Myth #3: If I Work, I Will Lose My Health Care 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 Arizona Health Care Cost Containment System (AHCCCS) 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). If you have gotten SSDI benefits for more than 24 months (or two years), you are probably on Medicare. If you’ve gotten SSDI benefits for less than 24 months (or two years), your Medicare will start when you’ve gotten benefits for 24 months (or 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 AHCCCS health coverage or AHCCCS’s Help with Paying for Medicare Costs Only program.

Medicare and Work

When you work and get SSDI cash benefits, you keep your Medicare — plain and simple. If your SSDI cash benefits stop because of work, you can keep your Medicare for at least seven years and nine months from the end of your Trial Work Period. After that, if you still have a disability and would like to keep Medicare, you can maintain it by paying a monthly Part A premium.

Extended Medicare

You can keep your Medicare coverage for at least 8½ years after you return to work. (The 8½ years includes your nine-month Trial Work Period.) After your Trial Work Period, you will get at least seven years and nine months of continued Medicare coverage, as long as you continue to have your disabling condition according to Social Security’s rules.

The Arizona Health Care Cost Containment System (AHCCCS)

Keeping AHCCCS is a big concern for people with disabilities who want to work.

Eligibility for AHCCCS is based on your income. There are a couple of common ways you may qualify:

If you work and your income is low enough, you should be able to qualify in these ways for AHCCCS. But $16,753 per year or less is not a lot of money to live on. And what if you want to save money to buy a car or a house or go on vacation? There are several other ways you can keep your AHCCCS while working and earning more.

SSI’s 1619(b) Program

For people on SSI, the 1619(b) program lets you work and keep AHCCCS, even if you make too much money to get SSI cash benefits. If you are on this program, you will not have to pay a premium.

If you live in Arizona and are on SSI and AHCCCS, you can have up to $36,315 in gross income and still stay on AHCCCS. Your resources cannot be more than the $2,000 SSI resource limit ($3,000 for a family of two).

To qualify for 1619(b) you must:

  • Have been eligible for SSI cash benefits for at least 1 month
  • Not be getting SSI benefits because you earn too much
  • Still be considered disabled or blind
  • Not have more than the SSI resource limit ($2,000 for a single person, $3,000 for a couple)
  • Need AHCCCS to be able to work
  • Not make enough money to pay for the services you get with AHCCCS benefits
  • Respond to all Social Security requests for information

AHCCCS Freedom to Work Program

When you have a job and your income is more than regular AHCCCS allows, you may be eligible for the AHCCCS Freedom to Work Program. The AHCCCS Freedom to Work Program covers the same services that standard AHCCCS covers, including visits to the doctor, hospital stays, medical equipment, home care services, and mental health services. The program encourages you to work and enjoy the benefits of working without having to worry that you’ll lose your health benefits.

To qualify for AHCCCS Freedom to Work, you must meet all of the following eligibility criteria:

People in the program pay a monthly premium for their coverage. The premium is based on their income. The maximum monthly premium is $35. To see if you might qualify for AHCCCS Freedom to Work and what your estimated premium would be, use the DB101 AHCCCS Freedom to Work Calculator.

To learn more about Freedom to Work, call 1-602-417-5010 if you live in Maricopa County. For all other counties, call 1-800-528-0142. You can also read DB101’s AHCCCS Freedom to Work article.

Public and Private Coverage

Remember, you can have both private health coverage and public health coverage at the same time. Some private plans have rules limiting what services they will pay for. These rules may include some services that are critical to some people with disabilities, such as Personal Care Assistant services and private duty nursing.

If you are eligible for Medicare or AHCCCS, which are public health coverage programs, and you get a job that offers you private group coverage, be sure you understand how they will work together. Sometimes your AHCCCS coverage will help pay for some costs associated with your private coverage, such as copayments or deductibles.

Some reasons to consider having both private and public health coverage:

  • Many private health plans don’t cover things like transportation, private duty nursing, and Personal Care Assistant (PCA) services
  • With private coverage, you may have a wider pool of doctors and other medical service providers to choose from than with public coverage
  • Public programs may help pay some expenses of your private plan
  • Some private plans have annual or lifetime maximum amounts that they will pay

You can read more about private health coverage, click here.

If you don't qualify for AHCCCS or Medicare

If your income goes up so much that you no longer qualify for AHCCCS and you can't get Medicare or employer-sponsored coverage, the government may help you pay for a private health coverage plan on Healthcare.gov. You may get this help if your family’s income is at or below 400% of FPG ($48,560 for an individual; $100,400 for a family of four).

For more information, read DB101's Buying Health Coverage on Healthcare.gov article.