Going back to work is hard enough without the loss of your Social Security benefits of health coverage through Medicare or Medicaid. Fortunately, the Social Security Administration (SSA) recognizes the catch-22 of putting your benefits and health care on the line to earn a living. Through the Ticket to Work (TTW) program, beneficiaries can continue to access quality health care as they transition into the workforce.
How Working Affects Your Medicare Benefits
Disability beneficiaries who have received SSDI benefits for 24 months are automatically enrolled in Medicare. Just as your disability cash payments will continue during your Trial Work Period (TWP), your Medicare benefits are protected while you test your ability to work through TTW.
Your Trial Work Period (TWP) is the first nine months that you are able to work during a rolling five-year period. As long as you are still considered disabled and continue to report your work activity to SSA, you keep your Medicare hospital insurance (Part A), supplemental medical insurance (Part B), and prescription drug coverage (Part D).
However, your Medicare benefits won’t continue indefinitely. The SSA will reevaluate your health care coverage eligibility based on the following:
Extended Period of Medicare Coverage (EPMC)
Also known as Continuation of Medicare Coverage, this work incentive allows most beneficiaries to continue using Medicare for 93 months (over seven years) after the TWP ends. Combined with the trial work period, beneficiaries can receive Medicare Part A coverage premium-free for a total of eight and half years. These benefits can continue even if the beneficiary’s SSDI payments have stopped due to Substantial Gainful Activity (SGA). Part A has no premiums, but you (or a third party) must pay for Part B.
Medicare for People With Disabilities Who Work
Once your premium-free coverage ends due to work activity, you might be able to pay for continued Medicare (Parts A and B) through another work incentive called Medicare for People with Disabilities Who Work. This option is available to beneficiaries under age 65 whose disabling impairments have not medically improved but who are no longer eligible for Medicare based on their earnings. Under this incentive, beneficiaries can buy coverage for Part A, or both Part A and Part B. Part D coverage is only available if a beneficiary is qualified to receive Part A and is enrolled in Part B.
Limited Income or Resources
If you qualify for continuation of Medicare but have limited means, you might be eligible for state Medicare Savings Programs to cover your health care costs. Depending on where you live, these programs could pay for your premiums, deductibles, coinsurance, and copayments. The assistance program for you is based on whether you are considered a Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), or Qualified Disabled and Working Individual (QDWI).
Will I Lose My Medicaid Benefits?
Medicaid is typically unavailable to disabled workers who have a certain level of earnings. However, qualified workers with severe disabilities can buy into Medicaid through the Ticket to Work and Work Incentives Improvement Act (TWWIIA), which establishes a Medicaid Buy-In option at the state level. Currently, 46 states participate in the Medicaid Buy-In program.
What If I Get Insurance Through My Job?
If you return to full-time employment and qualify for private, employer-sponsored health insurance, you won’t necessarily lose your Medicare benefits. If you remain eligible for both forms of coverage, Medicare can be added as a secondary payer to your employer-provided insurance.
You can also relieve the burden of health care costs by using Medigap coverage. Once you become eligible for employer-sponsored insurance, you can suspend your Medigap coverage and premiums. Under Ticket to Work, your Medigap policy can be immediately reinstated if you stop working and lose employer coverage.
Let Us Help You Understand and Protect Your Disability Benefits
The employment professionals at Disability Services of America, LLC have been helping people return to work without risking their cash benefits for over 10 years. If you want to work but don’t know where to start, fill out our online contact form or call (888) 689-6760 to complete a quick intake with one of our team members.