SSDI includes Medicare, not Medicaid, after you have received benefits for 24 months

Social Security Disability Insurance (SSDI) automatically enrolls you in Medicare once you have been receiving monthly payments for 24 consecutive months. This is not Medicaid — it is the same federal health insurance program that covers people age 65 and older. You do not choose it, pay a separate premium for it, and you cannot turn it down without losing your SSDI cash benefit.

The 24-month waiting period starts the month your first SSDI payment arrives, not the month you were approved. If you were approved in March but your first check came in April, the 24 months begins in April. Medicare then starts the first day of the month after your 24-month mark is reached.

During those first 24 months, you are responsible for finding your own health coverage. Some people use Medicaid (a separate program run by your state), marketplace insurance, or coverage through a job. SSDI does not pay for any of these — you must arrange them yourself.

Key Takeaways

  • Medicare Part A (hospital insurance) and Part B (doctor visits) start automatically after 24 months of SSDI payments, with no process required.
  • You pay a monthly premium for Part B, which is deducted directly from your SSDI check; Part A is free for most people.
  • During the first 24 months of SSDI, you must find your own health coverage through Medicaid, a job, or the marketplace.
  • Medicare covers hospital stays, doctor visits, and some prescription drugs, but has copays, deductibles, and coverage limits you should understand before you need care.

What Medicare covers once you are enrolled

Medicare has four parts. Part A covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services. Part B covers doctor visits, outpatient care, lab tests, and some equipment. Both start automatically after your 24-month waiting period. Most people pay nothing for Part A but pay a monthly premium for Part B — the standard amount in 2024 is $164.90 per month, though it changes yearly and is higher if your income is above a certain threshold.

Part D is prescription drug coverage. You must choose and enroll in a Part D plan yourself during your initial enrollment window, which begins three months before the month you turn 65 or become Medicare-may be able to access through disability. If you do not enroll when you first become may be able to access, you may pay a penalty for late enrollment for as long as you have Medicare. Part D plans vary by region and by what drugs they cover, so comparing plans before you enroll matters.

Part C, also called Medicare Advantage, is optional. It is an alternative to Parts A, B, and D offered by private insurance companies. Some people choose it for lower out-of-pocket costs or added benefits like dental or vision, but it typically has narrower networks of doctors and hospitals. You do not have to choose Part C — you can stay with Original Medicare (Parts A and B) instead.

Costs you will pay under Medicare

Medicare is not free. Part B has a monthly premium deducted from your SSDI check. Part A is free for most SSDI beneficiaries, but you will pay copays and deductibles when you use hospital or skilled nursing care. In 2024, the Part A hospital deductible is $1,632 per benefit period, meaning you pay that amount out of pocket before Medicare starts paying. Skilled nursing facilities require a copay after day 20 of a stay.

Part B also has an annual deductible — $240 in 2024 — and you pay 20 percent of the cost of most doctor visits and services after you meet it. Prescription drugs under Part D have copays that vary by plan and by which tier the drug is on. Some drugs cost $5 to $15 per month; others cost much more if they are brand-name or specialty medications.

If your income is very low, you may be able to reduce these costs through Extra Help (for Part D) or Medicaid (which can cover your Part B premium and cost-sharing). These are separate programs with their own income limits. Your local Social Security office or your state Medicaid agency can tell you whether you may have access to.

What to do during the 24-month wait for Medicare

You need health coverage from the moment your SSDI begins, not 24 months later. The most common option is Medicaid, your state's program for people with low income. Medicaid rules vary by state — some states cover everyone with income below a certain level, others have stricter rules. You explore through your state's Medicaid office or online portal, not through Social Security.

If you do not may have access to for Medicaid, you can buy marketplace insurance through Healthcare.gov or your state's marketplace. You may be able to reduce the monthly premium if your income is low enough. You can also stay on a parent's or spouse's health plan if you are may be able to access, or get coverage through a job if you work.

Some people use a combination: Medicaid for the first 24 months, then Medicare after that. Others switch from marketplace insurance to Medicare. The key is to have something in place before your SSDI starts, because a gap in coverage can mean unpaid medical bills.

How Medicare works alongside other insurance

If you have both Medicare and Medicaid (called "dual may be able to access"), Medicaid usually pays your Medicare premiums and cost-sharing. If you have both Medicare and marketplace insurance, Medicare is primary — it pays first, and marketplace insurance pays second if there is anything left. You cannot use both to avoid paying anything; they coordinate to cover costs, not to double-cover them.

If you are still working and have health insurance through your job, you can keep it while you have Medicare. Medicare will coordinate with your employer plan, and you will pay both premiums. Some people do this if their employer plan is better than Medicare for their specific needs.

Enrolling in Part D and choosing a plan

Part D enrollment is your responsibility. Social Security will send you a notice about three months before you become Medicare-may be able to access, telling you to choose a plan. You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Part D plans differ in which drugs they cover, what the copays are, and which pharmacies you can use. If you take prescription medications, compare plans based on your specific drugs, not on the plan name or premium alone. A plan with a lower monthly premium might have higher copays for the drugs you need. Medicare.gov has a tool to compare plans by entering your medications.

You have a seven-month initial enrollment window: three months before the month you become may be able to access, the month itself, and three months after. If you miss this window and do not have other creditable drug coverage, you will pay a late enrollment penalty — usually 1 percent of the national average Part D premium for each month you were late — for as long as you have Medicare.

Changes to your coverage after you enroll

Once you are on Medicare, you can make changes during the annual open enrollment period, which runs from October 15 to December 7 each year. Changes take effect January 1. You can switch Part D plans, switch from Original Medicare to Medicare Advantage or vice versa, or add or drop coverage.

You can also make changes outside the annual period if you have a may have access to life event — you move out of your plan's service area, lose other health coverage, or have a significant change in income. Contact Medicare at 1-800-MEDICARE to report a may have access to event and see what changes you can make.

Frequently Asked Questions

Do I have to take Medicare when it starts, or can I turn it down?

You cannot turn down Medicare without losing your SSDI cash benefit. If you refuse Medicare, Social Security will stop your monthly payments. You can choose which Part D plan to enroll in, and you can choose Medicare Advantage instead of Original Medicare, but you cannot refuse Medicare itself.

What if I do not have a prescription drug plan when Medicare starts?

You should enroll in Part D during your initial enrollment window. If you miss it and do not have other drug coverage, you will pay a late enrollment penalty for life. If you have coverage through an employer or another source that is considered "creditable," you may not have to pay the penalty, but you must tell Medicare about it.

Can I use Medicaid and Medicare at the same time?

Yes. If you are may be able to access for both, Medicaid can pay your Medicare premiums and help with copays and deductibles. You explore for Medicaid through your state, not through Social Security. Income limits vary by state.

Does Medicare cover dental, vision, or hearing?

Original Medicare does not cover routine dental, vision, or hearing care. Medicare Advantage plans sometimes include these benefits, but they vary by plan and region. If these services matter to you, compare Medicare Advantage plans in your area or look into separate dental and vision plans.

What happens to my health coverage if I go back to work and earn too much for SSDI?

If your earnings cause you to lose SSDI, you can keep Medicare for at least 93 months (about 7.5 years) after your SSDI ends, though you will have to pay the Part B and Part D premiums yourself. After that, you can buy marketplace insurance or use coverage through your job. Talk to Social Security before you start working to understand how it affects your benefits.