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Understanding Medicare and Social Security Disability

If you are applying or have been approved for Social Security Disability benefits, you may be wondering if you will receive Medicare along with your monthly Social Security Disability payments. After all, medical bills can be an overwhelming expense. If you do not receive medical assistance, your medical expenses could possibly wipe out all of your Social Security Disability benefits. Fortunately, those who qualify for Social Security Disability payments will also qualify for Medicare, but there are some things you need to know about the date coverage starts and what type of coverage you are entitled to.

The Waiting Game with Social Security Disability

It is important to understand that your Medicare benefits may not begin as soon as your Social Security Disability payments start coming in. There is a waiting period for Medicare benefits and you will not be entitled to Medicare until two years after your date of Social Security Disability entitlement. What exactly does this mean, and do you have to wait another two years before you can begin receiving Medicare benefits? Not necessarily.

Let's say you became disabled in June of 2008. Your date of entitlement for Social Security Disability would be in November of 2008 since there is a five-month waiting period. Now, let's say you applied for Social Security Disability benefits in March of 2009 but you weren't actually approved for Social Security Disability until October of 2010 due to the lengthy application and disability appeals process. If you were approved for Social Security Disability with an entitlement date of November 2008, then your Medicare benefits would begin in November of 2010.

On the other hand, if you recently became disabled and applied for Social Security Disability and they approved you with an entitlement date of October 2010, you wouldn't be eligible to receive Medicare benefits until October of 2012. You would have to wait 2 years before you were covered by the Medicare program.

The Exception to the Rule

There is an exception to the above rule, and that is for Social Security Disability applicants who qualify for Supplemental Security Income. SSI is a needs-based program and if you qualify for SSI, you will not receive Medicare benefits. Instead, you will receive Medicaid benefits. Medicaid benefits are handled at the state level and there is not a two-year waiting period to qualify. However, you must meet the income guidelines and other criteria set forth by your state and local human services agency in order to qualify for Medicaid benefits.

What Does Medicare Cover?

Medicare is broken down into four different categories including Medicare Part A, Part B, Part C and Part D. When you become eligible for Medicare Part A (24 months after your entitlement date for Social Security Disability benefits) you will automatically be enrolled in the Medicare program. Most people who receive Social Security Disability do not have to pay for Medicare Part A. This portion of Medicare only covers hospital bills and some medical and hospice expenses.

The Part B program of Medicare is what covers your doctor's visits and other medical services and supplies that are not covered by Medicare Part A. Most of the people who receive Social Security Disability benefits do have to pay a premium for Medicare Part B, but you may choose to opt out of this program if you already have medical insurance. Just remember, if you choose not to enroll in Medicare Part B now and decide to do so later on, it may cost you more to enroll at that point.

Medicare Part D is the part of your Social Security Disability benefits that covers your prescription drug costs. Like Medicare Part B, you will need to pay a premium for Medicare Part D. If you choose not to enroll in Medicare Part D now, but decide to later, you will have to pay a penalty and will continue to pay this penalty for as long as you keep your Medicare Part D coverage. When enrolling in Medicare Part D it is important to understand that not all of the cost of your medications will be covered. You will need to pay a co-pay and if you enter the “gap” period you will be responsible for all of your prescription costs until you are out of that gap. The Medicare Part D gap occurs when you have reached total prescription drug costs of $2,830 (for 2010). Once that happens, you will be responsible for all of your medication costs until you have reached a total out-of-pocket expense of $4,550. At that point you will be out of the gap and your prescription coverage will begin again.

While You Wait to Get Social Security Disability Benefits

If you feel that you cannot afford your medical expenses after you have been approved for disability benefits and you are not yet eligible for Medicare, you may want to contact your local human services agency to determine whether or not Medicaid is an option. When you do become enrolled in Medicare, make sure you understand the premiums you will have to pay for Part B and Part D coverage. Fortunately, the premiums for Medicare coverage are usually nominal compared to medical costs you would incur if these coverages did not exist.

Comments

It has been two years since my husband became disabled, and now he is being automatically enrolled in Medicare, which is going to cost him a premium every month. He is a veteran and doesn't need health insurance. SSA recently sent him a notice that he will receive a certain amount of money each month for medicare. What I want to know is is this payment in addition to his SSD payment or are they lowering the amount he receives each month for SSD to cover this benefit of Medicare he doesn't even need?

Hi Cindy,
I think that may be a letter stating how much would be deducted from his benefits, you may want to contact your local SSA office for information about his options regarding Medicare.

I have the exact same question Cindy had which is not answered here. I get $1,200 SSDI and got a letter stating I have been disabled for 2 years and now qualified for Medicare and stated "you will receive $1,000 for July (month before it Medicare starts) and $134 will be removed for payments. (Side note I'm 45 not retiring age). So like Cindy I ask are the reducing my original payment or adding to it i.e. $1,200+1,100 - 134 OR reducing my payment and deducting Medicare

Hello I just got my Medicare I was on Medicaid for 4 years after 24 months I was suppose to have been getting it now will I get back pay for those 2 years thankou

Cindy I will try to assist you with how it worked for my wife. My wife is my private insurance plan so she doesn't need medicare at this point in time. There was some confusion at first when she started on disability because they had already started adjusting the SSDI payment thinking she needed medicare. In other words the medicare payment comes directly from you SSDI payment. Once she went through the process of stopping medicare her SSDI was adjusted about $110 higher because she no longer carried medicare. One thing to remember is to keep medicare Part A. There is no cost to have that on you once you qualify for medicare. It keeps your medicare in place in the event you need to get Part B it will save you a lot of time.

Hi Doug,
Thanks for sharing your story! That's a very good point, you can keep Part A without needing to enroll in part B.