Medicare Begins Automatically After 24 Months on SSDI

You do not need to take any action to start Medicare. Social Security automatically enrolls you in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) after you have been receiving SSDI payments for 24 consecutive months. The 24-month clock starts the first month you receive a payment, not the month you were approved.

Your Medicare coverage becomes active on the first day of the 25th month. Social Security mails your Medicare card to the address on file about two weeks before coverage starts. If you do not receive it, you can request a replacement card through your Social Security account or by calling 1-800-772-1213.

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 (the amount varies by income), and both have deductibles and copayments when you use services.

Key Takeaways

  • Medicare enrollment happens automatically 24 months after your first SSDI payment; you do not need to do anything.
  • Your coverage starts on the first day of month 25, and Social Security mails your card about two weeks before that date.
  • Part A (hospital) is free; Part B (doctor) has a monthly premium that is deducted from your SSDI check unless you opt out.
  • If you have other health insurance when Medicare starts, tell Medicare about it so they coordinate payments correctly.
  • You can choose to delay Part B enrollment, but doing so may result in a permanent penalty on your premium.

What Happens During Your First 24 Months on SSDI

During the 24 months before Medicare starts, you are responsible for finding your own health coverage. Many SSDI recipients use Medicaid, which is a separate program run by your state. Medicaid covers low-income individuals and has no waiting period — you may be able to start Medicaid the same month you start SSDI, depending on your state's rules.

If you have employer health insurance through a job or a family member's job, you can keep it while you wait for Medicare. Tell your employer or the plan administrator that you will be getting Medicare in a few months so they know to coordinate benefits when the time comes.

If you have neither Medicaid nor employer coverage, you can purchase a plan through the Health Insurance Marketplace (healthcare.gov) or through your state's marketplace. You may be may be able to access for subsidies that lower the monthly cost, depending on your income.

Your Medicare Card and Coverage Start Date

Social Security mails your Medicare card to your address on file approximately 14 days before your coverage begins. The card shows your Medicare number (which is your Social Security number followed by a letter), your name, and the date your coverage starts.

If your address has changed since you applied for SSDI, update it in your Social Security account online at ssa.gov or by calling 1-800-772-1213. If you do not receive your card by the time your coverage starts, you can still use Medicare — providers can look up your coverage using your Social Security number. Request a replacement card when ready so you have it for future visits.

Your coverage is active even if you have not received the physical card. Do not delay medical care waiting for it to arrive.

Part A and Part B: What You Pay

Part A has no monthly premium. You pay a deductible (a set amount you pay out of pocket before Medicare starts paying) when you are admitted to a hospital. The deductible amount changes each year; in 2024 it is $1,676 for a hospital stay. After you meet the deductible, Medicare covers most hospital costs, though you may owe copayments for longer stays.

Part B has a monthly premium that Social Security deducts from your SSDI check. The standard premium in 2024 is $164.90 per month, but the amount varies based on your income from two years prior. If your income was very low when you applied for SSDI, your premium may be lower. Part B also has a yearly deductible ($240 in 2024) and a 20% copayment for most services after you meet the deductible.

If you cannot afford the Part B premium, you may be able to get help through a program called Medicaid Buy-In or may have access to Medicare Beneficiary (QMB), which varies by state. Contact your state Medicaid office to learn whether you may have access to.

Coordinating Medicare With Other Insurance

If you have Medicaid when Medicare starts, both programs will work together. Medicare is your primary payer (it pays first), and Medicaid covers some of the costs Medicare does not, such as deductibles and copayments. This is called dual coverage. You keep both programs — do not cancel Medicaid when Medicare begins.

If you have employer health insurance, tell the plan administrator that you now have Medicare. Medicare becomes your primary payer, and the employer plan pays second. Your employer plan will coordinate with Medicare to avoid duplicate payments.

If you have a Marketplace plan (from healthcare.gov), you should cancel it when Medicare starts, because you cannot have both. Medicare is more comprehensive and costs less than most Marketplace plans for SSDI recipients. Contact the Marketplace to cancel your plan so you do not continue paying the premium.

What to Do If You Do Not Want Part B

You can refuse Part B enrollment when Medicare starts, though this is rarely the right choice. If you refuse Part B and later change your mind, you can enroll during the General Enrollment Period (January 1 to March 31 each year), but your premium will be permanently higher — it increases by 10% for each year you delayed enrollment.

The only reason to refuse Part B is if you have employer health insurance that covers you as an active employee (not as a retiree or dependent). If that is your situation, you can delay Part B without penalty as long as you enroll within eight months after your employer coverage ends.

If you are unsure whether to enroll, contact Medicare at 1-800-MEDICARE (1-800-633-4227) to discuss your specific situation. Do not refuse enrollment without understanding the long-term cost.

Checking Your Medicare Status and Making Changes

You can view your Medicare coverage details and make changes through Medicare.gov. Create an account using your Social Security number and password. From there you can see your coverage dates, your deductibles, your premium amount, and your claims history.

If you need to change your address, update your direct deposit information, or report a change in income, do this through your Social Security account at ssa.gov. Changes to your Social Security record automatically update your Medicare record.

If you move to a different state, your Medicare coverage continues without interruption. However, your Medicaid coverage may change because each state has different rules. Contact your new state's Medicaid office to learn about coverage in your new location.

Frequently Asked Questions

What if I turn 65 while receiving SSDI?

Your SSDI automatically converts to Social Security Retirement at age 65, but your Medicare coverage does not change. You keep the same Medicare card and the same coverage. Your monthly payment amount may change slightly because the calculation switches from disability rules to retirement rules, but most people see little difference.

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

Yes. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you become may be able to access for Medicare when ready when you start SSDI, not after 24 months. Social Security will notify you of your early Medicare start date. Contact Medicare at 1-800-MEDICARE to confirm your coverage has begun.

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

You can keep Medicare for at least 93 months (about 7.5 years) after your SSDI payments stop, as long as you pay the Part B premium. This is called Extended Medicare Coverage. After 93 months, you must pay the full premium yourself unless you are 65 or older. Contact Social Security to learn your specific end date.

Do I have to enroll in a Medicare Advantage plan or a Medigap plan?

No. Original Medicare (Part A and Part B) is automatic and sufficient for most people. Medicare Advantage and Medigap are optional supplemental plans that some people purchase to lower their out-of-pocket costs. You can enroll in these plans during the annual enrollment period (October 15 to December 7), but they are not required.

What if Social Security made a mistake and I have not actually been on SSDI for 24 months?

Contact Social Security when ready at 1-800-772-1213 to verify your payment history. If there was a gap or an error, Social Security will correct your Medicare start date. If Medicare coverage began incorrectly, Medicare will adjust your account and may refund premiums you paid in error.