Medicare Premiums Come Out of Your SSDI Payment Automatically

Once you turn 65 or have been on SSDI for 24 months, you become covered by Medicare Part A (hospital insurance) and Part B (medical insurance). The Social Security Administration deducts your Part B premium directly from your monthly SSDI check before you receive it. For 2024, the standard Part B premium is $164.90 per month, though higher earners pay more under income-related monthly adjustment amounts (IRMAA). You cannot stop this deduction straightforward by refusing Medicare — enrollment is automatic, and the deduction happens unless you take specific steps beforehand.

The only way to prevent the deduction is to decline Part B coverage before it starts. Once Part B is active and premiums are being withheld, you cannot retroactively undo the deduction or recover money already taken. Your window to act is narrow: you have about two months from the month you become may be able to access to submit a written refusal to Medicare.

Key Takeaways

  • Part B premiums are deducted from your SSDI check automatically once you turn 65 or complete 24 months on SSDI, unless you decline Part B in writing before coverage begins.
  • You must submit a signed, written statement to Social Security or Medicare declining Part B coverage — a phone call or verbal request does not count.
  • If you decline Part B now, you can enroll later during a General Enrollment Period (January through March each year), but you will pay a 10 percent penalty for each year you were not enrolled.
  • Declining Part B makes sense only if you have other health insurance that covers hospital and medical services; Medicare Part A (hospital only) cannot be declined once you are on SSDI.
  • If premiums have already been deducted, you cannot recover the money, but you can decline Part B for future months by submitting a written refusal when ready.

When You Become may be able to access for Medicare and When Deductions Begin

You become may be able to access for Medicare in one of two ways: when you turn 65, or after you have been receiving SSDI for 24 consecutive months. The 24-month clock starts the month your SSDI benefit begins, not the month you applied. Once you hit month 25, Medicare Part A and Part B coverage begins automatically on the first day of that month.

Social Security sends you a notice about three months before your Medicare coverage starts. This notice includes your Medicare card and explains your Part B premium. The deduction from your SSDI check begins the same month your coverage becomes active. If you want to refuse Part B, you must act during those three months — after coverage starts, the deduction is already happening and stopping it requires a separate written request.

How To Decline Part B Before Coverage Starts

To refuse Part B coverage, you must submit a written statement signed by you (or your representative, if you have a legal power of attorney or representative payee). A phone call, email, or verbal conversation does not count. Your statement should say something like: "I decline Medicare Part B coverage" or "I refuse to enroll in Medicare Part B." Include your name, Social Security number, and the date you sign it.

Mail your signed refusal to your local Social Security office or to Medicare directly. You can find your local Social Security office at ssa.gov/locator. If you mail to Medicare, send it to the address on your Medicare notice. Keep a copy for your records and consider sending it certified mail so you have proof of delivery. Social Security must receive your refusal before your Part B coverage becomes active — typically before the first day of the month you turn 65 or complete 24 months on SSDI.

If you are unsure whether your refusal was received, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask them to confirm that your Part B decline is on file. Do not assume silence means acceptance; get written confirmation.

What Happens If You Decline Part B Now

If you decline Part B before coverage starts, you will not be enrolled and no premium will be deducted from your SSDI check. You will still have Medicare Part A (hospital insurance), which covers inpatient hospital stays, skilled nursing facility care, and some home health services. Part A has no monthly premium for most people on SSDI.

Declining Part B makes sense only if you have other health insurance that covers doctor visits, outpatient care, and preventive services — for example, employer coverage through a spouse's job, or a private plan you purchase. If you have no other coverage, declining Part B leaves you without insurance for most medical care, and you will pay out of pocket for doctor visits, lab work, and prescriptions.

If you decline Part B and later change your mind, you can enroll during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage would begin July 1 of that year. However, you will pay a permanent 10 percent penalty on your Part B premium for each full year you were not enrolled. If you declined for three years, your premium would be 30 percent higher than the standard rate for the rest of your life.

If Premiums Are Already Being Deducted

If Part B coverage has already started and premiums are already coming out of your SSDI check, you cannot recover the money that has been deducted. However, you can still decline Part B for future months by submitting a written refusal when ready. Your refusal will stop the deduction starting the month after Social Security processes it, which usually takes two to four weeks.

When you submit a late refusal, Social Security will ask you to confirm that you understand you are declining coverage retroactively. This means you will have a gap in Part B coverage during the months you were enrolled but did not want to be. If you received any medical services during that time, Medicare will not cover them, and you may receive bills from providers. Before you decline, make sure you understand the gap and have other insurance in place.

Part A Cannot Be Declined — Only Part B

Medicare Part A (hospital insurance) is mandatory once you are on SSDI for 24 months or turn 65. You cannot decline Part A, and there is no premium deducted from your SSDI check for Part A coverage. Part A is free for most people on SSDI because they or a spouse paid Medicare taxes while working.

If you decline Part B, you keep Part A automatically. This means you remain covered for hospital stays and skilled nursing care, but you have no coverage for doctor visits, lab work, imaging, or outpatient services. Some people decline Part B intentionally because they have employer coverage or a spouse's plan that covers both hospital and medical services, making Part A redundant. Others decline because they cannot afford the premium and have no other insurance — this is a risky choice and usually not recommended.

Income-Related Premiums (IRMAA) and Whether They Can Be Avoided

If your income is above a certain threshold, you pay a higher Part B premium called an income-related monthly adjustment amount (IRMAA). For 2024, if your modified adjusted gross income is over $97,000 (single) or $194,000 (married filing jointly), you pay more than the standard $164.90 premium — sometimes significantly more. IRMAA is based on your tax return from two years prior, so 2024 premiums are based on your 2022 income.

Declining Part B is one way to avoid IRMAA premiums, but it also means losing Part B coverage entirely. You cannot pay the standard premium instead of the IRMAA premium; the two are linked to enrollment status. If your income drops in a later year, you can request that Social Security recalculate your IRMAA based on your current income, but this requires submitting a detailed form and proof of the income change. Declining Part B is a more permanent solution if your income is consistently high and you have other insurance.

Frequently Asked Questions

Can I decline Part B by phone or email?

No. Social Security and Medicare require a signed, written statement. A phone call, email, or conversation with a representative does not count as a valid refusal. You must mail a signed letter or form to Social Security or Medicare and keep proof of delivery.

What if I decline Part B and then get sick and need a doctor?

You will have to pay out of pocket for all doctor visits, lab work, imaging, and prescriptions unless you have other insurance. You can enroll in Part B during the next General Enrollment Period (January through March), but coverage will not start until July, and you will pay a 10 percent penalty for each year you were not enrolled. Plan carefully before declining.

Does declining Part B affect my SSDI payment amount?

No. Your SSDI benefit is calculated separately from Medicare. Declining Part B straightforward stops the premium deduction, so your full SSDI check will be deposited without the Part B amount withheld. Your benefit amount itself does not change.

Can I decline Part B temporarily and re-enroll later without a penalty?

Only during the General Enrollment Period (January through March each year). If you enroll during that window, you pay a 10 percent penalty for each year you were not enrolled. There is no penalty-free way to decline Part B and then re-enroll later; the penalty is permanent once you have a gap in coverage.

What if my income drops and I no longer may have access to for the higher IRMAA premium?

You can request that Social Security recalculate your IRMAA based on your current income by submitting a form and proof of the income change (such as a recent tax return or a letter from your employer). This usually takes a few weeks to process. You do not need to decline Part B to request a recalculation — contact Social Security to ask about an income-related premium reduction.