SSDI includes two types of medical insurance, but not when ready

Yes, Social Security Disability Insurance (SSDI) includes medical coverage, but there is a waiting period. After you have been receiving SSDI payments for 24 months, you become covered by Medicare. This is automatic — you do not need to sign up separately. Medicare Part A covers hospital stays, skilled nursing care, and hospice. Medicare Part B covers doctor visits, outpatient care, and medical equipment.

Before those 24 months pass, you may be covered by Medicaid instead, depending on your state. Medicaid is a joint federal and state program, so the rules about who gets it vary. Some states cover people on SSDI right away. Others have income or resource limits that may disqualify you even though you receive SSDI. A few states cover SSDI recipients only after a waiting period shorter than 24 months.

The key point: you will have some form of medical coverage during the waiting period in most states, but the type and what it covers depends on where you live.

Key Takeaways

  • Medicare begins automatically after 24 months of receiving SSDI payments and covers hospital care, doctor visits, and medical equipment.
  • Before 24 months, Medicaid may cover you, but coverage rules vary by state — some states cover SSDI recipients when ready, others do not.
  • You pay a monthly premium for Medicare Part B (the doctor visit portion), though the amount is deducted from your SSDI check.
  • Both Medicare and Medicaid have copays and deductibles, so you may still owe money when you receive care.

How the 24-month waiting period works

The 24 months begins the month your SSDI payments start, not the month you filed. If you are approved in March and your first check arrives in April, the 24-month clock starts in April. You will become may be able to access for Medicare in April of the following year, two years later.

During those 24 months, you are still receiving your monthly SSDI payment. You are just not yet covered by Medicare. If you need medical care before the 24 months are up, Medicaid is your main option — but again, whether you have it depends on your state.

After 24 months, Medicare coverage begins automatically. Social Security will send you a Medicare card in the mail before your coverage starts. You do not have to do anything to set up it.

Medicaid coverage before Medicare begins

Medicaid is run by each state, so the rules about who gets it are different in every state. In some states, receiving SSDI automatically qualifies you for Medicaid. In others, you have to meet additional income or resource limits. A few states have a separate waiting period.

To find out whether you have Medicaid coverage right now, contact your state's Medicaid office. You can find the phone number by searching "[your state name] Medicaid" online, or by calling 211 (a free helpline that connects you to local programs). They can tell you in one call whether you are covered and what services are included.

Medicaid covers doctor visits, hospital stays, prescription drugs, and mental health services. The specific services and copays vary by state. Some states cover dental and vision care through Medicaid; others do not.

What Medicare covers and what it costs

Medicare Part A covers inpatient hospital care, skilled nursing facility stays (after a hospital stay), home health care, and hospice. There is no monthly premium for Part A — it is included in SSDI.

Medicare Part B covers doctor office visits, outpatient surgery, lab tests, imaging, and durable medical equipment like wheelchairs or oxygen. Part B has a monthly premium, which is deducted automatically from your SSDI check. The premium amount changes each year. In 2024, the standard premium is $164.90 per month, but you may pay more or less depending on your income.

Both Part A and Part B have deductibles and copays. For example, Part A has a deductible for hospital stays (the amount you pay before Medicare starts paying). Part B has a yearly deductible and then you pay 20 percent of the cost of most services after that. These costs add up, which is why many people on SSDI also look into supplemental insurance or Medicaid to help cover the gaps.

Medicare Part D for prescription drugs

Prescription drug coverage is not automatic with Medicare. You have to choose a Part D plan, which is offered by private insurance companies approved by Medicare. Part D plans vary in cost and which drugs they cover.

When you become may be able to access for Medicare after 24 months of SSDI, you have a window of time to sign up for Part D without penalty. If you miss that window and sign up later, you may have to pay a higher premium for the rest of your life. You can sign up during the general enrollment period (January 1 to March 31 each year) or during the annual open enrollment period (October 15 to December 7).

Social Security will send you information about Part D plans before your Medicare coverage begins. You can also compare plans at Medicare.gov.

What happens to Medicaid after Medicare begins

In most states, you keep Medicaid even after Medicare begins. This is called dual coverage. Medicaid then acts as a secondary payer, covering some of the costs that Medicare does not — like copays, deductibles, and services Medicare does not cover.

In a few states, Medicaid ends when Medicare begins, or the coverage changes. Contact your state Medicaid office to find out what will happen in your state when you reach 24 months of SSDI.

How to sign up for Medicare when the time comes

You do not need to sign up for Medicare Part A — it starts automatically. Social Security will mail you a Medicare card about three months before your coverage begins.

For Part B, you should sign up during the initial enrollment period, which is the three months before the month you become may be able to access, the month itself, and the three months after. If you enroll during this window, your coverage starts the month you become may be able to access. If you miss this window, you can still sign up during the general enrollment period (January 1 to March 31), but your coverage will not start until July 1 of that year, and you may pay a higher premium.

You can sign up for Part B online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Frequently Asked Questions

Do I have to pay for Medicare if I am on SSDI?

Part A is free. Part B has a monthly premium (around $164.90 in 2024) that is taken out of your SSDI check automatically. Part D (prescription drugs) also has a monthly premium that varies by plan. You also pay copays and deductibles when you use services.

What if I cannot afford the Medicare premium?

If your income is very low, you may be able to get help paying the Part B premium through a program called Savings Programs. Contact your state Medicaid office or call 1-800-MEDICARE to see if you may have access to. Some people also may have access to for Extra Help with Part D costs.

Can I use Medicaid and Medicare at the same time?

Yes, in most states. This is called dual coverage. Medicaid covers some of the costs that Medicare does not, like copays and deductibles. Rules vary by state, so check with your state Medicaid office about what will happen when your Medicare begins.

What if I move to a different state after I start SSDI?

Your SSDI and Medicare coverage move with you. Medicaid rules are different in every state, so contact your new state's Medicaid office to find out what coverage you have there. Your Medicare coverage stays the same no matter where you live.

Does SSDI cover dental or vision care?

Medicare does not cover routine dental or vision care. Some state Medicaid programs do cover these services, but not all. Check with your state Medicaid office to see what is covered where you live.