SSDI includes Medicare, not Medicaid, after you've been receiving benefits for two years

When you start receiving Social Security Disability Insurance (SSDI), you do not automatically get health insurance. Instead, you become may be able to access for Medicare after you have been on SSDI for 24 consecutive months. This is different from Medicaid, which is a separate program run by states. Many people mix up the two because both are government health programs, but they work differently and cover different groups of people.

The 24-month waiting period starts the month your SSDI payments begin, not the month you applied. So if you were approved in March and your first check arrives in May, your two-year clock starts in May. After 24 months pass, Medicare enrollment happens automatically — you do not need to sign up separately or fill out additional forms.

Once you turn 65, your SSDI ends and you move to regular Social Security retirement benefits, but your Medicare continues without interruption. The insurance does not stop just because your benefit type changed.

Key Takeaways

  • Medicare coverage begins automatically after 24 months on SSDI; you do not have to explore for it.
  • Medicare has three main parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, and Part D covers prescription drugs.
  • You may still be able to get Medicaid at the same time as Medicare if your income and resources are low enough, depending on your state.
  • Some people on SSDI may have access to for both programs together, which is called "dual may be able to access" status.

How Medicare works once you're on SSDI

Medicare has different parts, and understanding what each one covers helps you know what to expect. Part A covers inpatient hospital care, skilled nursing facility stays, hospice care, and some home health services. You pay nothing for Part A premiums because you earned it through work history before your disability.

Part B covers doctor visits, outpatient services, lab tests, and medical equipment. Part B has a monthly premium that comes out of your SSDI check — the amount changes each year. In 2024, most people pay around $164.90 per month, but the exact amount depends on your income from the previous year. Higher earners may pay more.

Part D covers prescription drugs through a separate plan you choose. You pick a plan during your enrollment period, and the cost varies depending on which plan you select and which drugs you take. If you do not choose a plan when you first become may be able to access, you may pay a penalty if you sign up later.

What Medicare does not cover

Medicare has gaps. It does not cover dental care, vision care, or hearing aids in most cases. It also does not cover long-term custodial care in a nursing home or assisted living facility — only skilled nursing care for a limited time after a hospital stay. Prescription drugs are only covered if you enroll in Part D.

Many people on SSDI buy a Medigap policy (also called supplemental insurance) to cover some of these gaps. Medigap is sold by private insurance companies and helps pay for costs that Medicare does not cover, like copayments and deductibles. You pay a monthly premium for Medigap on top of your Medicare costs.

Another option is a Medicare Advantage plan (Part C), which is an alternative to Original Medicare sold by private insurers. These plans often include dental and vision coverage that Original Medicare does not, but they usually have smaller networks of doctors and hospitals you can use.

Whether you can get Medicaid while on SSDI

You may be able to get both Medicare and Medicaid at the same time. Medicaid is run by individual states, so the rules change depending on where you live. Some states are more generous about who qualifies; others are stricter. People who have both programs are called "dual may be able to access."

To may have access to for Medicaid while on SSDI, your income and resources (savings, property, and other assets) must fall below your state's limits. Most states use the federal poverty level as a starting point, but some states have higher thresholds. A few states have programs specifically designed for people on SSDI who have slightly higher income or resources.

If you live in a state that has expanded Medicaid under the Affordable Care Act, you may have an easier time may have access to. If your state has not expanded, the income limits are typically much lower. You can find out your state's rules by contacting your state Medicaid office or calling 211 for a local referral.

What happens to your insurance if you work while on SSDI

SSDI has a program called Plan to Achieve Self-Support (PASS) that lets you work and keep more of your earnings without losing benefits right away. If you use PASS, your Medicare continues even if your earnings are high. Without PASS, your benefits stop if you earn too much, but your Medicare coverage does not stop when ready — it continues for a grace period.

If your SSDI benefits end because you earned too much money, your Medicare continues for 93 days after your last month of benefits. After that, you can buy into Medicare by paying a monthly premium, or you can look for health insurance through your employer or the health insurance marketplace. This grace period gives you time to figure out your next step without losing coverage right away.

How to enroll in Medicare when your 24 months are up

You do not have to do anything. Social Security automatically enrolls you in Medicare Part A and Part B when you become may be able to access. About three months before your coverage starts, you will receive a Medicare card in the mail. The card shows your Medicare number and which parts you are enrolled in.

For Part D (prescription drugs), you do need to choose a plan. Social Security will send you information about available plans in your area. You can compare plans on Medicare.gov or call 1-800-MEDICARE to speak with someone who can walk you through your options. If you do not choose a plan by the important date, you can still enroll later, but you may owe a penalty for each month you waited.

If you want a Medigap policy or Medicare Advantage plan instead of Original Medicare, you can shop for those separately. Insurance companies sell these plans directly to you. It is a good idea to compare options before your Medicare starts so you know what coverage you want from day one.

Costs you will pay for Medicare

Part A has no monthly premium, but you pay a deductible when you go to the hospital. In 2024, that deductible is $1,632 per benefit period, though this amount changes yearly. After you pay the deductible, Medicare covers most of your hospital costs.

Part B has a monthly premium (around $164.90 in 2024 for most people) that comes directly out of your SSDI check. You also pay a yearly deductible of $240 in 2024, and then you typically pay 20 percent of the cost of doctor visits and services after that.

Part D premiums vary by plan and by year. Some plans cost $5 to $10 per month; others cost more. You also pay copayments when you fill prescriptions, and the amount depends on which tier your drug is on in your chosen plan.

Frequently Asked Questions

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

You are automatically enrolled in Part A and Part B, so you cannot decline them. However, if you have health insurance through an employer or a spouse's employer, you can request to delay Part B enrollment without penalty. You would need to contact Social Security to make this request before your coverage starts.

What if I cannot afford the Medicare premiums?

If your income is low, you may may have access to for programs that help pay Medicare premiums and cost-sharing. These include Medicaid (if your state covers it), the Medicare Savings Program, and the Low-Income Subsidy program for Part D. Contact your state Medicaid office or call 211 to learn what you might may have access to for.

Can I switch Medicare plans after I enroll?

Yes, but only during certain times. You can change plans during the Annual Enrollment Period (October 15 to December 7 each year). If you have a major life change like moving to a new state, you may be able to switch outside this window. Contact Medicare at 1-800-MEDICARE to ask about your specific situation.

Does Medicare cover mental health care and therapy?

Yes. Medicare Part B covers mental health services including therapy, counseling, and psychiatric care. You pay your regular Part B copayment (usually 20 percent after the deductible). Some services may require prior approval from Medicare, so ask your provider to check before your appointment.

What if I move to a different state while on SSDI?

Your SSDI and Medicare continue without interruption when you move. However, your Medicaid coverage (if you have it) may change because each state has different rules. Contact your new state's Medicaid office as soon as you move to find out whether you still may have access to and what you need to do.