Medicaid Spend Down Calculator: Work Out Your Monthly Spend Down (2026-2027)

Reviewed November 11, 2026. To calculate a Medicaid spend down, take your gross monthly income, subtract the income disregards your state allows, and subtract your state’s medically needy income level (MNIL). What is left is your monthly spend down. If your state uses a six-month budget period, multiply by six, and once your medical bills reach that amount, Medicaid covers you for the rest of the period.

This page is a do-it-yourself worksheet. If you are new to the idea, start with our guide to how Medicaid spend down works, then come back here to run your own numbers.

• Formula: countable income minus your state’s medically needy income level = monthly spend down.
• Budget period: federal rules let states use periods of up to six months. Illinois uses one month; New Jersey, Pennsylvania and Maryland use six; New York offers one or six.
• 2026 levels for one person range widely: from $350 a month in Maryland to $1,836 in New York.
• What counts: Medicare and other health insurance premiums, deductibles, copays, and paid or unpaid medical bills not covered by insurance.
• Your notice wins: this is an estimate. Your caseworker’s notice shows your official amount.

The 5-step Medicaid spend down calculator

Grab your Social Security statement, pension stubs and your latest Medicare premium notice. Fill in the right-hand column as you go.

When the Step 5 total equals or exceeds the Step 4 amount, you have met your spend down for that period.

Step 1: Gross monthly income

Use the amount before deductions. If Social Security takes your Part B premium out of your check, add it back. The 2026 standard Part B premium is $202.90 a month, so a $1,797.10 deposit usually means a $2,000 benefit.

Step 2: Subtract income disregards

Programs for people who are aged, blind or disabled usually follow SSI income rules. Federal SSI rules exclude “the first $20 of any unearned income in a month” (20 CFR 416.1124(c)(12)). New York applies a $20 disregard, and Illinois uses a $25 disregard for AABD Medical. Other deductions may apply, especially for earned income, so ask your caseworker which ones fit you.

Step 3: Find your state’s medically needy income level

Each state sets its own level, and the differences are large. Use the table in the next section, or check your state Medicaid agency’s current chart.

Step 4: Calculate the spend down for your budget period

Federal rules require states to use “budget periods of not more than 6 months” (42 CFR 435.831). In a monthly state, your Step 4 number is what you need each month. In a six-month state, compare six months of income with the six-month MNIL. The result is the total you need over the whole period.

Step 5: Count your qualifying bills

Under 42 CFR 435.831, states deduct medical expenses you incur that no third party pays, including:

• Medicare Part B and Part D premiums, Medigap premiums and other health insurance premiums
• Deductibles, coinsurance and copays (the 2026 Part B deductible is $283)
• Doctor, hospital, dental, prescription and medical supply bills, paid or unpaid
• Medically necessary care your state recognizes but Medicaid does not cover

Only the part of a bill that Medicare or other insurance did not pay counts. If a Medicare Savings Program pays your Part B premium, you cannot count that premium.

2026 medically needy income limits by state (1 person)

These are the states whose current levels we could confirm on the state Medicaid agency’s own website. Figures are monthly unless noted.

Notice the gap. The same income can mean no spend down in New York and a large one in Maryland, New Jersey or Pennsylvania. For more on two of these states, see our pages on New York’s Excess Income Program and Illinois spenddown and Pay-In.

Worked examples (illustrative numbers)

The people below are made up. The state income levels are the real 2026 figures from the table above. Your caseworker may apply other deductions.

Example 1: New York, one month or six months

A single 68-year-old has a $2,150 Social Security benefit and pays the $202.90 Part B premium.

The Part B premium covers $202.90 of the $294 each month. This person needs only $91.10 more in medical bills, or a pay-in, to have Medicaid for that month.

Example 2: Illinois, month by month

A single 72-year-old living at home receives $1,500 a month from Social Security.

In any month this person shows $145 in allowable bills or receipts, Medicaid covers them from that day through the end of the month. If the state already pays their Part B premium through a Medicare Savings Program, that premium cannot be counted.

Example 3: Maryland, six-month period

A single 66-year-old has $1,200 a month in countable income after disregards.

That works out to $850 a month on average. Six months of Part B premiums ($1,217.40 in 2026) would count toward it, but this person would likely meet it only with large bills, such as a hospital stay or ongoing home care. The same $1,200 income in New York would fall below the $1,836 level, with no spend down at all.

