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Aged, Blind and Disabled Manual Policy Manual Number: 120.025 Section: Medicare Savings Programs Chapter: Qualified Disabled Working Individuals
May 1, 2025 Division of TennCare 1 QUALIFIED DISABLED WORKING INDIVIDUALS Legal Authority: Social Security Act § 1905(p)(2)(D); § 1905(s); Tenn. Comp. R. & Regs. 1200-13-20- .08(7)(d) 1. Overview Section 6012 of the Omnibus Budget Reconciliation Act (OBRA) of 1989 provides an option to purchase Medicare Hospital Insurance Benefits (Part A) for an indefinite period for certain Disabled Working Individuals (DWI) under age 65 who are no longer entitled to premium-free Medicare Part A because they returned to work. Section 6048(s) of OBRA 1989 requires states to “buy in” the Medicare Part A only premium for those DWIs who meet all the requirements of being a Qualified Disabled Working Individual (QDWI). 2. Policy Statement To be eligible in the QDWI category an individual must: a. Be under age 65; b. Have a disabling impairment (determined by the Social Security Administration (SSA)); c. Be eligible to enroll in Medicare Part A, but no longer entitled to free Medicare Part A due to Substantial Gainful Activity (SGA); d. Have income that does not exceed 200% of the Federal Poverty Level (FPL); e. Not have resources over $4,000 for an individual or $6,000 for a couple; f. Not be eligible for TennCare Medicaid; and g. Meet all non-financial eligibility requirements.
3. SSA’s Responsibility When an individual who was previously disabled returns to work, the SSA will:
a. Determine continuous disability; b. Determine whether the income the individual receives exceeds the SGA limits; c. Notify the individual of Medicare termination and the opportunity to purchase continued coverage and/or apply for Medicaid assistance; and d. Update the Social Security system with the DWI eligibility determination and enrollment. 4. QDWI Benefits QDWI individuals receive payment of Medicare Part A premiums only. QDWI eligibility does NOT pay for Part B Medicare premiums, co-insurance or deductibles. If the individual is enrolled as a DWI more than 3 months prior to becoming eligible as a QDWI, the individual may be responsible for the premiums in the months prior to QDWI eligibility.