Qualified Disabled and Working Individuals Program

If you get Medicare on disability, at some point your employment may disqualify you from getting free Part A hospital insurance or a Qualified Disabled and Working Individuals Program. This is because Social Security deems “Substantial Gainful Activity” (SGA) a sign you no longer need complete Medicare coverage. If your work involves “significant” physical or mental energy, and you get paid (or could get paid) to do it, Social Security could reduce your insurance coverage.

As of 2016, the SGA income limit for free hospital insurance was earning $1,130 a month. But since Social Security counts things other than your paycheck into your SGA, you could be disqualified making less than that. For example, if you’re working without pay (like volunteering), Social Security adds what it estimates you could be paid into your SGA. Similarly, if you go from full-time work to part-time, your limited hours could still be determined “substantial” enough to lose free Part A hospital insurance.

Help after you lose Part A insurance

Once you’ve lost free Part A hospital insurance, there are still avenues that will help you pay for Part A monthly premiums. One of these avenues is the Qualified Disabled and Working Individuals (QDWI) Program. Like Medicaid, this is a state program designed to offer insurance benefits to low income individuals. However, to qualify you must not already be eligible for or receiving Medicaid or other state aid for medical insurance. Other requirements for the QDWI program are:

  • Getting Social Security payments for disability
  • Being signed up for Medicare Part A
  • Making less than $4,045 in monthly income ($5,425 if married)
  • Having less than $4,000 in resources ($6,000 if married)

It is important to note that your salary or income from working may not be the only thing that will be looked at to determine eligibility. Other types of income, like “deemed income” and “in-kind income” can also be considered. “Deemed income” refers to a portion of the income from your parents or sponsor family, if you’re living with them. “In-kind income” is the fair market value of food and shelter you have been given for free.

As far as resources go, remember that “resources” don’t include the value of your primary home, furniture, or one car. It doesn’t even include up to $1,500 set aside for burial expenses. Resources do, however, include money set aside in stocks, bonds, checking accounts, and savings accounts.

The Medicaid option

If you meet those requirements, you should call your state Medicaid Program to see about getting coverage under a Qualified Disabled and Working Individuals Program. Even if you have an income or resources exceeding the limits listed above, you may still benefit from applying for the QDWI program. In Alaska and Hawaii, for instance, the limits are slightly higher to account for the high cost of living in those states. And by 2017, the amounts listed above may increase nationally.

In the end, the QDWI program will only help you pay monthly premiums for Part A hospital insurance. It will not help pay for Part A copayments or yearly deductibles. It also won’t cover anything in Part B nor will it cover prescription drugs. If you need help with those expenses and your income is low, you should consider also signing up for a Medicare Savings Program. Among these are the Qualifying Individuals (QI) program, a Qualified Medicare Beneficiary (QMB) program, or a Specified Low Income Medicare Beneficiary (SLMB) program.

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