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 big 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 offer employer-sponsored health care benefits, but that might 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 happens to that coverage when you go to work. Here are descriptions of the most 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, the amount you pay is deducted from your monthly SSDI benefits amount. However, you may not have to pay a Part B premium if you qualify for 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 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 at least 8.5 years after you go back to work. (The 8.5 years include your nine-month Trial Work Period.) After your Trial Work Period, you get at least seven years and nine months of continued Medicare coverage, 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) ($20,783 per year for an individual; $43,056 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 SSI-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 Medicaid based on your disability and you start to save up some money? There are a few ways you can keep your Medicaid while working and earning more than these limits:

1. You can get Medicaid with a spenddown. Medicaid with a spenddown lets people with disabilities with higher income keep getting Medicaid coverage. It works like an insurance deductible: You have to pay for some of your medical expenses each month before Medicaid starts paying for them. Learn more about Medicaid with a spenddown in DB101's How Health Benefits Work article.
2. You can 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.
3. You can get Medicaid through the Freedom to Work program. This program helps people with disabilities who work get Medicaid coverage, even as their income and resources go up. Most people have to pay a premium for this coverage. Learn more about Freedom to Work in DB101's How Health Benefits Work article.

How much money you can make and if you have to pay a monthly premium or spend your own money for care 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 that limit the services they 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 you get a job that offers you private coverage, be sure you understand how they work together. Your Medicaid coverage may help pay for some of the costs of your private insurance, like your premium, copayments, or deductibles.

To learn more, read the DB101 articles about Employer-Sponsored Health Coverage and Individual Health Coverage.