Understanding Medicare and Social Security Disability

Submitted by Deanna on Thu, 10/22/2015 - 12:42

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.

Blog comments

Cindy (not verified)

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?

Sat, 02/04/2017 - 21:51 Permalink

In reply to by Cindy (not verified)

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.

Wed, 02/08/2017 - 10:24 Permalink
Julia (not verified)

In reply to by Cindy (not verified)

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

Fri, 06/30/2017 - 22:06 Permalink
Clay (not verified)

In reply to by Cindy (not verified)

Cindy I to am a veteran and eligible for care at the VA hospital and VA prescriptions. How ever I would advise to consider long and hard before canceling out Medicare. Some times the VA doesn't have certain services at some hospitals and may have to refer you to one a great distance away. And they don't have some medications either. I know, trust me I know, that money is tight, but if you can afford it I'd advise your husband to keep his Medicare. Just my opinions.

Thu, 09/14/2017 - 13:39 Permalink
Doug (not verified)

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.

Wed, 06/14/2017 - 11:47 Permalink

In reply to by Doug (not verified)

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.

Wed, 06/14/2017 - 13:04 Permalink
Nancy (not verified)

My husband started on SSI Disability in 2009 following a massive stroke in 2008. His was given Medicare Disability. We also purchase a Medicare Advantage insurance to cover the medical part. SSI takes out $100 a month from his SSI check for Medicare. If Medicare A is automatic and he is on a Medicare Advantage ins for medical why is SSI taking $100 each month for Medicare? Please advise and thank you.

Thu, 09/07/2017 - 12:30 Permalink

In reply to by Nancy (not verified)

Hi there,
Medicare Part A is automatic and does not have a monthly premium. Medicare Part B has premiums associated with it, however SSI recipients may be eligible for reduced or free premiums for Medicare. You may have that money taken out due to your Medicare Advantage plan, as those are supplemental and are not required for Medicare Part B coverage. It may be a good idea to contact the SSA or your insurer regarding this.

Thu, 09/07/2017 - 13:26 Permalink
Sophia (not verified)

My SSD starts in November I am currently on general assistance which ends October 1st. I also receive Medicaid. I received a letter saying I would stay on Medicaid until 2019 which then the Medicare kicks in. Just wanted to verify this

Wed, 09/20/2017 - 08:55 Permalink

In reply to by Sophia (not verified)

Hi Sophia,
I cannot verify this as we are not affiliated with any federal or state governments or the SSA, however there is a 2 year waiting period for Medicare with SSDI benefits.

Wed, 09/20/2017 - 09:52 Permalink
Vivian (not verified)

My husband became eligible for disability benefits December 1, 2015. It is now September 2017 and we have not heard anything about Medicare coverage. Will he be automatically covered December 1, 2017?

Mon, 09/25/2017 - 22:32 Permalink

In reply to by Vivian (not verified)

Hi Vivian,

We aren't affiliated with the Federal government or any of the state governments, so I would recommend speaking to a representative at the Medicare office.

Wed, 09/27/2017 - 09:45 Permalink
Anonymous (not verified)

My husband receives social security no longer works he has a heart condition can't read he had a mild heart attack and stroke is he eligiable for medicaid or Medicare he's only 58 will be 59 in feb

Tue, 11/07/2017 - 07:24 Permalink

In reply to by Anonymous (not verified)

Hi there,
It sounds like he might qualify--heart conditions are commonly-approved conditions. Consider having his case evaluated by an attorney or advocate by taking our Free Disability Evaluation.

Tue, 11/07/2017 - 08:45 Permalink
Precious Torres (not verified)

Hi I received a letter from supplement program saying as if December 1st 2017 my benefits will discontinued what does that mean

Fri, 11/24/2017 - 19:58 Permalink
Constance (not verified)

I became elible for ssd last November due to advanced stage cancer. I am 60 years old. I was eliblbe for a cheap insurance through affordable care act in 2017 but cannot afford it for 2018 as it is $641.00 a month after subsidy. I have some outstanding medical bills too. Will I have to wait another year before I am eligible for Medicare? Should I apply for Medicaid? I am single.

Mon, 11/27/2017 - 14:09 Permalink
Pam (not verified)

Hi ... My husband is eligible for Medicare A & B this spring. (disability). He is currently under my health plan at work. I understand Part A is free, and Part B you pay a premium. We would like to defer Part B at this time, because he has coverage, but I understand that if you defer Part B now, you will have to pay substantially more should you later need it. What should we do?

Wed, 11/29/2017 - 14:12 Permalink
Heather Powell (not verified)

Cindy: I was told that when you get approved for disability that the back pay check goes straight to your back medical bills and you get nothing. Is this true?

