Medicare and Medicaid are the two insurance programs tied to Social Security Disability Insurance (SSDI), but which one you get depends on your work history and how long you have been receiving benefits.
If you receive SSDI, you become covered by Medicare automatically after you have been on the program for 24 months. This is true regardless of your age. Most people on SSDI receive Medicare Part A (hospital insurance) and Part B (medical insurance) at no cost, because the Social Security Administration pays your premiums.
Some people on SSDI also receive Medicaid at the same time. Whether you get Medicaid depends on your state's rules and your income and assets. In some states, Medicaid is automatic if you receive SSDI. In others, you must meet separate income or asset limits. A few states use a different system altogether.
If you are under 65 and receiving SSDI, you will not have access to Medicare until the 24-month waiting period ends. During those first 24 months, Medicaid may be your only coverage option, depending on your state.
Key Takeaways
- Medicare Part A and Part B coverage begins automatically after 24 months on SSDI, and Social Security pays the premiums for you.
- Medicaid availability while waiting for Medicare depends on your state's rules and your income and assets, and some states provide it automatically to SSDI recipients.
- During the first 24 months of SSDI, before Medicare starts, Medicaid may be your only health insurance option.
- Once you turn 65, your SSDI payments convert to retirement benefits, but your Medicare coverage continues without interruption.
- Some people on SSDI may have access to for both Medicare and Medicaid at the same time, which is called "dual may be able to access" status.
How Medicare works when you receive SSDI
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. You pay nothing for Part A premiums because Social Security covers the cost. You may still owe a deductible when you use the service — for example, a hospital deductible applies when you are admitted — but you do not pay a monthly premium.
Medicare Part B covers doctor visits, outpatient services, lab work, and medical equipment. Social Security also pays your Part B premium, so you have no monthly cost. Like Part A, Part B has a deductible and copayments when you use services, but the premium itself is covered.
You do not have to do anything to enroll in Medicare once you have been on SSDI for 24 months. The Social Security Administration automatically registers you and sends you a Medicare card in the mail about three months before your coverage begins.
If you want prescription drug coverage (Medicare Part D), you must enroll during your initial enrollment period or during the annual enrollment period in the fall. Part D is not automatic, and missing the enrollment window can result in a penalty if you enroll later.
Medicaid coverage while waiting for Medicare
Medicaid is a joint federal and state program, so the rules vary significantly by state. Some states automatically enroll you in Medicaid when you begin receiving SSDI. Other states require you to meet additional income or asset tests, even though you are receiving SSDI. A small number of states use a different pathway altogether.
To find out whether your state provides Medicaid to SSDI recipients and what the rules are, contact your state Medicaid office. You can find your state office through the Centers for Medicare & Medicaid Services website or by calling your local Social Security office and asking for a referral.
If you live in a state that does not automatically provide Medicaid to SSDI recipients, you may still be able to receive it if your income and assets fall below your state's limits. The income limit for Medicaid is often higher than the SSDI payment amount, so it is worth checking even if you think you earn too much.
Medicaid covers many services that Medicare does not, including dental care, vision care, hearing aids, and long-term care in a nursing home. If you have both Medicare and Medicaid, Medicaid often covers costs that Medicare does not pay.
The 24-month waiting period before Medicare begins
The 24 months starts from the date you are approved for SSDI, not from the date you applied. Social Security will tell you the exact date your Medicare coverage will begin when they send you your SSDI approval letter.
During this waiting period, you have no Medicare coverage. If you do not have Medicaid through your state, you may have no health insurance at all. Some people purchase coverage through the health insurance marketplace during this time, or they may be covered through a spouse's employer plan.
If you need health care during the waiting period and have no insurance, you can still receive emergency services at a hospital. However, you may receive a bill afterward. Some hospitals have financial information programs for uninsured patients, and you can ask about these when you arrive.
Once your 24 months are complete, Medicare begins automatically. You do not need to do anything or contact Social Security to set up it.
What happens to your insurance when you turn 65
When you reach age 65, your SSDI payments automatically convert to retirement benefits under Social Security's retirement program. The amount you receive may change slightly, but your Medicare coverage continues without any gap or interruption.
You keep the same Medicare Part A and Part B coverage, and Social Security continues to pay your premiums. If you have Medicaid, your coverage continues as well, though your state may review your case to confirm you still meet the income and asset limits.
You do not need to reapply for Medicare or take any action when you turn 65. The transition from SSDI to retirement benefits is automatic.
Dual may be able to access status: having both Medicare and Medicaid
If you receive both Medicare and Medicaid at the same time, you are considered dual may be able to access. This status means Medicaid can help pay for costs that Medicare does not cover, such as the Part B deductible, copayments, and services like dental or vision care.
Dual may be able to access status is common among people on SSDI who live in states with higher Medicaid income limits. The exact benefits you receive from Medicaid depend on your state's program, so contact your state Medicaid office to learn what services are covered.
Some states offer special programs for dual may be able to access people that coordinate care between Medicare and Medicaid. These programs may assign you a care manager or limit which doctors and hospitals you can use. Your state Medicaid office can tell you whether such a program exists in your area.
Frequently Asked Questions
Do I have to pay for Medicare if I receive SSDI?
No. Social Security pays your Medicare Part A and Part B premiums automatically. You may still owe a deductible or copayment when you use a service, but you have no monthly premium cost.
What if I do not want Medicare after 24 months on SSDI?
You can decline Medicare Part B, though Part A is automatic. If you decline Part B and later want to enroll, you may face a penalty. Contact Social Security before your coverage begins if you want to decline Part B.
Can I get health insurance through my job while waiting for Medicare?
Yes. If you work and your employer offers health insurance, you can enroll in that plan during the 24-month waiting period. You can also purchase coverage through the health insurance marketplace. Once Medicare begins, you can keep your employer plan if you wish, though Medicare becomes your primary insurance.
What if my state does not provide Medicaid to SSDI recipients?
You may still may have access to for Medicaid if your income and assets are below your state's limits. Contact your state Medicaid office to find out. If you do not may have access to, you can purchase coverage through the health insurance marketplace or ask about programs that help low-income people pay for insurance.
Does Medicare cover dental, vision, or hearing aids?
Original Medicare does not cover routine dental, vision, or hearing services. If you have Medicaid as well, your state's Medicaid program may cover these services. You can also purchase a separate dental or vision plan through Medicare Advantage or the marketplace.