Yes, Medicare is included with SSDI after a waiting period
When you receive SSDI payments, you become covered by Medicare automatically — but not right away. Medicare coverage begins in the 25th month after your SSDI payments start. This means if your first SSDI check arrives in January, your Medicare coverage will begin in February of the following year.
Medicare under SSDI is the same program that covers people age 65 and older. You pay the same premiums and have the same coverage options. The waiting period exists because SSDI itself has a five-month waiting period before payments begin, and Medicare coverage is tied to when you have been receiving SSDI for 24 months.
You do not need to do anything to enroll in Medicare when you become may be able to access through SSDI. The Social Security Administration automatically registers you, and your Medicare card will arrive in the mail about three months before your coverage starts.
Key Takeaways
- Medicare coverage begins in your 25th month of receiving SSDI, not when you are approved or when payments start.
- You are automatically enrolled in both Medicare Part A (hospital insurance) and Part B (medical insurance) at no action required on your part.
- You will pay a monthly premium for Part B, which is deducted directly from your SSDI check unless you opt out.
- If you have other health coverage through a job or family member, you can delay Part B enrollment without penalty if certain conditions are met.
What Medicare Parts A and B cover under SSDI
Medicare Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. There is no monthly premium for Part A. You pay a deductible when you are admitted to the hospital, and you may owe copayments for longer stays.
Medicare Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part B has a monthly premium that changes each year. In 2024, the standard premium is $164.90 per month for most people, though higher earners pay more. This premium is taken directly from your SSDI payment.
Neither Part A nor Part B covers dental, vision, or hearing services. If you need these, you can purchase a separate Medigap policy or a Medicare Advantage plan that includes them, though these have additional costs.
How to handle health coverage before Medicare starts
The 24-month wait for Medicare creates a gap. During this time, you need other coverage. Many people use Medicaid, which is a separate program run by your state. Medicaid covers low-income individuals and has no waiting period — you may be covered as soon as your SSDI is approved, depending on your state's rules.
To learn about you may have access to for Medicaid while waiting for Medicare, contact your state's Medicaid office or your local Social Security office. Some states cover SSDI recipients automatically; others require a separate process. A few states have not expanded Medicaid, which affects what is available to you.
If you have a job and employer health coverage, you can keep that coverage during the waiting period. You do not have to switch to Medicaid. When Medicare starts, you can coordinate it with your employer plan.
What happens to your coverage if you return to work
If you earn enough money to lose SSDI benefits, your Medicare coverage does not stop when ready. You can continue Medicare Part A for up to 93 months (about 7.5 years) after your benefits end, even if you are working and earning above the limit. Part A has no premium, so this is valuable coverage for hospital care.
Part B coverage continues as long as you pay the monthly premium. If you do not pay, your coverage ends and you may face a penalty if you enroll later. You can drop Part B if you have other coverage through your employer, and you can enroll again without penalty when that coverage ends.
This extended Medicare coverage is one reason people on SSDI can afford to try working — you do not lose health insurance the moment your earnings go up.
Medicare Advantage and Medigap plans available to SSDI beneficiaries
Once you have Medicare, you can choose between Original Medicare (Part A and Part B as described above) or a Medicare Advantage plan. Medicare Advantage plans are offered by private insurance companies and usually include prescription drug coverage, dental, and vision. They often have lower premiums than Original Medicare plus a separate drug plan.
You can also buy a Medigap policy, which is supplemental insurance that covers costs Original Medicare does not pay. Medigap policies have their own monthly premiums on top of your Part B premium.
You can switch between Original Medicare and Medicare Advantage once per year during the Annual Enrollment Period, which runs from October 15 to December 7. If you miss this window, you may not be able to change plans until the next year.
Prescription drug coverage through Medicare Part D
If you choose Original Medicare, you need to enroll in a Medicare Part D prescription drug plan separately. These plans are offered by private insurance companies and cover medications. Each plan has a different list of covered drugs, so you should compare plans based on the medications you take.
Part D enrollment happens during the same Annual Enrollment Period as Medicare Advantage changes. If you do not enroll when you first become may be able to access, you may pay a penalty for each month you go without coverage. The penalty is added to your Part D premium for as long as you have Medicare.
If you are on a Medicare Advantage plan, prescription drug coverage is usually included, so you do not need a separate Part D plan.
How SSDI and Medicaid work together during the waiting period
In most states, being approved for SSDI makes you automatically may be able to access for Medicaid. This is called Section 1619(b) coverage in some states, which means you can keep Medicaid even if your SSDI payments are reduced because of work earnings. The rules vary by state.
Medicaid covers services that Medicare does not, including dental, vision, hearing aids, and long-term care. During your 24-month wait for Medicare, Medicaid is often your main coverage. Once Medicare starts, you have both — Medicaid fills in gaps that Medicare leaves.
To understand what Medicaid covers in your state and whether you are automatically enrolled, contact your state's Medicaid office or ask at your local Social Security office. They can tell you what to expect and what paperwork you might need.
Frequently Asked Questions
Do I have to take Medicare Part B when it starts, or can I turn it down?
You can decline Part B by submitting a form to Social Security, but this is rarely a good idea. If you turn it down and later want to enroll, you will pay a permanent penalty on top of the premium. The only reason to decline is if you have employer coverage that is considered "creditable" — ask your employer's benefits office before you refuse.
What if I cannot afford the Medicare Part B premium?
If your income is very low, you may may have access to for Medicare Savings Programs (MSP), which are run by your state and pay your Part B premium and other costs. Contact your state Medicaid office to see if you may have access to. Some people also may have access to for Extra Help with Part D drug costs.
Does Medicare cover mental health and substance use treatment?
Yes. Medicare Part B covers outpatient mental health visits and therapy. Hospital stays for mental health or substance use treatment are covered under Part A. Coverage rules are the same as for physical health conditions, though some plans have limits on the number of visits per year.
Can I switch from Medicaid to Medicare when my coverage starts, or do I have both?
You have both. Medicaid and Medicare work together — Medicare is your primary coverage, and Medicaid covers costs Medicare does not pay. You do not have to choose one or the other. In some states, Medicaid coverage ends when Medicare starts; in others, it continues. Contact your state Medicaid office to learn what happens in your state.
What if I move to a different state after I start receiving SSDI?
Your SSDI payments and Medicare coverage follow you to any state. Medicaid coverage may change because each state runs its own program with different rules. Contact the Medicaid office in your new state as soon as you move to find out what coverage you have there.