Medicare 2026

Keeping Medicare When You Go Back to Work: The Part A Buy-In and the QDWI Program

If you're under 65 and receive Medicare because of a disability, returning to work is good news for your paycheck but can create a worrying question: what happens to your Medicare? Federal rules anticipate exactly this situation. Two connected programs — the Part A "buy-in" for working people with disabilities, and the Qualified Disabled and Working Individuals (QDWI) Medicare Savings Program — are designed to keep your hospital coverage in place when earnings end your free Part A.

Why this rule exists

When someone receives Social Security Disability Insurance (SSDI) for 24 months, they generally get Medicare, including premium-free Part A (hospital insurance). If they return to work and earn above what Social Security calls the "substantial gainful activity" level, SSDI cash benefits — and after a transition period, premium-free Part A — can end. Without a backstop, people would face a painful choice between a job and their Medicare. The buy-in and QDWI exist so you don't have to make that choice.

Who qualifies for the Part A buy-in

To buy Part A under the working-disabled provision, all four of the following must be true:

• You are under 65.
• You lost premium-free Part A solely because of work at the substantial gainful activity level.
• You continue to have a disabling impairment.
• You do not qualify for Part A on any other basis.

If any of those change — for example, you later qualify for free Part A through age or another route — the buy-in ends.

When you can enroll

There are three enrollment windows:

• An 8-month Initial Enrollment Period that starts the month you're notified premium-free Part A is ending.
• The General Enrollment Period, January 1 through March 31 each year.
• A Special Enrollment Period if you meet the qualifying circumstances.

Signing up during the 8-month window matters for another reason too: if you were paying a Part B late-enrollment surcharge, enrolling in the buy-in during that window brings your Part B premium back to the standard rate. Note that Part B cannot be purchased under this provision unless you also enroll in premium Part A.

What it costs

People who buy Part A under the working-disabled rule pay the same premium as people 65 and older who buy Part A. For 2026, that is $565 a month at the full rate, or $311 a month at the reduced rate.

You qualify for the reduced $311 premium if any of these apply:

• You have 30 or more quarters of coverage on your own work record.
• You have been married at least one year to a worker with 30 or more quarters.
• You were married at least one year to a deceased worker who had 30 or more quarters.
• You were divorced after at least 10 years of marriage from a worker who had 30 or more quarters at the time the divorce became final.

Importantly, there is no late-enrollment penalty on Part A under this buy-in. Part B, however, follows the normal rules.

When buy-in coverage ends

The buy-in coverage ends with the earliest of three events: medical recovery, your own request to end it, or re-entitlement to premium-free Part A.

The QDWI program: help paying the Part A premium

The Qualified Disabled and Working Individuals (QDWI) program is a Medicare Savings Program run by each state. It pays the Part A premium — and only that — for people who have a disability, are working, and lost Social Security disability benefits and premium-free Part A because they returned to work.

For 2026, Medicare.gov lists these federal QDWI limits:

• Individual: $5,405 a month in income, $4,000 in resources.
• Married couple: $7,299 a month in income, $6,000 in resources.

These limits rise each year. Just as important, you may still qualify in your state even if your income or resources appear to be over the federal limits, because many states don't count certain types or amounts of income or resources. If you're close to the numbers — or even somewhat above them — apply anyway.

How this fits with the rest of Medicare

Having Part A (whether free or bought) opens the door to the rest of Medicare: Part B (outpatient care), Part D (prescription drugs), and the choice between Original Medicare (often paired with a Medigap policy and a stand-alone Part D plan) and Medicare Advantage. Each path has trade-offs. Original Medicare with Medigap gives broad provider access and more predictable out-of-pocket costs for covered services, but Medigap and Part D are separate premiums. Medicare Advantage often bundles drug coverage and extra benefits with a network, and rules differ plan by plan. Neither is universally better; the right fit depends on your doctors, medications, budget, and travel patterns.

A few program-wide numbers worth knowing as you plan for 2027: the Part D out-of-pocket cap rises to $2,400 (up from $2,100 in 2026); no Part D plan may charge a deductible higher than $700; the Part D base beneficiary premium used for the late-enrollment penalty is $41.33; and Annual Enrollment runs October 15 – December 7, 2026, with choices taking effect January 1, 2027. Social Security also announced a 3.6% cost-of-living adjustment for benefits starting January 2027. The 2027 Part B standard premium, Part B deductible, and IRMAA income-related surcharges have not yet been announced; CMS releases them in the fall, usually in November.

If you have Medicaid or Extra Help, since 2025 you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan — or to switch stand-alone Part D plans. If you are a full-benefit dual-eligible, you can join an integrated D-SNP in any month.

Where can you get help with Medicare questions?

For the official rules, forms, and plan comparison tools, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week. For QDWI specifically, your state Medicaid office handles the application.

Returning to work shouldn't cost you your health coverage. Between the Part A buy-in and QDWI, the system is built to keep you insured while you build your career.