- Substantial Gainful Activity (SGA)
- Trial Work Period
- Extended Period of Eligibility (EPE)
- Impact of Work Incentives on SGA Determination
- SGA Determination Process
- Extended Medicare Coverage (Pre TWWIIA)
- Extended Medicare Coverage Under TWWIIAA
- TWWIIA Extended Medicare Coverage Decision Tree
- Final Comments
- Practice Quiz
- Final Quiz
Extended Medicare Coverage Under TWWIIA
Section 202 of TWWIIA further extends Medicare coverage effective 10/01/2000 for most Title II beneficiaries who work. . Under this provision, Medicare coverage can continue for at least 93 months following the end of the TWP. Beneficiaries will get an additional 4 1/2 years coverage beyond the previous limit (for a total of 8 1/2 years including the TWP). (TWWIIA added 54 months to the original 15 months of EPE plus 24 months pre-TWWIIA extension for a total of 93 months.)
Specifically, effective 10/01/2000, where Title II benefits end because of SGA following a TWP, Medicare coverage 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, D-HI ends the last day of the 57th month following the 36th month of the EPE. It terminates on the first day of the 58th month.
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, D-HI ends with the last day of the 77th month following the first month of SGA occurring after the 16th month. It terminates on the first day of the 78th month.
3. If the first month of SGA following the end of the TWP occurs on the 14th month of the EPE or later, D-HI ends with the last day of the 80th month following that first month of SGA occurring after the TWP. It terminates on the first day of the 81st month.
Most beneficiaries will be eligible for the extension under TWWIIA unless the 36th month of their EPE was prior to 6/2000 and fraud or similar fault was involved. Remember that Medicare never terminates retroactively and it never terminates earlier than notice month plus 2 months. For example: Date of termination notice is 3/15/04. Medicare ends 4/30/04 and terminates 5/01/04.
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