Wed, 01/17/2018 - 15:35 Permalink

In reply to by Heather Powell (not verified)

Hi Heather,
While you may be able to pay your back medical bills with your back pay, you may not be required to pay them directly from the award amount.

Thu, 01/18/2018 - 09:53 Permalink
jan (not verified)

my daughter was just approved for SSI disability. Her medical insurance is now through the exchange in Massachusetts at no cost to her. Does she have to transfer to Medicare? There are two reasons that make me ask.....1st she currently has no monthly premium with her health plan in Mass; 2nd her therapist that has help her immensely with her BPD does not participate with Medicare. Obviously I would like her to continue to see the therapist that has helped her make such strides in her functionality.

Thu, 01/18/2018 - 20:19 Permalink

In reply to by jan (not verified)

Hi Jan,
If your daughter is receiving SSI rather than SSDI, she would not be eligible for Medicare. If she was eligible for Medicare and she met the income criteria, she may be eligible for extra help with Medicare.

Mon, 01/22/2018 - 09:15 Permalink
Mel (not verified)

My husband is covered under my private insurance plan, we are waiting on decision on his disability claim (SSDI)... when he becomes eligible for Medicare, does Medicare become his primary insurance for things like standard of care?

Fri, 01/26/2018 - 08:07 Permalink

In reply to by Mel (not verified)

HI Mel,
Your private insurance may be the primary insurance in this case, however you may want to contact the SSA regarding this as how Medicare interacts with private insurance does depend on many factors and they would be able to give detailed information about your case.

Fri, 01/26/2018 - 10:26 Permalink
FL Mom (not verified)

I became disabled in 2009. I worked from home 30/hrs a week. Once I dropped my hours, I was not eligible for INS thru work and I got on to mcare. Since I am still working, SSA wants to charge for Part A. I have been paying Part B once I joined Mcare.

I am appealing but not sure if this will be in my favor. Any thoughts?

Tue, 01/30/2018 - 18:01 Permalink

In reply to by FL Mom (not verified)

Hi there,
I'm sorry to hear about that! I really could not say if there would be anything else you can do, unfortunately. Hang in there!

Wed, 01/31/2018 - 15:54 Permalink
Sarah (not verified)

I have been receiving my disability for a little over 2 years, and I have always received my payment on the third Wednesday of the month. But when my Medicare kicked in in September, I started receiving my SSDI earlier. Example, I received my deposit in Jan. 3rd this year, instead of the 17th. Do you know if this changed because I am now on Medicare? I can not find any answers to my question of why my payment date changed! Thanks!

Tue, 01/30/2018 - 20:41 Permalink

In reply to by Sarah (not verified)

Hi Sarah,
I could not say, you may want to contact the SSA regarding this as they would have detailed information about your case.

Wed, 01/31/2018 - 15:58 Permalink
Sara (not verified)

I am wondering how a person might have SSDI and masshealth, which is Massachusetts Medicaid, but still be told by the disability office/SSA that they don't qualify for Medicare? I am wondering if they unknowingly opted out of Medicare when they were given it after the initial 2 year period on disability and if that is making it hard to get back on? We have an excellent dual enrolled (Medicare part b and d plus Medicaid) health insurance plan in Massachusetts so I know you can have Medicare and Medicaid at the same time. Just wondering why it would be difficult to get Medicare if you are on disability for years.

Fri, 02/16/2018 - 17:53 Permalink

In reply to by Sara (not verified)

Hi Sara,
That is an excellent question! All disability recipients are automatically enrolled into Medicare, but you should be able to get back onto the program by calling 1-844-847-2659.

Thu, 02/22/2018 - 11:27 Permalink
Terri A Penrose (not verified)

I am currently receiving SSDI. My daughter who has Down's Syndrome receives SSI ( she is 29). She receives benefits from me. I was told she is eligible to be covered on my Medicare also. But I have never received a card for her. How do I prove her Medicare coverage?

Tue, 03/27/2018 - 17:59 Permalink

In reply to by Terri A Penrose (not verified)

Hi Terri,

Anyone who receives SSI is automatically eligible for medicaid. 877-267-2323 is the number for medicaid.gov headquarters, maybe call them for more information.

Tue, 04/03/2018 - 16:28 Permalink
Mary Ann (not verified)

If I am working and collecting my husband's disability, can I retire one yr before my retirement yr...and how much can I make while I work?

Tue, 10/09/2018 - 17:40 Permalink

In reply to by Mary Ann (not verified)

Hi Mary Ann,
When you're receiving auxiliary benefits you can work as much as you'd like and still receive benefits. I'd actually speak with the SSA to determine the best way to maximize your benefits, but yes, you can retire early and receive reduced retirement.

Tue, 10/16/2018 - 16:45 Permalink

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