Getting Past the Myths

Myth 3: If I Work, I'll Lose Health Benefits

I have ongoing health care needs that I would never be able to pay for myself. People tell me I shouldn’t work because then I might not be able to see my doctors and get the care I need.

Losing your health care benefits can be a huge concern, if you are thinking about going to work. However, several programs can help you keep your health care benefits when you go to work. Some jobs will offer employer-sponsored health care benefits. But for some people that will not be enough. Some people may also want to keep their Medicare or MO HealthNet benefits.

It is important to know what type of health care coverage you have, so you know what will happen to that coverage when you go to work. Here we will describe the most common public health care coverage programs for people with disabilities.

You can also try DB101's Finding the Right Coverage for You interactive guide to get an idea of which of these programs might work best in your situation.

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.


Medicare is the federal health insurance program for people over age 65 and people with disabilities who are on Social Security Disability Insurance (SSDI). If you have gotten SSDI benefits for more than 24 months (or 2 years), you are probably on Medicare. If you’ve gotten SSDI benefits for less than 24 months, your Medicare will start when you’ve gotten benefits for 24 months.

If you’re on SSDI and have to pay a Medicare Part B premium, it will be deducted from your monthly SSDI benefits amount. You may not have to pay a Part B premium if you qualify for:

Medicare and Work

When you work and get SSDI cash benefits, you keep your Medicare — plain and simple. If your SSDI cash benefits stop because of work, you can keep your Medicare for many years. This means that even if your SSDI benefits stop, your Medicare will continue for many more years. This is called “Extended Medicare.”

Extended Medicare

You can keep your Medicare coverage for at least 8.5 years after you return to work. (The 8.5 years includes your 9-month Trial Work Period.) After your Trial Work Period, you will get at least 7 years and 9 months of continued Medicare coverage, as long as you continue to have your disabling condition according to Social Security’s rules.

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

MO HealthNet

Keeping MO HealthNet is a big concern for people with disabilities who want to work.

Eligibility for MO HealthNet is based on your income and resources:

  • If your household's Modified Adjusted Gross Income (MAGI) is 138% of FPG or less ($20,783 per year or less if you are single), you may qualify for income-based MO HealthNet (also called "Medicaid expansion"). It doesn't matter how much your family has in resources.

  • If you are disabled, you may instead qualify for disability-based MO HealthNet if your countable income is less than 85% of the Federal Poverty Guidelines (FPG), $1,067 per month, and your resources are below $5,726 ($11,452 for couples).

  • If you are blind, you may also qualify if your countable income is less than 100% of FPG, $1,255 per month, and your resources are below $5,726 ($11,452 for couples).

If you work and your income is below these levels, you should be able to keep MO HealthNet. But that’s not a lot of money to live on every month. And what if you want to save money to buy a car or a house or go on vacation? There are a few ways you can keep your MO HealthNet while working and earning more than these limits:

  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 the Ticket to Work Health Assurance (TWHA) program.

To qualify through these you must:

  • Have or apply for a Social Security number
  • Live in Missouri and intend to stay
  • 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 programs.

How to apply for MO HealthNet when you work

The MO HealthNet website has instructions on how to apply for health coverage online, by phone, or by mail.

When you apply for MO HealthNet, you don’t have to tell them you are applying for the spend down or the Ticket to Work Health Assurance program. They’ll look at your application and figure out which is the best MO HealthNet program for you. If you are in 1619(b) status, you need to tell your local Family Support Division (FSD) office, because they do not get notice from Social Security.

If you need help completing your application, talk to a Benefits Specialist.

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 or an insurance premium. With a spend down, you are responsible for part of your medical expenses each month before MO HealthNet will start paying for them.

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 can meet the spend down by either paying the spend down to the Department of Social Services (DSS) MO HealthNet Division or submitting bills for medical expenses you are personally responsible for to the Family Support Division (FSD). You may choose to pay the spend down some months and not pay it in other months, if you do not have health care expenses every month.

To see some common questions people ask about how the MO HealthNet spend down works, click here.

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.

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 got MO HealthNet (Medicaid) in the month prior 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

If you have a disability and are working 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 be 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.

Public and Private Coverage

Remember, you can have both private health coverage and public health coverage at the same time. Some private plans have rules limiting what services they will pay for. These rules may include some services that are critical to some people with disabilities, such as Personal Care Assistant services and private duty nursing.

If you are eligible for Medicare or MO HealthNet, which are public health coverage programs, and you get a job that offers you private group coverage, be sure you understand how they will work together. Sometimes your MO HealthNet coverage will help pay for some costs associated with your private coverage, such as your premium, copayments, or deductibles.

To learn more, read DB101's pages about employer-sponsored coverage and individual coverage through

If you don't qualify for MO HealthNet or Medicare

If your income goes up so much that you no longer qualify for MO HealthNet and you can't get Medicare or employer-sponsored coverage, the government may help you pay for a private health coverage plan on

For more information about individual coverage, read DB101's article on How Health Benefits Work.

Learn more