Health Insurance Options for SSDI Recipients in Dallas County

What Insurance Covers SSDI Recipients in Dallas County

If you receive SSDI in Dallas County, you are covered by Medicare automatically after you have been on SSDI for 24 months. This is federal coverage that works the same way across Texas. Before those 24 months are up, you may be covered by Medicaid if your income and resources fall below Texas limits — this is state coverage that Dallas County administers through the Health and Human Services Commission (HHSC).

You do not choose between them. Medicare starts automatically; Medicaid runs alongside it if you meet the income test. Both are free or low-cost. The key difference is what they cover and which doctors accept them. Many Dallas County providers accept both, but some accept only one.

Your SSDI payment amount does not change based on which insurance you have. The insurance is separate from your cash benefit.

Key Takeaways

Medicare begins automatically 24 months after your SSDI start date, with no action required on your part.
Before Medicare starts, you may be covered by Texas Medicaid if your monthly income is below the state limit, which you can check by contacting HHSC Dallas County.
Dallas County has Medicaid managed care plans (HMOs) and fee-for-service Medicaid; you choose which plan if you are on Medicaid.
Medicare has three parts — Part A (hospital), Part B (doctor visits), and Part D (prescriptions) — and you pay premiums for Parts B and D once you are on SSDI.
If you work while on SSDI, your earnings may affect Medicaid coverage but not Medicare coverage.

Medicare Coverage for SSDI Recipients

Medicare Part A covers hospital stays, skilled nursing facility care, and hospice. It starts automatically 24 months after your SSDI begins. You pay nothing for Part A premiums.

Medicare Part B covers doctor visits, outpatient care, and some preventive services. Part B also starts at month 24, but you pay a monthly premium — the amount changes each year. In 2024, the standard premium is $164.90 per month, though it may be higher or lower depending on your income. Social Security deducts the premium directly from your SSDI payment.

Medicare Part D covers prescription drugs. You must enroll in a Part D plan during your initial enrollment period or you may face a penalty if you enroll later. Part D plans are offered by private insurance companies approved by Medicare. You choose which plan covers your specific medications. In Dallas County, dozens of Part D plans are available, and their costs and drug lists change each year.

You can view and compare Part D plans at Medicare.gov or call 1-800-MEDICARE. The Social Security Administration (SSA) will also send you information about Part D enrollment when you become may be able to access for Medicare.

Texas Medicaid Coverage Before Medicare Starts

Between the time your SSDI starts and month 24, you may be covered by Texas Medicaid if your income is low enough. Texas sets the income limit for SSDI recipients at 75% of the federal poverty level. For 2024, that means a single person on SSDI can earn up to approximately $1,033 per month and still be covered by Medicaid. This limit changes yearly.

You do not have to be on SSDI to be on Medicaid — you can be on Medicaid alone if you have no income or very low income. But if you are on SSDI, Medicaid is the main coverage option before Medicare begins.

To find out whether you meet the income limit, contact the Health and Human Services Commission (HHSC) Dallas County office at 214-819-6000 or visit the Texas HHSC website. You can also explore for Medicaid through the Texas HHSC portal or in person at a local office.

If you are approved for Medicaid, you will be assigned to a managed care plan (HMO) unless you request fee-for-service Medicaid. Managed care plans include HealthTexas, Molina Healthcare, UnitedHealthcare, and others. Each plan has its own network of doctors and pharmacies. You can switch plans once per year during the open enrollment period in November and December.

What Happens When You Turn 65 or Reach Month 24 of SSDI

At month 24 of SSDI, Medicare replaces Medicaid as your primary insurance. If you were on Medicaid before month 24, your Medicaid coverage ends on the day Medicare begins — you do not stay on both.

However, you may be covered by a program called Medicaid Buy-In if you work while on SSDI and your earnings are above the Medicaid income limit. This program lets you keep Medicaid coverage even after Medicare starts, as long as you meet the work requirement. Contact HHSC Dallas County to ask whether you are covered by Buy-In.

If you turn 65 while on SSDI, you automatically convert to Social Security retirement benefits at age 65. Your Medicare coverage continues without interruption. Your SSDI payment becomes a retirement payment, but the amount stays the same.

Choosing Doctors and Pharmacies in Dallas County

Medicare Part B and Medicaid both have networks of doctors and pharmacies in Dallas County. Not all doctors accept both. Before you schedule an appointment, call the doctor's office and ask whether they accept your insurance.

For Medicare, you can search for doctors at Medicare.gov or call 1-800-MEDICARE. For Medicaid, search your managed care plan's website or call the plan's member services number — this number is on your Medicaid card.

If you are on both Medicaid and Medicare (which happens only if you are on Medicaid Buy-In), Medicaid is your secondary insurance. This means Medicare pays first, and Medicaid covers some of what Medicare does not pay. Tell your doctor's office that you have both insurances.

Costs and Out-of-Pocket Expenses

Medicare Part A has no premium, but you pay a deductible when you are admitted to a hospital. In 2024, the Part A deductible is $1,632 per benefit period. You also pay copayments for hospital stays longer than 60 days.

Medicare Part B has a monthly premium (deducted from your SSDI payment) and an annual deductible of $240 in 2024. After you meet the deductible, you typically pay 20% of the cost of covered services.

Part D prescription drug plans have monthly premiums that vary by plan, an annual deductible (usually $35 to $100), and copayments for each prescription. The copayment amount depends on which tier the drug is on in your plan's formulary.

Texas Medicaid has no premium for most recipients. You may pay small copayments for doctor visits and prescriptions, but the amounts are capped. Managed care plans sometimes have $0 copayments for preventive care.

Reporting Changes That Affect Your Insurance

If your income changes, your living situation changes, or you move out of Dallas County, tell HHSC and Social Security. These changes can affect whether you stay on Medicaid and which plan you are in.

If you work and your earnings go above the Medicaid income limit, you may lose Medicaid coverage — unless you are on Medicaid Buy-In. Report your earnings to SSA within 30 days of the month they occur.

If you move to a different county in Texas, your Medicaid coverage continues, but your managed care plan may change because plans operate in specific counties. Contact your new county's HHSC office to confirm your coverage.

Frequently Asked Questions

Do I have to pay for Medicare if I am on SSDI?

You pay no premium for Medicare Part A. You pay a monthly premium for Part B (deducted from your SSDI payment) and a premium for Part D if you enroll in a prescription drug plan. Medicaid before month 24 is free.

What if my doctor does not accept Medicare or Medicaid?

You can still see that doctor, but you will pay the full cost out of pocket. Medicare and Medicaid will not cover any part of the visit. Ask your doctor whether they accept your insurance before you schedule.

Can I switch Medicare plans after I enroll?

You can switch Part D prescription drug plans once per year during the annual enrollment period from October 15 to December 7. You cannot switch Medicare Part A or Part B — those are federal coverage you cannot change.

What if I disagree with a claim denial from Medicare or Medicaid?

You can file an appeal with the insurance company within 60 days of the denial letter. The letter will explain how to appeal. If you disagree with the appeal decision, you can request a hearing before an independent reviewer.

Do I need supplemental insurance (Medigap) on top of Medicare?

Medigap is optional. It covers some costs that Medicare does not pay, like copayments and deductibles. You can buy it from a private insurance company. If you are on Medicaid Buy-In, Medicaid acts as your secondary insurance, so you may not need Medigap.

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.