Medicare has been beneficial to me when I was employed. I was born with Spina Bifida with level of C3, a birth defect that reflects the nervous system due to the opening spine. I worked in the non-profit sector for a year. Because of my legitimate disability, I was able to participate in Extended Medicare. This work incentive was able to provide me with access to my doctors so that I could still receive care after I had entered the workforce. For example, my urologist whom I’ve been seeing at UCLA in Westwood, CA since the age of 10, I am still able to see. With the help of Extended Medicare, I was able to maintain good health while working.
Not only was Medicare excellent at maintaining access to my doctors while working, it also provided me access to my medical supplies. I was able to gain access to all my needs. During my time working, Medicare was able to provide me with my medical supplies that I needed to live and maintain a good healthy lifestyle. At the workplace, because Medicare was able to attain access to my supplies, I was able to do my protocol where I catheterize every 4 hours; basically five times a day which I continue to do today.
~ Brian, Sociology Major in Cerritos College
Transferring to Cal State University of Los Angeles for their Rehabilitation Services B.S. Program in Fall 2015.
The Basics
Medicare is the Federal health insurance plan. People who receive Social Security disability benefits for 24 months are eligible for Medicare. Medicare is our country’s health insurance program for people age 65 or older. If you are younger than age 65, you can qualify with certain disabilities or permanent kidney failure. The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. There are four parts: (A) Hospital Insurance which is free, (B) Medical Insurance which requires you to pay a premium, (C) Medicare Advantage, and (D) Medicare Prescription Drug.
Upon completion of your Trial Work Period, many people are concerned about maintaining access to their Medicare coverage while working. Even if your cash benefits stop because you are making above substantial gainful activity (SGA), your health benefits can continue for some time, here’s how it works:
The incentive is called Extended Medicare Coverage for the Working Disabled. Medicare coverage continues for – 93 months (7 years and 9 months). During this time your Medicare Part A benefits will continue for free as long as your disabling condition meets SSA’s rules. During these 93 months, you can continue to pay the Part B premium as well. After your 93 months of premium free Medicare Part A ends, you will get a notice that will tell you when you can file an application to purchase Medicare coverage at a reduced rate.
FAQs & Facts
Who is eligible to use it?
Individuals with disabilities who work are eligible to receive these extended services for 93 months after their Trial Work Period (TWP). You must already have Medicare and be working at substantial gainful activity level and remain disabled.
How does an individual get signed up to use it?
As long as your disabling condition still meets the Social Security Administration (SSA) rules, you can keep your Medicare coverage for at least 8 ½ years after you return to work. (The 8 ½ years includes your nine month trial work period.)
What type of reporting requirements are there when you use this work incentive?
Promptly report any changes in your work activity to your local Social Security office. This way you can be paid correctly, and Social Security can tell you how long your Medicare coverage will continue after you return to work.
Helpful Hints on signing up or tracking this work incentive
Social Security will provide this incentive based on the work activity you report so it is important to keep Social Security informed of any changes in your work status.
Other FAQs, from the Social Security website:
I have Medicare hospital Insurance (Part A) and medical insurance (Part B) coverage. Will I get to keep both parts under this law?
Yes, as long as your disabling condition still meets the SSA rules. Your Medicare hospital insurance (Part A) coverage is premium-free. Your Medicare medical insurance (Part B) coverage will also continue. You or a third party (if applicable) will continue to pay for Part B. If your Social Security Disability Insurance cash benefits stop due to your work, you or a third party (if applicable) will be billed every 3 months for your medical insurance premiums. If you are receiving cash benefits, your medical insurance premiums will be deducted monthly from your check.
I have Medicare (Part A) but I did not take Part B coverage when it was first offered to me. Can I get Part B now?
Yes, this law did not change the enrollment periods. If you did not sign up for Part B when you first could, you can only sign up for it during a general enrollment period (January 1st through March 31st of each year) or a special enrollment period.
The special enrollment period is a period of time, during which you may enroll if you did not enroll during your initial enrollment period because you were covered under a group health plan based on your own current employment or the current employment of any family member.
The special enrollment period may occur during any month you are covered under a group health plan based on current employment, or during the 8-month period that begins the first full month after employment or group health plan coverage ends, whichever comes first.
When I return to work and get medical coverage through my employer, will this change my Medicare? Do I need to notify anyone?
- Medicare is often the “secondary payer” when you have health care coverage through your work.
- Notify your Medicare contractor right away.
- Prompt reporting may prevent an error in payment for your health care services.
Under this law will I still be able to purchase Medicare after my premium – free Medicare (hospital insurance) ends?
Yes, this law did not change this. The same rules apply.
- As long as you still have a disabling condition, you can purchase Medicare (hospital insurance, Part A).
- If you purchase Part A, you may purchase medical insurance (Part B).
- You cannot purchase Part B in this situation, unless you purchase Part A.