Myth 3: If I Work, I'll Lose Health Benefits

I have ongoing health care needs that I would never be able to pay for myself. People tell me I shouldn’t work because then I might not be able to see my doctors and get the care I need.Losing your health care benefits can be a huge concern, if you are thinking about going to work. However, several programs can help you keep your health care benefits when you go to work. Some jobs will offer employer-sponsored health care benefits. But for some people that will not be enough. Some people may also want to keep their Medicare or Medicaid benefits.

It is important to know what type of health care coverage you have, so you know what will happen to that coverage when you go to work. The following are common public health care coverage programs for people with disabilities:

Medicare

Medicare is the federal health insurance program for people over age 65 and people with disabilities who are on Social Security Disability Insurance (SSDI). Medicare coverage starts automatically after you get SSDI benefits for 24 months (two years).

If you’re on SSDI and have to pay a Medicare Part B premium, it will be deducted from your monthly SSDI benefits amount. You may not have to pay a Part B premium if you qualify for Medicaid health coverage or a Medicare Savings Program. Medicare Savings Programs help people who have low income and get Medicare pay for their premiums and may help pay for some other Medicare costs, such as deductibles and copayments. Learn more about Medicare Savings Programs in DB101's How Health Benefits Work article.

Medicare and Work

When you work and get SSDI cash benefits, you keep your Medicare — plain and simple. If your SSDI benefits stop because of work, you can keep your Medicare for many years. This means that even if your SSDI benefits stop, your Medicare continues for many more years. This is called “Extended Medicare.”

Extended Medicare

You can keep your Medicare coverage for seven years and nine months after your Trial Work Period, as long as your disabling condition meets Social Security’s rules.

Medicaid

Keeping Medicaid is a big concern for people with disabilities who want to work. You may qualify for Medicaid if you are in one of these situations:

• Your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($2,249 per month for an individual; $4,623 for a family of four). The income limits are higher if you are 18 or younger or are pregnant. There are no limits to how much money or other resources you have. Learn more about income-based Medicaid.
• You have a disability or are elderly, have low resources, and low income (the income rules are different if you qualify for Medicaid due to your disability). Learn more about APA-related Medicaid.

If you work and your income stays below the regular income limit for Medicaid, you should be able to keep your Medicaid coverage. But what if your income goes up? Or what if you get APA-related Medicaid based on your disability and you start to save up some money? Here are a couple of ways you can keep your Medicaid while working and earning more than these limits:

• You may be able to get Medicaid through the Supplemental Security Income (SSI) 1619(b) rule. This rule helps people who used to get SSI benefits keep getting Medicaid coverage, even after their SSI benefits end because of their work income. Learn more about 1619(b) rule in DB101's SSI article.
• You may be able to get Medicaid through the Working Disabled Medicaid Buy-In program. This program helps people with disabilities who work get Medicaid coverage, even as their income and resources go up. You may have to pay a premium for this coverage. Learn more about the Working Disabled Medicaid Buy-In.

How much money you can make and if you have to pay a monthly premium depends on your situation.

Learn more about the different ways of qualifying for Medicaid in DB101's How Health Benefits Work article.

Public and Private Coverage

You can have private health coverage and public health coverage at the same time. Some private plans have rules limiting what services they will pay for. These plans may not cover some services that are important to some people with disabilities, like Personal Care Assistant services and private duty nursing. However, Medicare or Medicaid might pay for those services.

If you have Medicare or Medicaid coverage and get a job that offers you private coverage, be sure you understand how they will work together. Your Medicaid coverage may help pay for some costs of your private coverage, like your premium, copayments, or deductibles.

To learn more, read the DB101 pages about employer-sponsored coverage and buying individual health coverage.