New Medicare Law for People with Disabilities

A new law extends premium-free Medicare Part A (Hospital Insurance) coverage for an additional 4 1/2 years beyond the current […]

A new law extends premium-free Medicare Part A (Hospital Insurance) coverage for an additional 4 1/2 years beyond the current limit. This new law is for people who receive Social Security disability benefits and who want to go to work.

When does this change for Medicare occur?

October 1, 2000.

How long is Medicare extended for?

Medicare (Part A) coverage is extended for 4 1/2 years.

General Rule: You will get the extended Medicare coverage for the additional 4 and 1/2 years if:

You still have a disabling condition, and You are starting to work for the first time after your disability benefits began; or You are in a trial work period (TWP); or You are in your 36 month extended period of eligibility EPE which began after June 1997; or Your Medicare coverage under the current law is not due to end until after September 30, 2000.

Under the new law, how long will I get to keep Medicare if I return to work?

As long as your disabling condition still meets our rules, you can keep your Medicare coverage for at least 8 1/2 years. (The 8 1/2 years includes your nine month trial work period.)

After my TWP, under this new law, how long will I have Medicare coverage?

You will get at least 7 years and 9 months of continued Medicare coverage, as long as your disabling condition still meets our rules.

I completed my TWP. I am now in my 36 month EPE. Will the new law apply to me?

If you are in an EPE that began after June 1997, the new law will apply to you. This means you will get the additional Medicare coverage of 4 1/2 years. If your EPE began before July 1997, we must consider the following factors listed below before we can decide if the new law applies to you:

* Are you still disabled?

* When did your trial work period end?

* Are you working at substantial gainful activity (SGA)?

* What was the first month you worked SGA after your TWP?

Note: Promptly report any changes in your work activity. This way you can be paid correctly, and we can tell you how long your Medicare coverage will continue after you return to work.

I have Medicare hospital Insurance (Part A) and medical insurance (Part B) coverage. Will I get to keep both parts under this new law?

Yes, as long as your disabling condition still meets our rules. Your Medicare hospital insurance (Part A) coverage is premium-free. Your Medicare medical insurance (Part B) coverage will also continue. You or a third party (if applicable) will continue to pay for Part B. If your Social Security Disability Insurance cash benefits stop due to your work, you or a third party (if applicable) will be billed every 3 months for your medical insurance premiums. If you are receiving cash benefits, your medical insurance premiums will be deducted monthly from your check.

I have Medicare (Part A) but I did not take Part B coverage when it was first offered to me. Can I get Part B when the new law changes?

Yes, the law did not change the enrollment periods. However, you do not get a new enrollment period. If you did not sign up for Part B when you first could, you can only sign up for it during a general enrollment period (January 1st through March 31st of each year) or a special enrollment period.

The special enrollment period is a period of time, which you may enroll:

1. If you did not enroll during your initial enrollment period because you are covered under a group health plan based on your own current employment or the current employment of any family member; or

2. If you enrolled (or were deemed to be enrolled) in your initial enrollment period (and any subsequent special enrollment periods), and have been covered under a group health plan based on your own current employment or the current employment of any family member.

The special enrollment period may occur during any month you are covered under a group health plan based on current employment, or during the 8-month period that begins the first full month after employment or group health plan coverage ends, whichever comes first.

When I return to work and get medical coverage through my employer, does this change my Medicare? Do I need to notify anyone?

Medicare is often the “secondary payer” when you have health care coverage through your work.

Notify your Medicare contractor right away. Prompt reporting may prevent an error in payment for your health care services.

Under the new law will I still be able to purchase Medicare after my premium -free Medicare (hospital insurance) ends?

Yes, the new law did not change this. The same rules apply.

As long as you still have a disabling condition, you can purchase Medicare (hospital insurance, Part A). If you purchase Part A, you may purchase medical insurance (Part B). You cannot purchase Part B in this situation, unless you purchase Part A.

Do I need to apply for this premium Medicare (hospital insurance, Part A)? If so, when?

Once your Medicare ends, you will get a notice that will tell you when you can file an application to purchase Medicare coverage.

Note: There is a program that may help you with your Medicare Part A premiums if you decide to purchase Part A after your extended coverage terminates. To be eligible for this help, you must be:

Under age 65. Continue to have a disabling impairment. Sign up for Premium Hospital Insurance (Part A). Have limited income. Have resources worth less than $4,000 for an individual and $6,000 for a couple, not counting the home where you live, usually one car, and certain insurance. Not already be eligible for Medicaid.

To find out more about this program, contact your county, local or State Social Services or medical assistance office. Ask about the Medicare buy-in program for Qualified Disabled and Working Individuals.

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