Medicare is not free when you receive SSDI, but your costs are lower than they would be for someone buying Medicare on their own

When you start receiving SSDI, you become covered by Medicare automatically after 24 months of receiving benefits. You do not pay a monthly premium for Part A (hospital insurance), but you will pay a monthly premium for Part B (medical insurance) unless your income is very low. You may also have out-of-pocket costs like deductibles and copayments when you use healthcare services.

The amount you pay depends on your income and whether you have other resources. Most people on SSDI pay the standard Part B premium, which changes each year. In 2024, the standard Part B premium is $174.70 per month, but this amount varies year to year. If your income is below a certain threshold, you may pay a reduced premium or nothing at all through programs like Medicaid or the Medicare Savings Program.

Your SSDI benefit itself does not cover your Medicare premiums — the premiums come out of your own money, not from your SSDI check. However, if your SSDI benefit is very small, you may be poor enough to may have access to for Medicaid, which can pay your Medicare premiums for you.

Key Takeaways

  • Medicare Part A (hospital insurance) has no monthly premium for SSDI recipients, but Part B (medical insurance) costs money unless your income qualifies you for a premium reduction program.
  • The standard Part B premium changes yearly and is deducted from your SSDI check if you enroll, or you can pay it separately.
  • You become covered by Medicare 24 months after your SSDI benefits start, not when ready.
  • Medicaid can pay your Medicare premiums if your income is low enough, which many SSDI recipients may have access to for.
  • You will still owe deductibles and copayments when you use healthcare services, even though your premiums may be reduced or free.

How Part A and Part B premiums work with SSDI

Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. You pay nothing for Part A as an SSDI recipient — there is no monthly premium. However, you do pay a deductible when you are admitted to the hospital. In 2024, the Part A deductible is $1,632 per benefit period, but this amount changes yearly.

Part B covers doctor visits, outpatient services, medical equipment, and preventive care. You must pay a monthly premium for Part B unless you are covered by Medicaid or another program that pays it for you. If you enroll in Part B when you first become covered by Medicare, you pay the standard premium. If you delay enrolling, you may pay a higher premium for the rest of your life as a penalty.

The premium is usually taken directly from your SSDI check each month. If your SSDI benefit is smaller than the premium, you will owe the difference out of your own money. If you have other income or resources, Social Security will send you a bill for the premium instead.

When your income is low enough for Medicaid to help

Medicaid is a separate program run by your state that covers low-income people. If you receive SSDI and your income and resources are below your state's limits, you may be covered by Medicaid at the same time you have Medicare. This is called "dual coverage."

When you have both Medicare and Medicaid, Medicaid can pay your Part B premium, your Part A deductible, and your copayments. This means you may have almost no out-of-pocket costs for healthcare. However, Medicaid rules vary by state — some states are more generous than others, and some have waiting lists.

To find out whether you may have access to for Medicaid in your state, contact your state Medicaid office or your local Social Security office. You can also call 211 to be connected to local benefits programs. Your state's Medicaid office will tell you the income and resource limits and whether you are covered.

The Medicare Savings Program for people with modest income

If your income is above your state's Medicaid limit but still low, you may may have access to for the Medicare Savings Program (MSP). This program pays your Part B premium and sometimes your Part A premium and deductibles, depending on which tier you may have access to for.

There are three tiers of the Medicare Savings Program. The may have access to Medicare Beneficiary (QMB) program pays both Part A and Part B premiums plus deductibles and copayments. The Specified Low-Income Medicare Beneficiary (SLMB) program pays only your Part B premium. The may have access to Individual (QI) program pays part of your Part B premium. Which tier you may have access to for depends on your income level relative to the federal poverty line.

Income limits for the Medicare Savings Program change yearly and vary slightly by state. To explore, contact your state Medicaid office or your local Social Security office. You will need to provide proof of income and citizenship. Processing usually takes two to four weeks.

Extra Help with prescription drug costs

If you enroll in Medicare Part D (prescription drug coverage), you may also may have access to for Extra Help, a program that pays part or all of your drug premiums and out-of-pocket costs. Extra Help is separate from the Medicare Savings Program, though you can have both.

