You get Medicare Part A and Part B automatically after you've been on SSDI for 24 months

When you receive Social Security Disability Insurance (SSDI) for 24 consecutive months, Medicare enrollment happens automatically. You do not have to explore separately or contact Medicare — Social Security handles the enrollment and your coverage begins the first day of the 25th month. This means hospital insurance (Part A) and medical insurance (Part B) both start on the same date.

The 24-month waiting period starts the month your SSDI payments begin, not the month you applied. If you were approved in March and your first check arrived in April, your 24 months begin in April. Your Medicare coverage would start in April of the following year, two years later.

You will receive a Medicare card in the mail before your coverage begins. The card shows your Medicare number, which is usually your Social Security number followed by a letter. Keep this card with you when you see doctors or go to the hospital.

Key Takeaways

  • Medicare Part A covers hospital stays, skilled nursing care, hospice, and some home health services with no monthly premium.
  • Medicare Part B covers doctor visits, outpatient care, and medical equipment, with a monthly premium that is usually deducted from your SSDI check.
  • You become enrolled in both Part A and Part B automatically after 24 months on SSDI — you cannot choose to have only one.
  • Part A and Part B both have deductibles and copayments that you pay when you use services, separate from the Part B premium.
  • You can add prescription drug coverage (Part D) or choose a Medicare Advantage plan (Part C) if you want different coverage options.

What Medicare Part A covers

Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice services, and some home health services. You pay nothing for Part A — there is no monthly premium. However, you do pay a deductible when you use hospital services, and the amount depends on how long you stay.

For a hospital stay in 2024, you pay a deductible of $1,632 for the first 60 days. If you stay longer than 60 days, you pay a daily copayment for days 61 through 90, and a higher daily copayment for days 91 and beyond. These amounts change each year. After you have paid the deductible once in a benefit period, additional hospital stays in the same benefit period may have lower or no deductible, depending on how many days pass between stays.

Skilled nursing care is covered only after a hospital stay of at least three days. Part A pays the full cost for the first 20 days, then you pay a daily copayment for days 21 through 100. After day 100, you pay all costs. Home health services are covered if a doctor orders them and you are homebound, with no copayment.

What Medicare Part B covers

Part B is medical insurance. It covers doctor visits, outpatient care, diagnostic tests, mental health services, physical therapy, durable medical equipment (like wheelchairs or oxygen), and preventive services such as screenings and vaccines. Part B has a monthly premium, which is usually taken directly from your SSDI check. In 2024, the standard premium is $164.90 per month, but the amount varies based on your income.

Part B also has an annual deductible. In 2024, you pay $240 out of pocket before Part B starts to pay. After you meet the deductible, you typically pay 20 percent of the cost for most services, and Medicare pays 80 percent. For some services like office visits, you may pay a fixed copayment instead of a percentage.

Preventive services covered by Part B include annual wellness visits, cancer screenings, diabetes screenings, heart disease screenings, and flu and pneumonia vaccines. Most preventive services have no copayment or deductible if you see an in-network provider.

How much you pay out of pocket

Your costs depend on which services you use and whether you see in-network or out-of-network providers. In-network providers have agreed to accept Medicare's approved amount as payment, which limits what you owe. Out-of-network providers can charge more, and you may owe the difference between what Medicare pays and what the provider charges.

Part B has an annual out-of-pocket maximum, but Part A does not. Once you reach the Part B maximum in a calendar year, Medicare covers 100 percent of your Part B services for the rest of that year. The maximum changes each year and depends on whether you use in-network or out-of-network providers.

If you cannot afford the Part B premium, you may be able to get help through Medicaid or a Medicare Savings Program run by your state. These programs can pay your Part B premium and sometimes your deductibles and copayments. Contact your state Medicaid office to learn whether you may have access to.

Adding prescription drug coverage or switching to Medicare Advantage

Original Medicare (Part A and Part B) does not cover prescription drugs. You can add Part D, which is prescription drug coverage offered by private insurance companies approved by Medicare. You enroll in Part D during the annual enrollment period, which runs from October 15 to December 7 each year. If you do not enroll when you first become may be able to access, you may pay a penalty if you enroll later.

Alternatively, you can choose a Medicare Advantage plan (Part C) instead of Original Medicare. Medicare Advantage is an all-in-one plan offered by private insurance companies that includes Part A, Part B, and usually Part D in one plan. Medicare Advantage plans often have lower premiums than Original Medicare plus a separate Part D plan, but they typically have higher copayments and may limit which doctors and hospitals you can use. You can switch between Original Medicare and Medicare Advantage during the annual enrollment period.

You cannot have both Original Medicare and Medicare Advantage at the same time. If you switch from one to the other, your previous coverage ends on the first day of the month your new coverage begins.

What happens to your Medicare if you return to work

If your SSDI payments stop because you return to work and earn above the substantial gainful activity level, your Medicare coverage does not stop when ready. You can continue Medicare Part A and Part B for up to 93 months (approximately 7.75 years) after your SSDI payments end, as long as you pay the Part B premium. This period is called Extended Medicare Coverage.

During Extended Medicare Coverage, you pay the full Part B premium yourself — it is no longer deducted from your SSDI check. You also continue to pay Part A and Part B deductibles and copayments as usual. If you do not pay the Part B premium, your coverage ends and you may face a penalty if you enroll later.

If you stop working and your SSDI is reinstated within five years, your Extended Medicare Coverage period ends and your regular SSDI Medicare coverage resumes.

Frequently Asked Questions

Do I have to take Medicare when I become may be able to access after 24 months on SSDI?

Yes, enrollment is automatic and you cannot decline it. Part A and Part B both begin on the same date. However, if you have other health insurance through an employer or a family member, you can keep that coverage and use Medicare as secondary insurance.

What if I cannot afford the Part B premium?

Your state may offer a Medicare Savings Program that pays your Part B premium and sometimes your deductibles and copayments. You can also ask Social Security about Medicaid, which may cover your premium if your income is low enough. Contact your state Medicaid office or call 1-800-MEDICARE to learn what programs are available in your state.

Can I use any doctor with Medicare?

Most doctors accept Medicare, but not all. Before you schedule an appointment, ask the doctor's office whether they accept Medicare and whether they are in-network. Out-of-network providers can charge more, and you may owe the difference. You can search for in-network providers on Medicare.gov.

What if I need prescription drugs but cannot afford them?

Part D prescription drug plans have different costs and cover different drugs. You can compare plans during the annual enrollment period to find one that covers your medications at a lower cost. If you cannot afford your medications even with Part D, ask your doctor about generic alternatives or patient information programs offered by drug manufacturers.

Does Medicare cover dental, vision, or hearing care?

Original Medicare does not cover routine dental, vision, or hearing care. Some Medicare Advantage plans include these benefits, but they vary by plan and location. You can search for plans that include dental, vision, or hearing coverage on Medicare.gov during the annual enrollment period.