What You Pay for Medicare Part B When You Receive SSDI

Medicare Part B costs when you have SSDI

When you start receiving SSDI, you become covered by Medicare automatically after 24 months. Medicare Part B is the portion that covers doctor visits, outpatient care, and other services. Most people with SSDI pay a monthly premium for Part B, though the amount depends on your income from the previous year.

The standard Part B premium changes each year. For 2024, the base premium is $164.90 per month, but you may pay more or less depending on your modified adjusted gross income (MAGI) from two years prior. If your income was higher in that earlier year, you could pay significantly more — sometimes $500 or higher monthly. If your income is very low, you may pay the standard amount or potentially may have access to for help paying it.

Part B also includes an annual deductible — the amount you must pay out of pocket before Medicare starts covering services. This deductible is separate from your premium and changes yearly. Once you meet the deductible, Medicare typically covers 80 percent of approved services, and you pay 20 percent.

Key Takeaways

Part B premiums are deducted directly from your SSDI check each month, so you do not receive a separate bill.
Your premium amount is based on your income from two years before, not your current income, which means changes to your earnings take time to affect what you pay.
If your income is very low, you may be able to get help paying Part B premiums through Medicaid or other programs in your state.
Part B also includes an annual deductible and a 20 percent coinsurance amount for most services after you meet the deductible.

How your Part B premium is calculated

Social Security uses your tax return from two years before the current year to determine your Part B premium. This is called your modified adjusted gross income, or MAGI. If you had higher earnings in that year — whether from work, investments, or other sources — your premium will be higher than the standard amount.

Social Security sends you a notice each year showing what your premium will be and explaining why it changed. If you believe the income figure they used is wrong, you can request a recalculation by submitting a new tax return or other proof of your actual income. This process is called an Income-Related Monthly Adjustment Amount appeal, or IRMAA appeal.

The premium brackets change yearly. In general, the higher your income, the more you pay — sometimes substantially more. Someone with significant investment income or ongoing work earnings could pay three or four times the standard premium, even while receiving SSDI.

What happens if you cannot pay Part B

If you cannot afford the Part B premium, you have options before you stop paying. First, contact Social Security to ask about an IRMAA appeal if you believe your income was overstated. Second, look into whether your state's Medicaid program can help pay your Part B premium — many states have programs specifically for this.

If you straightforward do not pay your Part B premium, Social Security will not deduct it from your SSDI check, but you will lose your Part B coverage. Losing Part B creates a gap in your Medicare coverage that can be expensive to fix later. If you go without Part B for more than 12 months and then want to rejoin, you may have to pay a permanent penalty on top of your regular premium for as long as you have Medicare.

Before your coverage ends, reach out to your local Social Security office or call 1-800-772-1213. They can discuss your situation and point you toward local resources that help pay medical costs.

Part B coverage and what you still pay

Part B covers doctor office visits, lab tests, X-rays, ambulance services, and some equipment and supplies. It does not cover dental, vision, or hearing care — those require separate coverage. After you pay your annual deductible, Medicare covers 80 percent of the approved cost, and you pay 20 percent.

This 20 percent coinsurance can add up quickly if you see specialists or need ongoing treatment. Many people with SSDI also have Medicaid, which can help cover that 20 percent coinsurance. If you have both Medicare and Medicaid, Medicaid is called your "dual coverage," and it often covers costs that Medicare does not.

Some people purchase a Medigap policy — private insurance that covers some or all of the costs Medicare does not. Medigap premiums are separate from your Part B premium and vary by plan and location. Whether Medigap makes sense depends on how much medical care you use and what your state's Medicaid program covers.

Income changes and how they affect your premium

Your Part B premium is locked in based on income from two years ago. This means if you started working or your income changed recently, your premium will not change until two years have passed. On the other hand, if your income drops significantly — because you stopped working or had a major life change — you may be able to request an IRMAA appeal sooner.

Life events that can trigger an earlier premium adjustment include losing a job, getting divorced, or a spouse's death. You must report these changes to Social Security within 60 days and provide documentation. Social Security will then recalculate your premium based on your current income rather than the two-year-old figure.

Keep records of any major income changes and report them promptly. The sooner you report, the sooner your premium can be adjusted downward if your income has fallen.

Part B and other costs you may encounter

Part B premium is only one piece of your Medicare costs. You also pay the annual deductible, the 20 percent coinsurance on covered services, and the full cost of services Medicare does not cover at all. If you need prescription drugs, Medicare Part D is a separate coverage with its own premium and deductible.

Many people with SSDI have limited income and may have access to for both Medicare and Medicaid. Medicaid can cover your Part B premium, your deductible, and your coinsurance, which makes a huge difference in what you actually pay out of pocket. To learn about you may have access to for Medicaid in your state, contact your state's Medicaid office or call 211 for a referral.

If you do not have Medicaid and your income is very low, you may also may have access to for Extra Help, a federal program that helps pay Part D drug costs. You can learn about Extra Help by visiting Medicare.gov or calling 1-800-MEDICARE.

When Part B coverage begins and ends

Part B coverage starts automatically 24 months after your SSDI benefits begin. Your first premium is deducted from your SSDI check in the month your coverage starts. If you turn 65 while receiving SSDI, your Part B coverage continues — you do not have to do anything.

If you work and your earnings become high enough that you no longer may have access to for SSDI, your SSDI benefits stop, but your Medicare coverage continues. You will still pay your Part B premium, though it will no longer be deducted from an SSDI check — instead, you will receive a bill directly from Social Security or Medicare.

If you move out of the United States, your Medicare coverage generally ends. If you plan to live abroad, contact Social Security before you leave to understand how this affects your benefits and coverage.

Frequently Asked Questions

Can I delay starting Part B to avoid paying the premium?

Part B starts automatically 24 months after your SSDI begins, and you cannot delay it. Your premium is deducted from your SSDI check whether you use Medicare services or not. If you want to refuse Part B coverage, you must contact Social Security in writing, but this creates a coverage gap that can result in a permanent penalty later.

What if I think my Part B premium is too high?

Request an IRMAA appeal by contacting Social Security. You will need to show current income documentation — a recent tax return, pay stubs, or proof of a life event like job loss or divorce. Social Security will recalculate your premium if your current income is significantly lower than the figure they used.

Does Medicaid pay my Part B premium?

Many states have Medicaid programs that pay Part B premiums for people with low income. Whether your state does depends on where you live. Contact your state's Medicaid office or call 211 to learn about you may have access to and whether your state covers Part B costs.

What is the difference between Part B and Part D?

Part B covers doctor visits, lab tests, and outpatient services. Part D covers prescription drugs. Both have separate premiums and deductibles. You pay Part B premium automatically through your SSDI check; Part D is optional and you choose a plan during enrollment periods.

If I have both Medicare and Medicaid, which one pays first?

Medicare is your primary insurance and pays first. Medicaid is secondary and covers costs that Medicare does not, including your Part B premium, deductible, and coinsurance. Having both together usually means you pay very little out of pocket for covered services.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.