Federal work incentive provisions protect Medicare coverage for disabled workers.
The Medicare program became effective for eligible individuals 65 years of age and over in 1965. Beginning in 1972, Medicare eligibility was extended to recipients who had received Social Security Disability Insurance for 24 months. Disabled Medicare recipients became reluctant to attempt working for fear work might result in loss of their valuable Medicare coverage. Legislation such as the Ticket to Work and Work Incentives Improvement Act gave disabled Medicare recipients coverage protection even if benefits ended.
Medical Cessation Appeal
Medicare terminates if the Social Security Administration decides evidence establishes the claimant is no longer disabled. Medicare coverage and benefit checks both end when cessation is based on medical recovery, not work. The recipient, however, has the right to appeal the decision if he feels he has not recovered. If he appeals promptly--within 10 days of receiving the cessation decision--he can request that benefits, including Medicare, continue until receiving an appeal decision through the reconsideration and hearing appeal levels. If he loses the appeal, Medicare payments for services are not an overpayment.
Medical Recovery Appeal Decision
If the recipient receives a favorable decision on his appeal of a medical cessation, Medicare eligibility resumes without interruption. If the appeal decision is unfavorable and he does not file another appeal, Medicare coverage continues until the end of the month following the month of issuance of the unfavorable decision.
Benefits Stop Due to Work
Social Security allows a disability beneficiary to work nine months, not necessarily consecutively, without losing benefits. This trial work attempt helps a beneficiary test his ability to work despite his disability. If he completes nine months of work at the minimum level (at least $720 monthly in 2010), he has completed his trial work period. If he then works one more month with substantial earnings (considered to be $1,000 in 2010), benefits end. However, Medicare continues during an additional 93 months. For example, if a recipient completes nine total months of work above the $720 level on September 30, 2010, and continues working, benefits stop but Medicare continues until the last day of June, 2018. Medicare could continue indefinitely after the end of the nine-month trial work period if the person does not work an additional month of substantial work.
Premium Medicare Insurance
If a Social Security beneficiary's Medicare ended because 93 months elapsed since he completed his nine-month trial work period, he can buy Medicare coverage. He can qualify for premium Medicare despite continued work and ineligibility for benefits if his medical condition still meets Social Security's definition of disability. The initial period to enroll is the eight months beginning with the month he received the notice that Medicare would end. If he fails to enroll, there are annual general enrollment periods, but premium penalties and coverage delays may apply. In 2010, the premium for both parts of Medicare Hospital and Medical Insurance is $571.50. If a recipient cannot afford the premiums, he can apply to his state's Medicaid agency, which must pay premiums for beneficiaries with limited income and resources.
Expedited Reinstatement Provisional Payments
Beginning in 2001, disability recipients whose benefit terminated due to work can reapply for expedited reinstatement of benefits if they are suddenly unable to continue working. The expedited application option only applies if the new application is within 60 months of the last month of benefit eligibility. If Medicare has terminated because the 93 months of extended Medicare coverage elapsed, applicants for reinstatement can also have premium-free Medicare reinstated. The Social Security Administration will make a new medical decision to verify that the applicant remains disabled. While Social Security is making the decision, recipients receive provisional benefits and Medicare for up to six months. Upon approval of the reinstatement, Medicare and benefits continue. If Social Security denies the reinstatement application, Medicare and provisional benefits end the month after the month of the decision's date.
Tags: Social Security, Medicare coverage, trial work, appeal decision, trial work period, work period
