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 huge 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 will offer employer-sponsored health care benefits. But for some people that will not be enough. Some people may also want to keep their Medicare or NC Medicaid benefits.

It is important to know what type of health care coverage you have, so you know what will happen to that coverage when you go to work. The following are 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, it will be deducted from your monthly SSDI benefits amount. You may not have to pay a Part B premium if you qualify for NC Medicaid health coverage or 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 Medicare article.

Medicare and Work

When you work and get SSDI cash 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 seven years and nine months after your Trial Work Period, as long as your disabling condition meets Social Security’s rules.

NC Medicaid

Keeping NC Medicaid is a big concern for people with disabilities who want to work. You may qualify for NC Medicaid if you are in one of these situations:

• Your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($1,800 per month for an individual; $3,697 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 NC Medicaid.
• You have a disability or are elderly, have low resources, and low income (the income rules are different if you qualify for NC Medicaid due to your disability). Learn more about disability-based NC Medicaid.

If you work and your income stays below the regular income limit for NC Medicaid, you should be able to keep your NC Medicaid coverage. But what if your income goes up? Or what if you get NC Medicaid based on your disability and you start to save up some money? There are a few ways you can keep your NC Medicaid while working and earning more than these limits:

1. You can get NC Medicaid through the Supplemental Security Income (SSI) 1619(b) rule. This rule helps people who used to get SSI benefits keep getting NC Medicaid coverage, even after their SSI benefits end because of their work income. Learn more about 1619(b) rule in DB101's SSI article.
2. You can get NC Medicaid through the Health Coverage for Workers with Disabilities (HCWD) program. This program helps people with disabilities who work get NC Medicaid coverage, even as their income and resources go up. You may have to pay a premium for this coverage. Learn more in DB101's HCWD article.
3. You can get NC Medicaid with a spend down. NC Medicaid with a spend down lets people with disabilities with higher income keep getting NC Medicaid coverage. It works like an insurance deductible: You have to pay for some of your covered medical expenses over a six-month period before NC Medicaid starts paying for them for the rest of the six months. Note: NC Medicaid with a spend down is much more expensive than HCWD. Learn more about NC Medicaid with a spend down in DB101's Disability-Based NC Medicaid 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 NC Medicaid in DB101's Programs section.

Public and Private Coverage

You can have private health coverage and public health coverage at the same time. Some private plans have rules limiting what services they will 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 NC Medicaid might pay for those services.

If you have Medicare or NC Medicaid coverage and get a job that offers you private coverage, be sure you understand how they will work together. Your NC Medicaid coverage may help pay for some costs of your private coverage, like your premium, copayments, or deductibles.

To learn more, read the DB101 articles about employer-sponsored coverage and buying individual health coverage.