The QDWI Program: How Disabled Workers Can Keep Medicare When They Start Working

If your earnings from a business or work are over the SGA amount but you are still disabled, you can continue to get Medicare.

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If you became eligible for Medicare because you were receiving Social Security disability insurance (SSDI), you can continue to receive it while you attempt to go back to work, through your extended period of eligibility and even later, if you continue to be disabled.

Premium-HI and QDWI

After your trial work period and extended period of eligibility end, you can remain eligible for Medicare through the Premium-HI (Hospital Insurance) program even if you go back to work and make too much money to get SSDI.

Eligibility

To be eligible for the Premium-HI program, you need to have lost your SSDI benefits only because your earnings went over the SGA limit, and you need to remain disabled.

Cost of Premium-HI Medicare

Medicare Hospital Insurance (HI), which is also known as Part A, is free for most people over 65 and those under 65 with disabilities. However, when you lose your SSDI benefits, you will no longer be eligible for premium-free HI coverage. If this happens, your Medicare coverage converts to “Premium-HI for the Working Disabled” and you will have to start paying for your benefits. But if you meet certain requirements, the state you live in must pay your premium for Medicare Part A (Premium-HI) through the Qualified Disabled Working Individual (QDWI) program.

If you can't get QDWI assistance, you will have to pay a monthly premium for Part A coverage. For 2013, the monthly rate for Premium-HI is capped at $441 a month. But with a qualifying work history (30 credits or more), you can get a premium reduction from Social Security, which will reduce your premium to $243.

What Is QDWI?

The Qualified Disabled Working Individual (QDWI) program is a state-administered program that pays Medicare Part A (hospital insurance) premiums for disabled people who have gone back to work. There are certain basic requirements you must meet to be eligible. You must:

  • be under the age of 65
  • be disabled
  • be ineligible for free Medicare Part A because your disability benefits were ceased due to working above the SGA limit
  • be ineligible for state medical assistance (Medicaid), and
  • meet the income and asset tests in your state (see below).

QDWI pays your premiums for Part A, but it does not pay the Part A deductible or copayments or anything toward Part B. If your income is very low (under 135% FPL) despite working, you could qualify for a Medicare Savings Program that pays some of these expenses.

Income and Asset Limits by State

Here are the financial limits you must meet to be eligible for QDWI (the income limits represent 200% of the federal poverty level).

 

Individual

Couple

Income limit for all states except Alaska and Hawaii

$3,915

$5,255

Alaska income limit

$4,869

$6,545

Hawaii income limit

$4,495

$6,035

Asset limits for all states

$4,000

$6,000

Counting Resources and Income

The states generally follow the same countable income rules as for SSI. However, some states are more lenient when counting income. This means that even if you think you don’t meet these financial requirements, you should still contact your state’s Medicaid administration office to see if you can qualify. Here are the basic rules.

Resources

The following are counted as resources when determining your eligibility for QDWI:

  • any money in your checking or savings account, and
  • the value of stocks and bonds.

The following are not counted as resources:

  • your primary residence
  • one automobile
  • the value of your burial plot
  • money set aside for burial expenses
  • furniture, and
  • household and personal items (like appliances, clothes, and jewelry).

Income

Here are the income sources that are considered when determining your eligibility:

  • earned income: wages, net earnings from self–employment, royalties, and payments from employment in a sheltered workshop

  • unearned income: income that you have from not working, such as Social Security benefits, pensions, disability payments made by your state, unemployment benefits, interest income, and money given to you from from friends and relatives
  • in–kind income: the fair market value of food and shelter that is given to you for free, and
  • deemed income: a portion of the income from your spouse or parents (if you live with them) or, if you are a resident alien, from your sponsor.

A portion of your earned and unearned income is excluded. To learn more see, our article on how income is calculated.

When Can I Become Eligible for Premium-HI and QDWI?

When your eligibility begins depends on when you enroll in the Premium-HI program.

Initial Enrollment Period. Your Initial Enrollment Period (IEP) begins when you first lose free coverage, due to your earnings being too high for SSDI. It lasts for eight months from the time you get your notice from Social Security that the free coverage has ended. Here is the chart that shows when coverage can begin if you enroll during the IEP.

When Your Enrollment Is Filed

When Coverage Begins

If you enroll the month before you lose eligibility for free Part A Medicare…

…then your coverage begins the first month you meet the above eligibility requirements.

If you enroll during the first month of 
premium-HI eligibility…

…then your coverage begins the month after you enroll.

If you enroll during the second month of Premium-HI eligibility…

…then your coverage begins the second month after the month you enroll.

If you enroll during the remainder of your IEP…

…then your coverage begins the third month after the month of enrollment.

GEP. The General Enrollment Period (GEP) runs from January to March of each year. If you enroll during the GEP, your coverage will begin on July 1 following the GEP in which you enrolled.

Special Enrollment Period (SEP). If you get insurance from your employer, there is an Special Enrollment Period (SEP). The SEP lets you enroll at any time as long as you, your spouse, or if you are disabled, a family member are working and you are covered by insurance through the employer or a union based on that employment.

When Does My Premium-HI and QDWI Coverage End?

You will no longer be covered by Premium-HI Medicare if you cease to be disabled or if you neglect to pay your Medicare premiums. If you are on QDWI, the financial assistance will end if you exceed the income or resource limits discussed above or if you go back on SSDI.

How Do I Apply for QDWI?

To apply for QDWI, you contact your state’s Medicaid office.

That said, you should get a notice in the mail from Social Security if the agency thinks you are eligible for the QDWI program. Remember, though, that QDWI is a state program. This means that your state, and not the SSA, will decide if you qualify. If you do not get a letter from Social Security, you should contact your state’s Medicaid office to see if you are eligible for QDWI.

Depending on your income, you may also be eligible for Medicare Part D's "Extra Help" program, which helps you pay preimums, deductibles, and copayments. 

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