Medicare costs money even when you get it through SSDI
When you start receiving SSDI, Medicare becomes available to you after 24 months. But Medicare is not free. You will pay premiums (monthly fees), deductibles (amounts you pay before coverage kicks in), and copayments (your share of each service). These costs come out of your SSDI check or your bank account, depending on how you set it up.
The amount you pay depends on which parts of Medicare you use and your income. Most people on SSDI pay less than people who are not on SSDI, because Social Security adjusts premiums based on what you earn. If your income is very low, you may also be on Medicaid at the same time, which can cover costs Medicare does not.
Understanding these costs before you turn 65 or reach your 24-month mark helps you budget and know what to expect when your Medicare coverage begins.
Key Takeaways
- Most people on SSDI pay a monthly premium for Medicare Part B (doctor visits and outpatient care), which is deducted from their SSDI payment.
- You also pay deductibles and copayments when you use services, and these amounts vary by which part of Medicare you use.
- If your SSDI income is low enough, you may be on both Medicare and Medicaid, and Medicaid can pay some or all of your Medicare costs.
- Medicare Part A (hospital care) usually has no premium for people on SSDI, but you pay a deductible if you are admitted to the hospital.
- Costs change each year, so you should review your coverage during the annual enrollment period to see if a different plan saves you money.
What you pay for Medicare Part A (hospital care)
Part A covers hospital stays, skilled nursing care, hospice, and some home health services. Most people on SSDI do not pay a monthly premium for Part A because they have enough work credits from before they became disabled.
You do pay when you use the service. If you are admitted to a hospital, you pay a deductible — a flat amount per hospital stay. In 2024, that deductible is $1,632, but this amount changes each year. After you pay the deductible, Medicare covers most of your hospital costs, though you may pay a daily copayment if your stay is very long.
If you need skilled nursing care after a hospital stay (like physical therapy in a nursing facility), you pay nothing for the first 20 days. Days 21 through 100 cost you a copayment per day. After 100 days in a benefit period, you pay the full cost yourself.
What you pay for Medicare Part B (doctor visits and outpatient care)
Part B covers doctor visits, lab tests, X-rays, ambulance services, and outpatient hospital care. Almost everyone on SSDI pays a monthly premium for Part B. In 2024, the standard premium is $164.90 per month, but your actual premium may be lower if your income is very low.
This premium is usually taken directly from your SSDI payment before you receive it. You do not have to write a check or set up a separate payment.
Beyond the premium, you also pay a yearly deductible (in 2024, $240) before Part B coverage begins. After you meet the deductible, you typically pay 20% of the cost of each service, and Medicare pays 80%. For some services like office visits, you may pay a fixed copayment instead.
What you pay for Medicare Part D (prescription drugs)
Part D is optional coverage for prescription medications. If you want it, you choose a plan from private insurance companies, and each plan has its own premium, deductible, and copayments.
Premiums for Part D plans range widely — from roughly $7 to $100 per month depending on the plan and your location. You also pay a deductible before coverage begins, typically between $0 and $500. Once you meet the deductible, you pay a copayment for each prescription, which varies by drug and plan.
If your income is very low, you may be on both Medicare and Medicaid. Medicaid can pay your Part D premium and reduce your copayments for drugs. You should compare plans each year during the annual enrollment period, because premiums and which drugs are covered change.
How Medicaid can lower your Medicare costs
If you are on SSDI and your income and resources are below your state's limit, you may also be on Medicaid. Medicaid is a separate program run by your state, and it can pay some or all of your Medicare premiums, deductibles, and copayments.
When you have both Medicare and Medicaid, Medicaid is called your "secondary payer." This means Medicare pays first, and then Medicaid covers what Medicare does not. In many cases, Medicaid covers your entire Part B premium and reduces your copayments to nearly zero.
To know whether you are on Medicaid, check your SSDI award letter or contact your state Medicaid office. Income limits vary by state, so what qualifies in one state may not in another. If you are not on Medicaid but your income is very low, you can ask your local Social Security office whether you should be.
Costs that Medicare does not cover
Medicare has gaps. It does not cover dental care, vision care, hearing aids, or long-term care in a nursing home or at home. It also does not cover many prescription drugs if you do not have Part D, and it does not cover most mental health services beyond a limited number of outpatient visits per year.
Some people on SSDI buy Medigap (supplemental insurance) to cover some of these gaps, but Medigap premiums are separate from Medicare and can be expensive. Others rely on Medicaid to cover what Medicare does not, if they are on both programs.
Before you turn 65 or reach your 24-month mark on SSDI, think about what services you use most often. If you see a dentist regularly or need hearing aids, you will need to budget for those costs outside of Medicare.
When your costs change and how to review your coverage
Medicare premiums, deductibles, and copayments change every January. Social Security sends you a notice in December showing your new Part B premium and what will be deducted from your January payment. Read this notice carefully, because your premium may go up or stay the same depending on your income.
You have a chance to change your Medicare coverage during the annual enrollment period, which runs from October 15 to December 7 each year. If you are on Part D, you can switch to a cheaper drug plan. If you have a Medigap policy, you can compare plans and switch if you find a better price.
If your income changes — for example, if you start working part-time or receive money from another source — your Medicare premiums may change too. Report income changes to Social Security as soon as they happen, so your premiums are correct.
Frequently Asked Questions
Do I have to take Medicare when I become may be able to access?
No, but if you delay Part B after you become may be able to access, you may pay a penalty for the rest of your life. Part A (hospital care) is automatic and free for most people on SSDI, so there is no reason to turn it down. Part D (drugs) is optional, and you can enroll later without penalty if you do not take it now.
What happens if I cannot afford my Medicare premiums?
If your income is very low, Medicaid may pay your premiums. Contact your state Medicaid office to see if you may have access to. If you are not on Medicaid and cannot pay, call Social Security to discuss your situation — they may be able to help you understand your options.
Can I use my SSDI to pay for Medicare costs?
Your SSDI payment is yours to use as you need. The Part B premium is deducted automatically before you receive your check, but deductibles and copayments come out of your own money when you use a service. If you cannot afford a service, talk to the provider about payment plans.
Does Medicare cover mental health care?
Medicare Part B covers some outpatient mental health visits, and you pay 20% of the cost after you meet your deductible. However, the number of visits may be limited. If you are on Medicaid as well, Medicaid may cover additional mental health services that Medicare does not.
What if I work and earn money while on SSDI?
If you work and your earnings go above the limit, your SSDI payment may stop, but your Medicare continues for a period of time. Your income from work may also change your Medicare premiums. Report all work and earnings to Social Security right away so your benefits and premiums are calculated correctly.