Work Incentives

Health Care Work Incentives

If you get health care benefits like Medicare or MO HealthNet, there are also incentives that make sure you continue to have good health coverage after you get a job.

Note: DB101 keeps track of changes to health coverage and related laws. DB101 articles and tools have recently been updated to include MO HealthNet's expansion of coverage for adults 18-64 years old (Medicaid Expansion). Get more information about applying for this coverage.


Many people with disabilities get Medicare health coverage, usually because they also get Social Security Disability Insurance (SSDI). If your income goes up while you’re on SSDI, your benefits can go down, though the work incentives described earlier in this article can help you to gradually try out working without fear of suddenly losing your cash benefits. Likewise, you can gradually try out working without fear of suddenly losing your Medicare coverage, thanks to the incentives described here.

Continuation of Medicare Coverage

Once you become eligible for Medicare, you can continue getting Medicare coverage for at least 93 months (or 7 years and 9 months) after your SSDI Trial Work Period (TWP) ends, if you are still disabled under Social Security’s guidelines. The 93-month period starts the month after the last month of your TWP.

Medicare for Persons with Disabilities Who Work

If you are still working after your Continuation of Medicare Coverage period ends, you may be able to buy continued Medicare coverage. You are eligible to buy Medicare coverage if:

  • You are under age 65
  • You continue to be disabled
  • Your Medicare stopped because of work

For more information about buying Medicare continuation coverage, visit Medicare’s website or call them at 1-800-633-4227 or 1-877-486-2048 (TTY). The line is open 24 hours a day, 7 days a week. You can also talk to a Benefits Specialist.

Learn more about Medicare in DB101's How Health Benefits Work article.

MO HealthNet

Many people with disabilities get MO HealthNet health coverage. Some worry that if they make too much money or save up too much, they'll lose their health coverage. However, if you have a disability, there are a few ways you can keep your MO HealthNet while working and earning more than the usual income limits for income-based MO HealthNet or disability-based MO HealthNet:

  1. You can get MO HealthNet with a spend down
  2. You can get MO HealthNet through the Supplemental Security Income (SSI) 1619(b) rule
  3. You can get MO HealthNet through a program called Ticket to Work Health Assurance (TWHA)

To qualify through these you must:

  • Have or apply for a Social Security number
  • Live in Missouri and intend to remain in the state
  • Be a United States citizen or an eligible noncitizen
  • Have limited resources
    • For most MO HealthNet programs, including the spend down and TWHA, you must have less than $5,726 in available resources ($11,452 for couples).
    • For people who get MO HealthNet through 1619(b), the resource limit is the same as SSI’s, $2,000 for an individual, $3,000 for a couple.

The amount of money you can make and whether you have to pay a monthly premium or spend money of your own for care depends on your situation. Here we’ll explain the differences between these three rules.

Learn more about MO HealthNet in DB101's How Health Benefits Work article.

MO HealthNet with a Spend down

If you make more than MO HealthNet’s income limit, you may qualify for MO HealthNet with a spend down. A spend down is like an insurance deductible. With a spend down, you are responsible for part of your medical expenses each month before MO HealthNet will start paying for them.

Each month you have the option of meeting the spend down by paying for some of your medical expenses directly (like a deductible) or by paying your spend down amount to MO HealthNet (like a premium).

Whichever of these options you choose, every month when you meet the spend down, you will get MO HealthNet coverage. When you don’t meet the spend down, you won’t get MO HealthNet coverage. You may choose to meet the spend down some months and not in other months, if you do not have health care expenses every month.

SSI’s 1619(b) Program

For people on SSI, the 1619(b) program lets you work and keep MO HealthNet, even if you make too much money to get SSI cash benefits. If you are on this program, you will not have to pay a premium or meet a spend down.

In addition to the eligibility requirements listed earlier for all MO HealthNet programs, to qualify for MO HealthNet based on 1619(b) you must:

  • Be found eligible for 1619(b) status by Social Security
  • Have gotten MO HealthNet in the month prior to becoming eligible for 1619(b) status

To be eligible for 1619(b) status you must:

  • Have been eligible for SSI cash benefits for at least 1 month
  • Be working and have gross earnings below $44,287 per year
  • Not be getting SSI benefits because you earn too much
  • Still be considered disabled or blind by SSI
  • Need MO HealthNet to be able to work
  • Not make enough money to pay for the services you get with MO HealthNet benefits
  • Respond to all Social Security requests for information

Note: When your income is counted, Social Security won’t count all of your income, thanks to various SSI work incentives. So you may be making more than $44,287 per year and still qualify for 1619(b).

MO HealthNet Ticket to Work Health Assurance (TWHA) Program

When you have a job and your income is more than regular MO HealthNet allows, you may be eligible for the Ticket to Work Health Assurance (TWHA) program. TWHA covers the same services that standard MO HealthNet covers, including visits to the doctor, hospital stays, medical equipment, home care services, and mental health services. The program encourages you to work and enjoy the benefits of working without having to worry that you’ll lose your health benefits.

In addition to the eligibility requirements listed earlier for all MO HealthNet programs, to qualify for TWHA you must:

  • Be age 16 – 64
  • Be working and paying Social Security and Medicare taxes
  • Get Social Security disability benefits or considered disabled by the Missouri Department of Social Services (DSS) Family Support Division (FSD)
  • Have gross income of $3,765 per month or less for an individual, $5,110 or less for a couple.
  • Also meet countable net income limits. Your countable net income is calculated by the Family Support Division and includes various deductions from your gross income.

Depending on your gross income, you may have to pay a monthly premium for this type of MO HealthNet coverage. Premiums range from a minimum of $42 per month to a maximum of $211 per month, depending on your situation.

Learn more about Ticket to Work Health Assurance in DB101's How Health Benefits Work article.

Subsidized Individual Coverage Through

If your income is too high to qualify for MO HealthNet, you should be able to buy individual health coverage through The government may help you pay for your monthly premium through tax credits. If your family's income is at or below 250% of the Federal Poverty Guidelines (FPG), the government may also help you get a plan that has lower copayments and other expenses.

Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.

Learn more about individual coverage in DB101's How Health Benefits Work article.

Learn more