Most people on SSDI receive Medicare automatically after 24 months

If you receive Social Security Disability Insurance (SSDI), you become covered by Medicare Part A (hospital insurance) and Part B (medical insurance) automatically after you have been on SSDI for 24 consecutive months. You do not need to sign up separately or pay an enrollment fee for this coverage to begin. The 24-month clock starts from the month your SSDI payments begin, not from the month you filed your claim.

This automatic enrollment is different from how Medicare works for people over 65. You will receive your Medicare card in the mail about three months before your 24-month period ends. If you do not receive it, contact Social Security to confirm your address is correct in their system.

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Both have costs — Part B has a monthly premium, and both have deductibles and copayments when you use services.

Key Takeaways

  • Medicare Part A and Part B start automatically after 24 months on SSDI; you do not need to enroll or pay to set up this coverage.
  • The 24-month waiting period begins when your SSDI payments start, not when you filed your claim.
  • You will receive your Medicare card by mail roughly three months before coverage begins.
  • Part A is free, but Part B has a monthly premium that is usually deducted from your SSDI check.
  • You can choose to add prescription drug coverage (Part D) and supplemental insurance (Medigap) once you have Medicare.

What happens during the 24-month waiting period

Before your Medicare coverage begins, you are responsible for your own health insurance. Some people on SSDI during this period use Medicaid instead, which is a separate program run by your state. Medicaid rules vary by state — some states cover people on SSDI automatically, while others require a separate Medicaid process. Contact your state Medicaid office or call 211 to learn what is available where you live.

Others purchase private insurance through the health insurance marketplace or through an employer. If you have very low income, you may be able to get a tax credit to reduce your marketplace premium. You can enroll in marketplace coverage during the annual open enrollment period (usually November through January) or if you have a may have access to life event, such as losing other coverage.

Some people have employer coverage through a spouse or family member. If that is your situation, you can keep it during the 24-month wait and coordinate it with Medicare once it begins.

Part A is free; Part B has a monthly cost

Part A costs you nothing. It is funded through payroll taxes and is free to all people on SSDI once the 24-month period ends. There is no monthly premium, though you will pay a deductible when you are admitted to a hospital ($1,600 in 2024, though this amount changes yearly).

Part B has a monthly premium. For most people in 2024, the standard premium is $164.90 per month, but the amount depends on your income from two years prior. If your income is higher, your premium may be higher. Social Security deducts the Part B premium directly from your SSDI check each month, so you do not receive a separate bill.

Both Part A and Part B have copayments and coinsurance when you use services. For example, Part A covers the first 60 days of a hospital stay fully after you pay the deductible, but days 61–90 require a daily copayment. Part B typically covers 80 percent of approved services after you meet your annual deductible ($240 in 2024), and you pay the remaining 20 percent.

Prescription drug coverage and supplemental insurance options

Medicare does not automatically include prescription drug coverage. You can add Part D (prescription drug coverage) through a private insurance company during the annual enrollment period (October 15 through December 7 each year) or when you first become Medicare-may be able to access. If you do not enroll in Part D when you first become may be able to access and you go without it for more than 63 days, you may pay a penalty for as long as you have Medicare.

You can also purchase Medigap (supplemental insurance) to cover costs that Medicare does not pay, such as copayments and coinsurance. Medigap is sold by private insurance companies and is separate from Medicare itself. If you enroll in Medigap within six months of your Part B start date, insurance companies cannot deny you coverage or charge you more based on your health history.

Some people on SSDI with very low income may be covered by both Medicare and Medicaid (called "dual may be able to access"). If that applies to you, Medicaid may pay your Part B premium and cover some of your copayments. Your state Medicaid office can tell you whether you may have access to.

What to do if you do not receive your Medicare card

Social Security mails Medicare cards about three months before your coverage begins. If you do not receive yours, contact Social Security directly. You can call 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office in person. Have your SSDI case number ready.

You do not need your physical card to start using Medicare on your start date. Doctors and hospitals can look up your coverage using your Social Security number. However, it is useful to have the card for your records and to show providers if there are questions about your coverage.

If your address has changed since you filed for SSDI, update it with Social Security as soon as possible. You can change your address online at ssa.gov, by phone, or in person at a Social Security office.

How SSDI and Medicare interact with other coverage

If you have health insurance through an employer or a spouse while on SSDI, that coverage is called primary and Medicare is secondary. This means your employer plan pays first, and Medicare pays its share of costs that your employer plan does not cover. You should tell your employer's benefits administrator that you have Medicare so they can coordinate correctly.

If you are still working and earning income, you may have continued access to employer health insurance. Some employers allow employees to stay on the health plan even while on SSDI. Check with your employer's human resources department about your options.

If you have Medicaid and Medicare both, Medicaid is usually secondary. Medicaid may help pay your Medicare premiums and cover services Medicare does not, depending on your state's rules.

Frequently Asked Questions

What if I go back to work and stop receiving SSDI?

If your SSDI payments stop because you return to work, your Medicare coverage continues for at least 93 months (about 7.5 years) after your payments end, even if you no longer meet SSDI rules. After that period, you can continue Medicare by paying the full Part B premium yourself, or you may become may be able to access for Medicare through age or another route.

Can I enroll in Medicare before 24 months if I have end-stage renal disease or ALS?

Yes. People on SSDI with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) become Medicare-may be able to access when ready, not after 24 months. Contact Social Security to confirm your coverage start date if you have either condition.

Do I have to take Part B, or can I decline it?

You can decline Part B when it is first offered, but if you do and later want to enroll, you may face a permanent premium penalty. The only exception is if you have employer coverage when Medicare begins. If you are unsure, contact Medicare at 1-800-633-4227 to discuss your situation before declining.

Will my Part B premium change after I start receiving it?

Yes. Your Part B premium is based on your income from two years before. If your income changes significantly, your premium may change. Social Security will notify you if your premium amount changes and will adjust your SSDI check accordingly.

What if I move to a different state?

Medicare coverage follows you to any state. However, if you move, check whether your doctors and hospitals accept Medicare in your new state, and review your Part D prescription drug plan to make sure your medications are still covered. You may need to switch plans if your current one does not serve your new location.