:
medicare_part_b_premium: 0

- name: MSP coverage preserves IRMAA above the standard Part B premium
period: 2025
input:
age: 65
is_medicare_eligible: true
medicare_enrolled: true
gross_medicare_part_b_premium: 4_440
base_part_b_premium: 2_220
msp_income_eligible: true
msp_asset_eligible: true
output:
medicare_part_b_premium: 2_220
29 changes: 29 additions & 0 deletions .../tests/policy/baseline/gov/hhs/medicare/savings_programs/msp_part_b_premium_coverage.yaml
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@@ -0,0 +1,29 @@
- name: MSP part B coverage pays the standard premium for income- and asset-eligible enrollees
period: 2025
input:
medicare_enrolled: true
msp_income_eligible: true
msp_asset_eligible: true
base_part_b_premium: 2_220
output:
msp_part_b_premium_coverage: 2_220

- name: MSP part B coverage is zero for ineligible enrollees
period: 2025
input:
medicare_enrolled: true
msp_income_eligible: false
msp_asset_eligible: true
base_part_b_premium: 2_220
output:
msp_part_b_premium_coverage: 0

- name: MSP part B coverage is zero when not enrolled
period: 2025
input:
medicare_enrolled: false
msp_income_eligible: true
msp_asset_eligible: true
base_part_b_premium: 2_220
output:
msp_part_b_premium_coverage: 0
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