2674.1 Medicare Part A Eligibility Under Section 1818(a)

Under section 1818(a) of the Social Security Act, persons who lose eligibility for regular OASDI disability benefits and Medicare because they are working and earning above the SGA level as described in 2634 can continue to receive Medicare coverage if they pay the applicable premiums. Such individuals will continue to meet disability criteria and must have qualified for Medicare prior to losing their cash benefits. They may enroll for either Part A and/or Part B coverage. However, under the QWD program, Medicaid coverage is only available for payment of the Part A premium. Only if the person qualifies for full Medicaid coverage based on meeting a spenddown would Part B premiums be covered.

A person must enroll in Medicare Part A to be eligible for QWD coverage. Eligibility would begin no earlier than the first month of Part A premium coverage. Documentation of their status under section 1818(a) and their Part A effective date will be required.

Persons who qualify for QWD will not be automatically enrolled and bought in to the Part A program. If they want Part A coverage, they would need to enroll for it on their own at the local SSA office. There is a 7-month initial enrollment period which begins with the month the person is notified concerning the loss of disability benefits. Part A premium coverage would begin in one of the following three months depending on when the person enrolls. If this initial period has passed, the person can normally only enroll during a general enrollment period which is limited to the months of January through March. Part A coverage would not begin until July 1 in these instances. There is also a special enrollment period connected with the premium Part A program for persons who did not enroll at their first opportunity because they were covered under an employer group health program. If that coverage ends, they have a 7-month period from the month the coverage ends to enroll for Part A. If the person applies for QWD outside of the permitted enrollment period, QWD eligibility would have to be denied until such time that the person can enroll for and begin receiving Part A benefits.

Part A premium coverage under section 1818(a), and therefore QWD eligibility, ends in the month the individual turns 65.