Recipients of SSDI are automatically enrolled in Original Medicare Parts A and B beginning the 25th month of coverage. Find out when SSDI beneficiaries qualify for Medicare Supplement, Medicare Advantage, and Medicare drug coverage.
Do You Qualify for Medicare Coverage with Social Security Disability Benefits?
Everyone eligible for SSDI benefits is also eligible for Original Medicare Parts A and B after a 24-month qualifying period. This coverage automatically begins on the first day of the 25th month of disability. You then become eligible for Medicare Advantage and Medicare Drug coverage. SSDI and Medicare Supplement coverage is dependent upon state legislation and each state takes a different approach.
You can call the Social Security Administration (SSA) for information at (800) 772-1213.
How Do You Qualify for Social Security Disability Benefits?
Qualifying for SSDI is a complicated process and many people find the need to consult an attorney to expedite the process. SSA has instructions and offers an online application.
Qualification for SSDI has only two criteria, which are not entirely straightforward.
- You must have worked in jobs covered by SSA and worked enough quarters to qualify. Generally, the qualification is the same as Medicare — 40 quarters of qualifying work with 20 earned in the last 10 years ending with the year your disability begins. Younger workers may qualify with fewer credits. Learn how you can earn credits.
- Your medical condition must meet SSA’s strict definition of disability. This can be a tricky area to discern and is often the reason for seeking counsel. However, an article on the SSA website Disability Evaluation Under Social Security educates on this subject. Medicare Eligibility For People With Disabilities is also helpful in understanding SSDI qualifications.
How Do You Apply for Medicare if You Receive Social Security Disability Benefits?
Because Medicare is automatic for those on SSDI, Medicare should contact you during the three-month period prior to your 25th month of receiving SSDI benefits. But it is incumbent upon you to contact SSA if the information has not been received in a timely manner. For information, sign in or apply for a SSA account, or call (800) 772-1213.
- When do you become eligible for Medicare if you have Amyotrophic Lateral Sclerosis (ALS)? For years, the 24-month waiting period for SSDI was shortened to five months for those on SSDI due to ALS. However, Congress passed the ALS Disability Insurance Access Act of 2019, which waives any waiting period for ALS applicants approved for benefits on or after July 23, 2020.
- When do you become eligible for Medicare if you have End-Stage Renal Disease (ESRD)? If you have ESRD, you can receive Medicare no matter how old you are, but you must meet the following qualifications.
- Medical: Your kidneys no longer work, you have had a kidney transplant, or are receiving regular dialysis.
- Financial: You qualify for SSA or the Railroad Retirement Board (RRB) benefits through work credits, or you are currently receiving benefits.
- For in-depth information on ESRD and Medicare, download this pamphlet.
Do You Have to Pay for Medicare if You Receive Social Security Disability Benefits?
For those who qualify for Medicare based on SSDI, Medicare Part A is automatic and premium-free. However, the Part B premium of $170.10 in 2022 is applicable to SSDI recipients. Because you are receiving SSDI monthly benefits, premiums will be deducted from your check.
What Medicare Benefits Do You Receive With Social Security Disability Benefits?
Medicare benefits received under SSDI are considered full benefits. All hospital services received under Part A and Medical services received under Part B are applicable.
|SSDI Medicare Benefits|
|Part A services include:
||Part B services include:
Can you get a Medicare Supplement (Medigap) plan on disability?
At the present time, there is no federal legislation that guarantees enrollment in Medigap for beneficiaries under age 65. It is left to the states to enact legislation that makes Medigap coverage a guaranteed issue.
Only 11 states require insurers to offer at least one Medigap plan to those under age 65 with an equal number making all plans guaranteed-issue, but under-65 premiums can be much higher. Twelve states make all plans guaranteed-issue and include restrictions on premiums. Also, 12 states and Washington, D.C., have no coverage requirement for insurers. Four states have not even addressed the issue of Medicare for those under 65.
Can you get a Medicare Advantage plan on disability?
SSDI beneficiaries of any age are eligible for Medicare Advantage Plans offered in each state. Plans can be researched by logging on to the Medicare Plan Finder.
What is the Takeaway?
Both SSDI and Medicare are complicated programs that can be life-changing when combined in the lives of disabled individuals. While this article answers many of the common questions asked, it is recommended that counsel be enlisted for those with difficult circumstances.
Representatives at SSA field offices are available to help you apply for SSDI benefits and establish your qualification. You can make an appointment by calling 1 (800) 772-1213 or stopping by your local office.
Learn More From Our Sources
- https://www.ssa.gov/applyfordisability/ | Last accessed November 2022
- Social Security | Disability Evaluation Under Social Security | Last accessed November 2022
- Social Security | How You Earn Credits | Last accessed November 2022
- Social Security | Social Security Office Locator | Last accessed November 2022