When the calculator says your spend down is too high

A spend down only helps if your medical costs are high enough to meet it. If yours are not, check these first:

• Medicare Savings Programs. They have higher income limits than many medically needy levels and pay Medicare premiums with no spend down.
• Pay-in options. New York and Illinois let you pay your monthly amount to the state instead of collecting bills.
• Other eligibility groups. Our Medicaid eligibility tool can point you to programs you may qualify for.

States without a medically needy spend down

Not every state offers this calculation. According to Medicaid.gov, 36 states and the District of Columbia use spend down programs, either through a medically needy program or as 209(b) states. Elsewhere, people with income over the limit generally cannot spend down to qualify.

For nursing home care, some states without medically needy nursing home coverage use a special income limit instead. Federal law (42 U.S.C. 1396p(d)(4)(B)) lets people in those states place income in a trust “composed only of pension, Social Security, and other income,” often called a Miller trust or qualified income trust. The state must be repaid from what remains in the trust at death, up to what Medicaid paid. Nursing home budgeting also works differently, with most income going toward the cost of care. See our guides to Medicaid nursing home care and what nursing home residents pay.

What changes in 2027

• Social Security rises 3.6% in January 2027. A higher benefit raises your countable income. Unless your state’s level rises by at least as much, your spend down goes up. New York’s level is tied to 138% of the poverty level and usually updates January 1. Illinois ties its standard to 100% of the poverty level and usually posts new figures in the spring.
• Shorter retroactive coverage. Under the 2025 federal budget law (Public Law 119-21), starting January 1, 2027, retroactive coverage drops to two months before the application month for most groups (one month for expansion adults). Since spend downs often rely on older medical bills, apply as soon as large bills arrive.
• Home equity cap from 2028. For long-term care, the same law caps home equity at $1 million starting January 1, 2028, for homes not on agriculturally zoned land.

As of this review, none of the five states in the table had posted 2027 medically needy levels. The 2027 Part B premium had not been announced yet either.

Frequently asked questions

How do I calculate my Medicaid spend down?

Subtract any income disregards from your gross monthly income, then subtract your state’s medically needy income level. The result is your monthly spend down. Multiply it by the number of months in your state’s budget period to get the total.

Do Medicare premiums count toward a spend down?

Yes. Federal rules list Medicare and other health insurance premiums as deductible expenses. That includes Part B ($202.90 a month in 2026), Part D and Medigap premiums, unless someone else, such as a Medicare Savings Program, pays them.

Why is my spend down so high?

Usually because your state’s medically needy level is low. New Jersey ($367), Pennsylvania ($425) and Maryland ($350) set far lower 2026 levels for one person than New York ($1,836).

Does the spend down include my savings?

This calculator covers income. Assets have separate limits. In Illinois, for example, countable resources over the AABD Medical limit can be added to the spenddown amount. Ask your state how it treats excess assets.

Is an online spend down calculator exact?

No. Any calculator, including this one, gives an estimate. Your state applies its own deductions and household rules, and the amount on your eligibility notice is the one that counts.

This article is general information, not legal or financial advice. Medicare365 is not affiliated with or endorsed by CMS, any state Medicaid agency or any government agency.

Sources

• Medicaid.gov: Eligibility Policy (medically needy and spenddown)
• eCFR: 42 CFR 435.831, Income eligibility (medically needy)
• eCFR: 20 CFR 416.1124, Unearned income we do not count
• 42 U.S.C. 1396p(d)(4)(B): income trusts
• NY DOH: 2026 Income and Resource Standards for the Non-MAGI Population (GIS 26 MA/05)
• NY DOH: Medicaid Excess Income (Spenddown) Program
• Illinois Department on Aging: 2026 Medicaid Income Standards and Resource Limits
• IDHS Policy Manual PM I-03-01: Spenddown
• IDHS Policy Manual PM 15-04-03-a: AABD Income Disregard
• NJ DMAHS: Medicaid Communication 26-03, Income Eligibility Standards Effective January 1, 2026
• NJ DMAHS: Medically Needy fact sheet
• PA DHS: Medicaid for Older People and People with Disabilities
• Maryland Department of Health: Medicaid Manual appendix schedules, effective January 1, 2026
• CMS: 2026 Medicare Parts A and B premiums and deductibles
• SSA: SSI federal payment amounts and 2027 cost-of-living adjustment
• MACPAC: Summary of Medicaid provisions in P.L. 119-21