Myth 3: If I Work, I'll Lose Health Benefits

Losing your health care benefits can be a huge concern if you are thinking about work. However, there are several ways you can keep your health care benefits when you go to work. Many jobs will also offer employer-sponsored health care benefits. In general, you can keep your Medi-Cal or Medicare benefits when you start working. The sections below will explain several different options for health care benefits.

Medi-Cal Program

Keeping Medi-Cal is a big concern for people with disabilities who want to work. After you begin working, you may be able to maintain your Medi-Cal in several different ways. The following programs might help you keep your Medi-Cal coverage even if you make more money than usually allowed by Medi-Cal.

SSI 1619(b) Program

If you are eligible for SSI and you are working, your Medi-Cal coverage can continue under the 1619(b) program, even if your earnings become too high for SSI cash payments. However, you still have to stay under the SSI asset limit which is $2,000 for an individual; $3,000 for a couple. You can stay on this program until you earn $64,517 per year or more. In order to continue your Medi-Cal coverage under this program, you must:

• Have been eligible for an SSI cash payment for at least 1 month
• Still meet SSI requirements, like disability, blindness, or age, that don’t have to do with income
• Need Medi-Cal coverage to continue working, and
• Have less than $64,517 in gross earnings ($66,542, if blind) or have high medical expenses that will be evaluated on a case-by-case basis. Note that this program does not use the countable income calculation.

For information about 1619(b) eligibility, click here.

If you earn more than $64,517 per year ($66,542 if blind), you may be able to keep your Medi-Cal by enrolling in the Working Disabled Program.

Aged & Disabled Federal Poverty Level Medi-Cal

If you are not eligible for SSI, but you have a disability, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level Medi-Cal (A&D FPL) program. In order to qualify for A&D FPL Medi-Cal, you must:

• Be either aged (65+), or disabled (meet Social Security’s definition of disability, even if your disability is blindness)
• Have less than $1,800 in countable monthly income for an individual ($2,433 for a couple), and

• Have $130,000 in resources or less ($195,000 for a couple). Some of your resources, like your home and car, are not counted. Click here for a list of additional exemptions.

Read here for more information on the Aged & Disabled Federal Poverty Level Medi-Cal program.

Working Disabled Program (WDP)

The WDP program is another great safeguard for people in the state of California with disabilities. The WDP program lets working people with disabilities qualify for Medi-Cal even though you may be earning more than allowed. Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.

To qualify for the WDP program, you must:

• Have a disability that meets Social Security’s definition
• Be working
• Have resources at or below the limit ($130,000 for individuals; $195,000 for couples). Some resources are excluded for this program, including retirement funds like 401(k)s. Click here for more about the asset rules.
• Have countable income less than 250% of the Federal Poverty Level. Disability income does not count for the WDP program. This means that SSDI, Worker’s Compensation, California State Disability Insurance, and any federal, state, or private disability benefits are not considered as income for this program, and
• Not be eligible for regular Medi-Cal, including 1619(b)
  

The WDP program is a great option if you like your current Medi-Cal coverage and get a job. You don’t have to be afraid you will lose your health coverage. Even if you are only working part time, you may qualify for this program. For more information on the WDP program and to see if you qualify, click here.

Aged, Blind, and Disabled – Medically Needy Medi-Cal

If you are aged, blind, or disabled, but your income is too high for other Medi-Cal programs, you may be eligible for Aged, Blind, and Disabled – Medically Needy Medi-Cal. For this program, you may need to spend a certain amount of your own money before Medi-Cal begins to pay for medical services. This payment is called a share of cost. To see if you are eligible and what your share of cost would be, click here.

Employer-Sponsored Health Care Benefits

You can enroll in your employer-sponsored health care plan and still keep your 1619(b) program and/or your WDP program. In fact, if the employer-sponsored plan requires you to pay a share of the cost, the state of California may pay for some or all of this if it is cost effective for them to have you covered in both health care plans (Medi-Cal and employer-sponsored). Click here for more information on the Health Insurance Premium Payment program. Read more about private health coverage here.

Medicare

If you have been on SSDI for 24 months or more, you are eligible for Medicare. There are three ways you can keep your Medicare benefits after you begin, or return to, work:

• A Trial Work Period (TWP) lets you work and keep getting your Medicare benefits. You have 9 months of TWP to use; they do not need to be in a row. If you earn more than $1,210 in that month, it counts as a Trial Work month.If you earn less than $1,210, it doesn’t. Medicare hospital insurance coverage continues for 93 months (7 years, 9 months) after the end of the Trial Work Period. For more information on TWP, click here.
• An Extended Period of Eligibility (EPE) begins after TWP ends and continues for 36 months in a row whether you are working or not. During the Extended Period of Eligibility you remain eligible for your Medicare benefits. After the end of your Extended Period of Eligibility, you remain eligible for Medicare as long as you continue to be eligible for your SSDI payment. If your SSDI payments stop you may be eligible for Extended Medicare. Talk to your local Social Security office about Extended Medicare. For more information on the EPE, click here.

• If you continue to receive your SSDI when you work, your eligibility for Medicare simply continues. You can also keep your Medicare even if earnings cause your SSDI check to stop, as long as Social Security still considers you disabled. If your SSDI stops due to work, you can keep your Medicare coverage for at least 7 years and 9 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. For more information on Medicare Part A, click here.