How To Use The Disability Medicare Wizard

The Disability Medicare Wizard is designed to determine the correct Medicare Termination Month for a Title II Disability Recipient using the rules from the Ticket To Work legislation. Every attempt was made to make the Wizard as simple to use as possible. It asks a few questions about a recipient's work activity and then displays the results, showing the Disability Health Insurance [D-HI] termination date and a brief explanation of how the D-HI was determined.

You should be familiar with SSA’s Termination of Disability HI policy found in section HI 00820.025 of SSA’s Program Operations Manual Systems.

Before you use the Wizard, you will need to know:

• The last month of the recipient's Trial Work Period
• The first month of Substantial Gainful Activity performed after the end of the TWP
• Was there (or will there be) SGA performed prior to the 14th month of the Extended Period of Eligibility?
• Was there (or will there be) SGA performed in the 16th month of the Extended Period of Eligibility?
• Was there (or will there be) SGA performed after the 36th month of the Extended Period of Eligibility?

Be sure to read the "Caution" on the first page. Using this Wizard in cases involving Fraud or Similar Fault where the EPE ends prior to June 2000 can generate erroneous results.

Select the last month of the TWP from the drop-down list on the first page, and click on the 'Submit' button.

The next screen shows which month you've selected as the last month of the Trial Work Period, the 14th month of the EPE, and the 36th month of the EPE. If the month displayed as the last month of the Trial Work Period is incorrect, click on the 'Go Back One Page' button to correct this date. You can use the 'Go Back One Page' button on any page to step back through the Wizard if you want to make changes in the information you have entered.

Select the first month of SGA work following the end of the Trial Work Period from the drop-down list on this screen and click on the 'Submit' button.

Depending on your response, you may get an immediate Wizard Determination or another question. If the Disability Medicare Wizard is unable to immediately determine the D-HI termination month it will ask a few more questions that call for you to give either a 'Yes/No' response or to again pick a month from a drop-down list. The questions you see will change depending on your answers to previous questions. After two to five additional questions, you will get to the Wizard Determination Screen with the D-HI termination date.

If you have any questions or problems with this program, contact your Regional Technical Liaison.