Welcome to the Disability Medicare Wizard

The Disability Medicare Wizard is designed to assist benefits planners and advocates in determining when a Title 2 beneficiary's Extended Period of Medicare Coverage (EPMC) will end because of earnings over Substantial Gainful Activity (SGA). The Ticket to Work and Work Incentives Improvement Act (TWWIIA) extended Medicare coverage effective 10/1/2000 for most Title 2 beneficiaries whose work activity is over SGA. When the EPMC ends the worker is expected to have healthcare coverage through an employer or to maintain Medicare, they must pay the monthly Part A premium and continue to pay the premiums for Parts B and D. The Medicare Wizard helps determine the end of the EPMC and to help Title 2 workers know when they will be responsible for paying the Part A premium. Advocates should conduct research to find state programs to help pay for Medicare costs. These include Medicaid and Medicare Savings programs.

There are three scenarios to determine the end of the EPMC depending on when SGA was performed or anticipated to be performed after the 9th Trial Work Period.

Where Title 2 benefits end because of Substantial Gainful Activity (SGA) following the 9th Trial Work Period (TWP), the EPMC ends based on one of the following:

1. If the first month of SGA following the end of the TWP occurs prior to the 14th month of the EPE and the individual performed SGA in the 16th month of the EPE, the EPMC ends 93 months after the 9th TWP.

2. If the first month of SGA following the end of TWP occurs prior to the 14th month of the EPE and the individual does not engage in SGA in the 16th month of the EPE, EPMC ends with the last day of the 77th month following the first month of SGA occurring after the 16th month.

3. If the first month of SGA following the end of the TWP occurs on the 14th month of the EPE or later, the EPMC ends with the last day of the 80th month following that first month of SGA occurring after the TWP.