Medicare Starts Automatically After 24 Months on SSDI

When you have been receiving SSDI for 24 consecutive months, Medicare enrollment happens automatically. You do not need to do anything — Social Security will enroll you in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) without a separate process. Your coverage begins on the first day of the 25th month.

The only exception is if you have already turned 65, in which case you become may be able to access for Medicare based on age rather than disability. The 24-month waiting period still applies if you are under 65 and receiving SSDI, but once those 24 months pass, your coverage date is set by Social Security's records, not by when you turn 65.

You will receive a Medicare card in the mail before your coverage begins. Check it for accuracy — your name, date of birth, and Social Security number should all match your Social Security records. If anything is wrong, contact Medicare at 1-800-MEDICARE to request a corrected card.

Key Takeaways

  • Medicare Part A and Part B enroll you automatically after 24 months on SSDI; you will receive a card in the mail with no action required on your part.
  • Part A covers hospital stays, skilled nursing care, and hospice; Part B covers doctor visits, outpatient care, and some preventive services.
  • You pay a monthly premium for Part B (the amount depends on your income) and you are responsible for deductibles and copayments when you use services.
  • You can choose to stay in Original Medicare or switch to a Medicare Advantage plan, but the important date to change plans is limited to specific times of year.
  • If you have limited income, you may be able to reduce your Part B premium or out-of-pocket costs through state and federal information programs.

What Part A and Part B Cover

Medicare Part A covers inpatient hospital care, including room, meals, and nursing care during a hospital stay. It also covers skilled nursing facility care (up to 100 days per benefit period if you meet certain conditions), home health services ordered by a doctor, and hospice care for people with terminal illness. Part A has no monthly premium if you or your spouse paid Medicare taxes for at least 10 years while working.

Medicare Part B covers doctor visits, outpatient hospital services, medical equipment (such as wheelchairs or oxygen), and some preventive care like annual wellness visits and screenings. Part B requires a monthly premium, which is deducted from your SSDI payment. The standard premium for 2024 is $164.90 per month, but the amount changes each year and may be higher if your income exceeds certain thresholds.

Both parts require you to pay a deductible before Medicare begins to pay. For Part A in 2024, the deductible is $1,632 per benefit period (a benefit period begins when you enter a hospital and ends 60 days after you leave). For Part B, the deductible is $240 per year. After you meet the deductible, you typically pay a percentage of the cost (coinsurance) or a fixed amount per visit (copayment).

How Your SSDI Payment and Medicare Premium Work Together

Your Medicare Part B premium is automatically deducted from your monthly SSDI check. This means your net SSDI payment will be lower once Medicare begins. The amount deducted depends on your income from the previous year — if your income was higher in the past, you may pay a higher premium now, a situation called Income-Related Monthly Adjustment Amount (IRMAA).

If you believe your income has dropped significantly since the year Medicare used to calculate your premium, you can request a recalculation. You will need to submit evidence of the change — such as a letter from your employer showing reduced hours, or documentation of a major life event. Contact Social Security or Medicare to file this request, called a Life-Changing Event appeal.

Part A has no monthly premium for most SSDI recipients, but you do pay the deductible when you use hospital services. If you cannot afford your Part B premium or out-of-pocket costs, you may be able to get help through Medicaid (if your state offers it) or the Medicare Savings Program, which is run by your state and can pay your Part B premium, deductible, and copayments.

Original Medicare Versus Medicare Advantage Plans

When you turn 65 or complete 24 months on SSDI, you have a choice: stay in Original Medicare (Part A and Part B) or switch to a Medicare Advantage plan (also called Part C). Original Medicare is run by the federal government and accepted by most doctors and hospitals nationwide. Medicare Advantage is run by private insurance companies and typically includes prescription drug coverage (Part D), but limits you to a network of doctors and hospitals.

Original Medicare does not cover prescription drugs, dental, vision, or hearing aids. If you want drug coverage, you must enroll in a separate Part D plan during your initial enrollment period or during the annual open enrollment period (October 15 to December 7 each year). If you do not enroll in Part D when you first become may be able to access, you may pay a penalty for late enrollment for as long as you have Medicare.

Medicare Advantage plans often have lower or no monthly premiums and lower out-of-pocket costs for routine care, but they require you to use in-network providers and may require prior authorization before certain services. You can switch between Original Medicare and Medicare Advantage once per year during the annual open enrollment period, or during a special enrollment period if you have a may have access to life event (such as moving out of your plan's service area).

