The QDWI Program: How Disabled Workers Can Keep Medicare When They Return to Work

If you became eligible for Medicare because you were receiving Social Security disability insurance (SSDI), you can continue receiving it while you attempt to go back to work. Your Medicare eligibility will last through your trial work period and extended period of eligibility—or even longer if you continue to be disabled. And you might not have to pay all the premiums.

Medicare Eligibility After You Return to Work

After your trial work period ends, you'll continue to be eligible for Medicare as long as you're still disabled. And you don't have to pay Medicare Part A premiums for the first 93 months after your trial work period ends, no matter how much you earn.

At the end of those 93 months of premium-free Medicare Part A eligibility, 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. And thanks to a special program (QDWI), you might even get Medicare Part A coverage for free. (But you still might have to pay your Part B premiums.)

To be eligible for Premium-HI coverage, you must have lost your SSDI benefits because your earnings were more than the SGA limit and not because the Social Security Administration no longer considered you disabled. (42 U.S.C. § 1395i–2a(a).) If the SSA says you're not disabled anymore, your Medicare eligibility ends.

What Is QDWI?

The Qualified Disabled Working Individual (QDWI) program is a state-administered program that helps pay Medicare Part A (hospital insurance) premiums for people with disabilities who've gone back to work and whose extended coverage (premium-free Medicare Part A benefit) has ended.

QDWI Eligibility

You must meet certain basic requirements to qualify for free Medicare through the QDWI program. To be eligible, you must be:

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

What Does QDWI Pay For?

QDWI pays your premiums for Medicare Part A. It doesn't pay the Part A deductible, copayments, or anything toward Part B. But if your income is very low despite working (under 135% FPL), you could qualify for a Medicare Savings Program that pays some of these expenses.

Cost of Premium-HI Medicare (Part A)

Medicare Hospital Insurance (HI), also called Medicare Part A, is free for most people over 65 and those under 65 with disabilities—as long as they're collecting Social Security disability benefits. Once you go back to work and earn enough to lose your SSDI benefits, you'll no longer be eligible for premium-free HI coverage—even if Social Security still considers you disabled.

If this happens, your Medicare coverage converts to "Premium-HI for the Working Disabled," and you'll have to start paying for your medical benefits if you want to keep them. For 2024, the monthly rate for Premium-HI (Part A) is capped at $505 a month.

But if you (or your spouse) have a qualifying work history (30 credits or more), you can get a 45% premium reduction in premiums from Social Security. With the reduction, your monthly premium would be $278 (for 2024).

But the Qualified Disabled Working Individual (QDWI) program could pay your monthly Medicare Part A premium if both of the following are true:

• you're eligible for Premium-HI for the Working Disabled, and
• you meet certain income and asset requirements.

QDWI Income and Asset Limits by State

The following table covers the income and asset limits you must meet to be eligible for QDWI.

	Individual	Couple
Income limit for all states except Alaska and Hawaii	$4,945	$6,659
Alaska income limit	$6,155	$8,299
Hawaii income limit	$5,675	$7,645
Asset limits for all states	$4,000	$6,000

While the income limits are based on 200% of the federal poverty level, they also include earned income exclusions. Because the QDWI program doesn't count half of the income you earn from work, you can actually earn quite a bit more than 200% of the FPL and still qualify for the program.

Counting Resources and Income

When counting your income for QDWI, the states generally follow the same countable income rules as for SSI. However, some states are more lenient when counting income.

So, 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 for QDWI. Here are the basic financial requirements.

QDWI Resource Limits

Not every asset you own counts against the QDWI resource limit. But the following always count as resources when determining your eligibility for QDWI:

• any money in your checking and savings account(s), and
• the value of stocks and bonds you own.

The following assets don't count as resources for QDWI eligibility purposes:

• your home (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).

QDWI Income Limits

Most sources of income count against the limit when determining your eligibility for QDWI, including the following:

• earned income, including your:
• wages from your job(s)
• net earnings from self–employment (freelancing)
• royalties from work you've done, and
• payments from employment in a sheltered workshop
• unearned income, including:
• Social Security benefits
• pensions
• disability payments made by your state
• unemployment benefits
• interest income
• money given to you by friends and relatives, and
• any other income from not working
• in-kind income: the fair market value of food and shelter that you get for free, and
• deemed income: a portion of the income from your spouse or parents (if you live with them) or, if you're a resident alien, from your sponsor.

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

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

Your eligibility for Premium-HI begins when your eligibility for premium-free HI ends. Your eligibility for QDWI depends on when you enroll in the Premium-HI program.

Premium-HI Initial Enrollment Period

Your Initial Enrollment Period (IEP) begins the month you lose free coverage because your earnings exceeded the limit for SSDI. It lasts for eight months after you get your notice from Social Security that the free coverage has ended.

When your Premium-HI health care coverage will begin depends on your enrollment date. The following chart shows when coverage begins if you enroll during your IEP.

When Your Enrollment Is Filed	When Coverage Begins
If you enroll the month before you lose eligibility for free Part A Medicare…	…your coverage begins the first month you meet the above eligibility requirements.
If you enroll during the first month you're eligible for Premium-HI or at any time during the remainder of your IEP…	…your coverage begins the first day of the month after you enroll.

General Enrollment Period for Premium-HI

The general enrollment period runs from January to March each year. If you enroll during the general enrollment period, your coverage will begin on the first day of the month following the month you enrolled. For example, if you enroll in Premium-HI on February 16, 2024, your coverage will begin on March 1, 2024.

Special Enrollment Period for Premium-HI

If you have group health insurance through your employer (or a family member's employer), you get a special enrollment period (SEP) for Premium-HI. Under the SEP rules, you can enroll in Premium-HI at any time as long as both of the following are true:

• You're covered by group health insurance through current employment (whether it's your job, your spouse's job, or another family member's job).
• The insurance is provided through an employer or union based on that employment.

Your special enrollment period ends eight months after the group health plan coverage or employment ends (whichever happens first). Premium-HI coverage usually begins on the first day of the month after you sign up for it.

Note that COBRA coverage doesn't count as a group health plan, and having COBRA insurance won't affect when your special enrollment period begins or ends. And if your coverage is based on a family member's employment (other than your spouse), for you to be eligible for the special enrollment period, the family member must be enrolled in a large group health plan.

When Does My Premium-HI and QDWI Coverage End?

You'll no longer be covered by Premium-HI Medicare (Part A) if you're no longer disabled or if you neglect to pay your Medicare premiums.

If your premiums are paid through the QDWI program, that financial assistance will end if you exceed the income or resource limits discussed above.

QDWI assistance will also end if you begin receiving SSDI again (because you'll be eligible for premium-free HI again).

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 if Social Security thinks you're eligible for the QDWI program. Remember, though, that QDWI is a state-run program. So, your state, and not Social Security, will decide if you qualify. If you don't get a letter from Social Security, you still should contact your state's Medicaid office to see if you're eligible for QDWI.

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

_{Updated January 12, 2024}