To may have access to for Extra Help, your income must be at or below 150 percent of the federal poverty line, and your resources must be below $15,510 (for an individual in 2024). These limits change yearly. If you may have access to, you pay little or nothing for your prescriptions.

You can explore for Extra Help through Social Security online, by phone at 1-800-772-1213, or at your local Social Security office. You can also explore through Medicare at 1-800-MEDICARE. Social Security will tell you whether you may have access to and how much help you will receive.

What happens if you do not enroll in Part B when you first become may be able to access

When you become covered by Medicare 24 months after your SSDI starts, you are automatically enrolled in Part A at no cost. However, you must actively enroll in Part B, or you can decline it. If you decline Part B and later change your mind, you can enroll during the General Enrollment Period (January 1 through March 31 each year), but you will pay a penalty.

The Part B late enrollment penalty is 10 percent of the standard premium for each full year you were may be able to access but did not enroll. This penalty is permanent — you will pay it for as long as you have Part B. For example, if you were may be able to access for Part B for three years but did not enroll, you would pay 30 percent more than the standard premium for the rest of your life.

The only exception is if you had other health insurance (such as employer coverage) when you became may be able to access for Medicare. In that case, you can enroll in Part B without penalty during an eight-month window after your other coverage ends. You will need to provide proof of your prior coverage.

Costs you will still pay even with reduced premiums

Even if your premiums are paid by Medicaid or the Medicare Savings Program, you will still have out-of-pocket costs when you use healthcare. These include deductibles (the amount you pay before Medicare starts paying), copayments (a fixed amount per visit or service), and coinsurance (a percentage of the cost).

In 2024, the Part A deductible is $1,632 per benefit period. The Part B deductible is $240 per year. After you meet the deductible, you typically pay 20 percent of the cost of doctor visits and outpatient services. If you have Medicaid, Medicaid usually pays these costs for you, but if you only have Medicare Savings Program help, you may still owe some amounts.

If you enroll in Part D (prescription drug coverage), you will pay a monthly premium, an annual deductible (usually around $545 in 2024), and copayments or coinsurance for each prescription. The exact amounts depend on which Part D plan you choose and which drugs you take.

How to find out what you will pay

To find out your exact costs, you need to know three things: your current income, your state of residence, and which Medicare parts you want to enroll in. Start by contacting your local Social Security office or calling 1-800-772-1213 to ask about Medicaid and the Medicare Savings Program in your state.

You can also use the Medicare.gov Plan Finder tool to compare Part D plans and see estimated costs for prescriptions you take. This tool shows you the monthly premium, annual deductible, and copayments for each plan available in your area. You can access it at Medicare.gov or call 1-800-MEDICARE for help.

If you think you may may have access to for Medicaid or the Medicare Savings Program, explore as soon as possible. These programs can significantly reduce your out-of-pocket costs, and there is no penalty for explore if you do not may have access to.

Frequently Asked Questions

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

You do not pay for Part A (hospital insurance), but you must pay for Part B (medical insurance) unless your income is low enough to may have access to for Medicaid or the Medicare Savings Program. Part B premiums are deducted from your SSDI check each month.

What if my SSDI benefit is smaller than my Medicare premium?

If your SSDI benefit is less than your Part B premium, Social Security will send you a separate bill for the difference. You must pay this bill with your own money. If you cannot afford it, contact your local Social Security office to ask about Medicaid or the Medicare Savings Program.

Can I get Medicare before 24 months on SSDI?

No. You must receive SSDI for 24 months before you become covered by Medicare. The only exception is if you are blind or have end-stage renal disease, in which case you may may have access to sooner. Contact Social Security to ask about your specific situation.

What is the difference between Medicare and Medicaid?

Medicare is a federal program based on age or disability status. Medicaid is a state program based on income. You can have both at the same time. When you have both, Medicaid usually pays your Medicare premiums and out-of-pocket costs.

If I have Medicaid, do I still need to enroll in Part B?

Yes. You should enroll in Part B even if Medicaid will pay your premium. If you do not enroll when you first become may be able to access, you will pay a penalty for the rest of your life. Medicaid can pay the premium, but you must still be enrolled in the plan.