Prescription Drug Coverage and Part D

If you stay in Original Medicare, you must enroll in a Part D prescription drug plan separately. Part D is offered by private insurance companies and covers most prescription medications. You choose a plan during your initial enrollment period (which begins three months before the month you turn 65 or become may be able to access for Medicare) or during the annual open enrollment period.

Each Part D plan has a different list of covered drugs, called a formulary, and different costs. You can compare plans on Medicare.gov or call 1-800-MEDICARE for help. Once you enroll, you pay a monthly premium and a deductible (which varies by plan), and then you pay a copayment or coinsurance for each prescription. If your income is low, you may be able to reduce your Part D costs through the Low-Income Subsidy (LIS) program.

If you enroll in a Medicare Advantage plan, prescription drug coverage is usually included, so you do not need to enroll in a separate Part D plan. However, you should still review the plan's formulary to make sure your medications are covered.

Getting Help With Costs: Medicaid and Other Programs

If your income is low, Medicaid can help pay for Medicare premiums, deductibles, and copayments. Medicaid is a joint federal and state program, so may be able to access and benefits vary by state. Some states cover all Medicare costs for people with low income; others cover only the Part B premium. To find out what your state offers, contact your state Medicaid office or call 1-800-MEDICARE.

The Medicare Savings Program (MSP) is a Medicaid program that specifically helps people with Medicare pay their premiums and cost-sharing. There are three levels: may have access to Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and may have access to Individual (QI). Each has different income limits and covers different costs. You explore through your state Medicaid office, not through Medicare.

The Low-Income Subsidy (LIS) program, also called "Extra Help," reduces your Part D prescription drug costs if your income and resources are below certain limits. You can explore online at SSA.gov, by phone at 1-800-MEDICARE, or by mail using form SSA-1020. If you are already receiving Supplemental Security Income (SSI), you may be automatically enrolled in LIS.

What Happens If You Work While on SSDI and Medicare

If you return to work while receiving SSDI, your SSDI payments may stop or be reduced, but your Medicare coverage continues for a period of time. Specifically, you can work and still receive Medicare for up to 93 months (roughly 7.75 years) after your SSDI payments end, as long as you report your work to Social Security. This is called the Medicare Continuation period.

During the Medicare Continuation period, you must pay your Part B premium yourself (it is no longer deducted from an SSDI check). You can pay by mail, phone, or online through Medicare. If you do not pay your premium, your coverage will end. After the 93-month period ends, you can continue Medicare by paying the full premium, or you can enroll in a Medicare Advantage plan if you are may be able to access.

Report all work to Social Security as soon as possible. Social Security has a Ticket to Work program that can help you understand how work affects your benefits and Medicare coverage. Call 1-866-4-TICKET or visit choosework.ssa.gov for more information.

Frequently Asked Questions

Do I have to accept Medicare when it starts, or can I decline it?

You can decline Part B (medical insurance) by contacting Social Security or Medicare in writing before your coverage begins, but Part A (hospital insurance) is automatic and you cannot decline it. If you decline Part B and later want to enroll, you may pay a penalty for late enrollment. Most people keep Part B because the premium is deducted from SSDI and the coverage is valuable.

What if I move to another state after I start Medicare?

Medicare coverage works the same in every state, so you can use your Medicare card anywhere in the United States. However, if you move out of your Medicare Advantage plan's service area, you can switch to Original Medicare or a different Medicare Advantage plan without waiting for the annual open enrollment period. Notify Medicare of your move as soon as possible.

Can I have both Medicare and Medicaid at the same time?

Yes. People who have both are called "dual may be able to access." Medicaid can help pay your Medicare premiums and cost-sharing, and it may also cover services Medicare does not, such as long-term care. If you think you may be may be able to access for Medicaid, contact your state Medicaid office or call 1-800-MEDICARE for a referral.

What if I disagree with a Medicare decision about coverage or payment?

You have the right to appeal. The process depends on whether you are in Original Medicare or a Medicare Advantage plan. For Original Medicare, you can file an appeal with Medicare within 120 days of receiving a denial notice. For Medicare Advantage, you appeal to your plan first. Call 1-800-MEDICARE or visit Medicare.gov for detailed appeal instructions.

Do I need a Medigap policy in addition to Original Medicare?

No, but many people buy one. A Medigap policy is supplemental insurance sold by private companies that covers some of the costs Medicare does not, such as copayments and coinsurance. Medigap is optional and costs extra, but it can reduce your out-of-pocket expenses. You can enroll in Medigap during your initial Medicare enrollment period or within six months of turning 65.