months have passed since that time, then Medicare eligibility will continue for at least 78 months after the last cash payment is due. Examples of EPMC lasting longer than 93 months: Example 1: Connie started working in March 2016 earning above the Trial Work Period threshold but below SGA. In month 30 of her EPE she began doing SGA-level work. Connie’s Medicare will last at least 78 months after the last grace month. If she is re-entitled, however, she will have Medicare as long as she is due a payment, even if it’s for the rest of her life. Example 2: completed her Trial Work Period in 2001. She has worked since then, but has never performed Substantial Gainful Activity. Kelly will continue to have Medicare as long as she is entitled to a disability payment. When she performs SGA, she would be due payments for her cessation and grace months, and then she would have Medicare at least another 78 months through the EPMC. Keep in mind that it’s impossible to know exactly when a beneficiary’s EPMC would end if the beneficiary hasn’t yet engaged in SGA. The EPMC months don’t begin to count until the TWP is over, SGA work has occurred, and Social Security has established the cessation month. It’s important to understand that the EPMC is a work incentive for Title II disability beneficiaries. It’s afforded to individuals who have lost cash benefits due to work. It’s NOT a way to keep Medicare when beneficiaries lose benefits due to medical recovery. People in the EPMC must still meet the Social Security disability requirement, even though these individuals may not be due cash payments. EPMC Complications When advising beneficiaries Medicare continuation, remember that Social Security is the only place to find out how long the coverage will last. The beneficiary may not know when or if the TWP ended, whether cessation has occurred, or even that work should have caused benefit termination. Some beneficiaries may have used most or all of their EPMC in the past without even realizing it.
months have passed since that time, then Medicare eligibility will continue for at least 78 months after the last cash payment is due. Examples of EPMC lasting longer than 93 months: Example 1: Connie started working in March 2016 earning above the Trial Work Period threshold but below SGA. In month 30 of her EPE she began doing SGA-level work. Connie’s Medicare will last at least 78 months after the last grace month. If she is re-entitled, however, she will have Medicare as long as she is due a payment, even if it’s for the rest of her life. Example 2: completed her Trial Work Period in 2001. She has worked since then, but has never performed Substantial Gainful Activity. Kelly will continue to have Medicare as long as she is entitled to a disability payment. When she performs SGA, she would be due payments for her cessation and grace months, and then she would have Medicare at least another 78 months through the EPMC. Keep in mind that it’s impossible to know exactly when a beneficiary’s EPMC would end if the beneficiary hasn’t yet engaged in SGA. The EPMC months don’t begin to count until the TWP is over, SGA work has occurred, and Social Security has established the cessation month. It’s important to understand that the EPMC is a work incentive for Title II disability beneficiaries. It’s afforded to individuals who have lost cash benefits due to work. It’s NOT a way to keep Medicare when beneficiaries lose benefits due to medical recovery. People in the EPMC must still meet the Social Security disability requirement, even though these individuals may not be due cash payments. EPMC Complications When advising beneficiaries Medicare continuation, remember that Social Security is the only place to find out how long the coverage will last. The beneficiary may not know when or if the TWP ended, whether cessation has occurred, or even that work should have caused benefit termination. Some beneficiaries may have used most or all of their EPMC in the past without even realizing it.
Understanding%20the%20EPMC%202018.docx