Keep Your Medicare In Force As You Go Back to Work (What To Do And When To Do It)

[We reprinted this article from The Voice of TII CANN (the newsletter of the Title II Community AIDS National Network); the author gave us updates to reflect the regulations as of February 16, 1999. Note that this information is for persons on Medicare (not Medicaid) as a result of long-term disability, who are returning to work. JSJ]


The following are suggestions to keep your Medicare, as you transition to the workplace.

1. You get twelve months (a nine month Trial Work Period, followed by a three month Grace Period) of Social Security Disability Insurance (SSDI) checks when your adjusted gross earnings total over $200 monthly. Medicare Part A is "free" and Medicare Part B's premium of $45.50 gets deducted out of your SSDI check.

2. Once the twelve months have passed, visit the Social Security office - or write them by certified mail - to inform the agency that the SSDI checks should be stopped, but that you want the Medicare to continue! If you don't, the checks will continue and you may be tempted to spend them. However, spending them is fraud under the Social Security statute. Ask for a written confirmation that they've continued your Medicare.

3. Whether or not SSA responds to your request for continued Medicare, you must now pay your Part B premium of $45.50 monthly (remember, the SSDI check from which it was deducted has now stopped - or if the checks haven't yet stopped, you're returning them, via certified mail). If you can afford to pay your premium, send a check for $45.50 payable to the U.S. Treasurer, with your Medicare card number, and an explanation that your SSDI has ended, to: Medicare Premium Collection Center, P.O. Box 371384M, Pittsburgh, PA 15250.

4. If you can't afford to pay the Medicare Part B premium, apply at the Welfare office (not SSA) for the QMB, SLIMB, and/or QI(I) programs. [Note: QMB means Qualified Medicare Beneficiary; SLIMB means Specified Low-Income Medicare Beneficiary; and QI(I) means Qualified Individual (I), where the 'I' is Roman numeral one.] If your gross monthly earnings are under $1,896 (or even higher, if you're paying out-of-pocket cash medical costs) welfare will pay the Part B premium for you; be aware that some welfare offices have not been properly trained in the eligibility rules for these programs. If you encounter difficulty applying to these programs, ask a supervisor to contact the state's head Medicaid eligibility policy staff in the state capital for guidance.

5. After 45 months back at work, "free" Part A Medicare coverage ends - but you can still keep it if you want. Don't rely on Social Security to tell you this. Visit or send a certified letter to the SSA office stating that you want to stay enrolled in Medicare Part A, even though you've been back at work for 45 months. Ask for a written confirmation that they've continued your enrollment. Whether you hear from them or not, start sending your Medicare Part A premium to the Medicare Premium Collection Center, P.O. Box 371384M, Pittsburgh, PA 15251, giving your Medicare number and informing them that you've used your "free" forty-five months-back-at-work Part A coverage and are paying it yourself now. Make the check payable to the U.S. Treasurer.

6. Medicare Part A premiums are either $170 monthly, if you worked with FICA deductions taken from your paycheck for over 7.5 years during your working life; or $309, if you worked with FICA deductions taken from your paycheck for less than 7.5 years. You'll have to calculate how many quarters you worked to find out which of the two Part A premium rates apply to you. (You can try calling 800-772-1213 for assistance, but this question is probably too complex for a quick and easy answer over the telephone.)

7. If you can't afford to pay the Medicare Part A premium of either $170 or $309, apply for the Qualified Disabled Working Individual (QDWI) program at the welfare office (again, not SSA). If your monthly earnings are under $2768 (or even somewhat higher if you're paying out-of-pocket medical costs yourself) the state will pay the Part A premium for you. Again, most welfare staff know little about this program--so you may need to ask a supervisor to contact the state Medicaid eligibility policy staff to properly process your case!

8. Medicare Part A and Part B premium amounts change each January 1. After about November 15 of each year, the staff at 800-772-1213 can tell you what the new premium amounts will be for the coming year.

9. The income levels for QMB, SLIMB, QI(I), and QDWI go up each year about April 1. Ask your local welfare office what the new income levels will be, or consult with a benefits advisor at the agency you rely on for casework help.

10. Keep your Medicare even if you're offered good health insurance in a new job! This is important because:

If you lose your job, you'll still have the Medicare.

Having both Medicare and the job insurance will reduce your deductibles and copayments. (Remember, you're still going to have high medical and drug bills.)

Medicare covers many services not adequately covered by private insurance, such as: unlimited home health and mental health therapy visits; hospice care; hospital care for mental health, alcoholism, or drug problems; and medical equipment/supplies purchases and rentals.