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Social Security Disability (SSDI) and Medicare: How Do They Work Together

Most people don’t become eligible for Medicare until they turn 65. However, if you’re receiving Social Security Disability Insurance benefits, you may qualify for Medicare early.

Do I Qualify for Social Security Disability and Medicare Benefits?

Medicare and disability benefits from Social Security help people who are unable to work due to injury or disease. You may qualify for Social Security Disability Insurance if you’re at least 18 years old, and can’t work for 12 months or longer. You can learn more about the requirements on the Social Security Administration’s website, and even apply online.

You’ll be eligible and automatically enrolled in Medicare Part A and Medicare Part B once you’ve been receiving Social Security Disability benefits, or disability benefits from the Railroad Retirement Board, for 24 months. You’ll receive your Medicare card in the mail up to three months before your coverage starts. If you want to verify your start date, or haven’t received your Medicare card, you can contact Social Security directly.

Medicare Eligibility for End-Stage Renal Disease and Amyotrophic Lateral Sclerosis (ALS)

 If you have Lou Gehrig’s disease (ALS) or ESRD, you don’t have to wait through the 24-month period before you’re eligible for Medicare. If you have ALS, your Medicare coverage starts when you begin collecting disability benefits.

If you’re being treated for ESRD, you’ll become eligible for Medicare 3 months after dialysis begins, or after you receive a kidney transplant. You won’t be automatically enrolled, so you need to contact Social Security or the Railroad Retirement Board to start the process.

Do I have to Pay for Medicare on SSDI?

Medicare isn’t free for most people on Social Security Disability Insurance. Unless you qualify for another form of income-based help, you’ll most likely need to pay the Medicare Part B premium, which for most people in 2020 is $144.60. It’s unlikely that you’ll have to pay for Part A. In addition to the Part B premium, you may be responsible for other costs, as outlined below.

What are the Medicare Disability Benefits?

Once you qualify for Medicare through Social Security Disability, you’ll receive all of the standard benefits of Medicare Parts A and B, also known as Original Medicare. These benefits include:

  • Inpatient care in hospitals
  • Inpatient rehabilitation facilities
  • Long-term care hospitals
  • Skilled nursing facilities
  • Home health care services
  • Hospice care
  • Ambulance service
  • Inpatient outpatient care
  • Partial hospitalization
  • Clinical research
  • DME (durable medical equipment)

It’s important to note that in most cases, Original Medicare only pays up to 80% of these costs, after deductibles and copays. These out-of-pocket costs can be difficult to manage, and don’t include prescription medications. Fortunately, there are a few options to help you control your expenses.

Disability and Medicare Supplement Plans

Medicare Supplement plans work secondary to Medicare, and come in a variety of coverage options. Unfortunately, the premiums for Medicare Supplement plans for people under 65 on disability can be expensive, and they don’t cover prescription medications.

Disability and Medicare Advantage Plans

Medicare Advantage plans are a form of private insurance, and are primary instead of Original Medicare. While the claims-paying process and doctor networks may be different, they’re required to offer benefits that are considered at least equal to Medicare. Some Advantage plans include prescription drug coverage.    

Disability and Medicare Part D Prescription Drug Plans

If you don’t have creditable prescription insurance through another source, like a Medicare Advantage plan, you should enroll in a Medicare Part D plan to start when your other Medicare benefits begin. A Part D Prescription Drug plan can help you control your medication costs, so you’re not paying for them entirely out-of-pocket.

Social Security Disability and Medicare can help support you if you’re unable to work. Once you’re eligible for Medicare, it’s important to keep in mind that all of your costs won’t be covered. You should begin looking into your options for additional coverage before your SSDI Medicare benefits begin, so that you know what to expect and don’t have any gaps in your coverage.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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