If your household includes someone who is 60 or older, or disabled, everything you spend over $35 a month on that person’s health comes off your income before your SNAP benefit is worked out. Lower income, higher benefit. No other household can do this.
Most people claim their Medicare premium and stop, because a premium is the only medical cost that arrives looking official. The list below is much longer than that, and every item on it is in the federal regulations.
Medicare Part B. A Medicare Advantage plan — in Hawaiʻi usually HMSA Akamai Advantage, Kaiser Senior Advantage, UnitedHealthcare or Humana. A separate Part D drug plan. A Medigap or supplement policy. Dental and vision cover. Any private health or hospital insurance you pay for.
7 CFR 273.9(d)(3)(iv) and (v)
Medicare has four Parts. A is hospital cover. B is doctors and outpatient care. C is Medicare Advantage — a private plan that replaces A and B and usually includes your drugs. D is prescription drugs on their own.
Medigap supplement policies are lettered as well — A, B, C, D, F, G, K, L, M and N. These are plan letters, not Parts, and the overlap catches everybody out. Medigap Plan G is not “Part G”; there is no Part G. Medigap Plan D is not Part D. Plans E, H, I and J stopped being sold in 2010, and Plans C and F closed to anyone who reached Medicare age after 1 January 2020 — so an older neighbour may have a policy you cannot now buy.
You will have either an Advantage plan or Original Medicare with a supplement. Never both. And if you are on Advantage you still pay your Part B premium, which still counts.
For SNAP, none of this matters. Nobody is going to test you on the alphabet. If a premium leaves your money every month, write it down.
Anything you pay yourself — deductibles, co-pays, the part insurance didn’t cover. Outpatient treatment, nursing care, nursing home care. Psychotherapy and rehabilitation from a licensed practitioner count too.
7 CFR 273.9(d)(3)(i) and (ii)
Prescription drugs. Over-the-counter medicines a practitioner told you to take. Medical supplies, sick-room equipment, and the cost of maintaining equipment.
7 CFR 273.9(d)(3)(iii)
Including hearing aid batteries, repairs and upkeep. Eyeglasses and contact lenses prescribed by a physician or optometrist.
7 CFR 273.9(d)(3)(vi) and (viii)
The reasonable cost of transport and lodging to obtain medical treatment. Bus fares, taxis, mileage in your own car, parking. In Hawaiʻi that includes inter-island flights to see a specialist, and somewhere to stay when you get there. It adds up faster than anything else on this list.
7 CFR 273.9(d)(3)(ix)
An attendant, homemaker, home health aide, housekeeper or child care, where it is needed because of age, infirmity or illness.
And if you provide most of that person’s meals, you get a further deduction equal to the one-person SNAP allotment — in Hawaiʻi that is over $500 a month on its own. Hardly anyone claims it. Note that if the same attendant cost could be claimed as dependent care instead, you must choose one or the other, not both.
7 CFR 273.9(d)(3)(x)
This is the one people are most often told they cannot claim. The federal regulation says otherwise, in so many words:
Securing and maintaining a seeing eye or hearing dog including the cost of dog food and veterinarian bills
Dog food is not an interpretation or a concession. It is named in the rule, in the same phrase as the veterinarian bills. Insurance premiums for the animal, grooming, and licensing are part of “maintaining” too.
The regulation’s own words are “seeing eye or hearing dog”. USDA guidance goes wider: its 2019 Guide to the Treatment of Medical Expenses for Elderly or Disabled Household Members says at page 10 that the costs of securing and maintaining any animal specially trained to serve the needs of an elderly or disabled participant are allowable, and that “food and veterinarian bills associated with the service animal are also allowable costs.”
If your vet bills are being allowed but the food is not, that position cannot stand. Veterinary bills are deductible under this subsection and no other — so allowing them means the animal has already been accepted as qualifying. The food sits in the same sentence. Ask for the refusal in writing, with the authority it relies on.
7 CFR 273.9(d)(3)(vii); FNS, A Guide to the Treatment of Medical Expenses for Elderly or Disabled Household Members (Certification Policy Branch, 2019), p.10
Only what comes out of your own pocket. If insurance reimbursed it, or a relative or a charity paid it, you cannot claim it.
Policies that pay a lump sum for death or dismemberment, and income-maintenance or disability income policies, are not medical expenses.
7 CFR 273.9(d)(3)(iv)
The deduction covers only the medical costs of the elderly or disabled members. A younger adult’s prescription does not count, even in the same household.
Food a doctor has told you to eat is not a medical expense, however much more it costs.
If you face a large expense — dentures, a hearing aid, a hospital bill — you can usually choose to have it counted in one month, or averaged across the rest of your certification period. Averaging often produces a better result over the year. Ask which the Department is doing, and ask for the one you want.
An old medical debt you are repaying monthly is a monthly medical expense while you are repaying it, even if the treatment was years ago.
Receipts, statements, the “Explanation of Benefits” your insurer sends, a printout from the pharmacy, a letter from the vet. A mileage log written by hand is acceptable evidence of travel.
When a premium goes up, tell the Department in writing and keep proof that you sent it. They are required to act on a reported change that increases your benefit no later than the first allotment issued ten days after you report it, and if they miss that, they must restore what you lost — without you having to ask.
7 CFR 273.12(c)(1) and 273.17(b)