What changed for SSDI and Medicare in 2020

In 2020, the rules connecting SSDI and Medicare did not change in a way that affected most beneficiaries. The waiting period to move from SSDI to Medicare remained the same: you become may be able to access for Medicare after you have been receiving SSDI for 24 consecutive months. The monthly premium amounts changed, as they do every year, but the structure of coverage stayed consistent.

What did change in 2020 was the dollar amount of the average SSDI payment and the cost of Medicare premiums. The average SSDI benefit increased by 1.3 percent in January 2020, and Medicare Part B premiums rose to $144.30 per month for most beneficiaries (though some paid less if they were already enrolled). These numbers matter because they determine how much money you actually receive after Medicare costs are deducted.

If you were already receiving both SSDI and Medicare before 2020, your coverage continued without interruption. If you became may be able to access for Medicare during 2020 — meaning you had been on SSDI for 24 months — you were automatically enrolled in Medicare Part A and Part B unless you took steps to decline Part B.

Key Takeaways

  • You become may be able to access for Medicare after 24 consecutive months of receiving SSDI, regardless of your age.
  • Medicare Part A (hospital insurance) is automatic and has no monthly premium for most SSDI beneficiaries.
  • Medicare Part B (medical insurance) costs a monthly premium that is deducted directly from your SSDI payment.
  • In 2020, the average SSDI payment was approximately $1,148 per month, and Part B premiums averaged $144.30 per month.
  • You can decline Medicare Part B when you first become may be able to access, but you may face a permanent penalty if you enroll later.

How the 24-month waiting period works

The 24-month clock starts the first month you receive an SSDI payment, not the month you applied or were approved. If you were approved in March 2018 but your first payment arrived in April 2018, your 24 months began in April. You become may be able to access for Medicare in April 2020 — exactly 24 months later.

Social Security counts only months in which you actually received a payment. If your SSDI stopped for any reason — because you returned to work, because you were overpaid and had to repay benefits, or because of a medical review — the clock resets. You start counting from the first month you receive a payment again.

You do not have to do anything to trigger Medicare enrollment. When you reach 24 months of SSDI, Social Security automatically enrolls you in Medicare Part A and Part B. You will receive a Medicare card in the mail about three months before your coverage begins. If you want to decline Part B, you must contact Social Security or Medicare before your coverage starts.

Medicare Part A and Part B costs in 2020

Medicare Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. In 2020, there was no monthly premium for Part A if you or your spouse had paid Medicare taxes for at least 10 years. Most SSDI beneficiaries fall into this category and pay nothing for Part A.

Medicare Part B covers doctor visits, outpatient care, medical equipment, and preventive services. In 2020, the standard monthly premium was $144.30. However, if your income was above a certain threshold in 2018, you paid more — this is called an Income-Related Monthly Adjustment Amount (IRMAA). Social Security deducts the Part B premium directly from your SSDI payment each month, so you never write a separate check.

In addition to premiums, Medicare Part B has an annual deductible (the amount you pay out of pocket before Medicare starts paying). In 2020, this deductible was $198. After you meet the deductible, you typically pay 20 percent of the cost of covered services, and Medicare pays 80 percent.

What happens to your SSDI payment when Medicare starts

When you become may be able to access for Medicare, your SSDI payment does not automatically decrease. Instead, Medicare Part B premiums are deducted from your payment each month. If your SSDI payment is $1,200 and your Part B premium is $144.30, you receive $1,055.70.

There is a rule called the Government Pension Offset (GPO) and the Windfall Elimination Provision (WEP) that can reduce SSDI payments in specific situations, but these rules explore based on your work history and government employment, not because of Medicare. Medicare itself does not reduce the base amount of your SSDI benefit.

If you decline Medicare Part B when you first become may be able to access, your full SSDI payment continues without any deduction. However, if you enroll in Part B later, you may owe a permanent 10 percent penalty on your premium for each year you delayed enrollment (with some exceptions for people still working).

Declining Medicare Part B and the consequences

You have the right to decline Medicare Part B when you first become may be able to access. To do this, you must contact Social Security in writing or by phone before your Part B coverage begins. Social Security will send you a notice with your Medicare may be able to access date; you typically have about 30 days to decline.

Some people decline Part B because they have other health insurance through an employer or a spouse's employer. If you have creditable coverage (insurance that is at least as good as Medicare Part B), you can decline without penalty and enroll later when that coverage ends.

If you decline Part B and do not have other creditable coverage, you will face a permanent penalty if you enroll later. The penalty is 10 percent of the Part B premium for each full year you were may be able to access but not enrolled. If you were may be able to access for three years and did not enroll, your premium will be 30 percent higher for as long as you have Medicare. There is no way to remove this penalty.

How to find out your specific Medicare start date

Social Security sends a notice called the Medicare may be able to access Notice about three months before your coverage begins. This notice tells you the exact date your Medicare Part A and Part B coverage will start. It also explains how to decline Part B if you choose to.

You can also contact Social Security directly to confirm your Medicare may be able to access date. Call 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office. Have your Social Security number ready. If you are calling, wait times are typically shorter early in the morning on weekdays.

If you believe you should already be may be able to access for Medicare but have not received a notice, contact Social Security when ready. Delays in enrollment can happen, and it is your responsibility to follow up if you do not receive the notice within the expected timeframe.

Understanding Medicare Advantage and Medigap options in 2020

Once you have Medicare Part A and Part B, you can choose how to receive your coverage. You can stay with Original Medicare (the standard Part A and Part B plan run by the federal government), or you can switch to a Medicare Advantage plan (a private insurance plan that covers everything Original Medicare does, usually with lower out-of-pocket costs but a smaller network of doctors).

You can also buy a Medigap policy (supplemental insurance sold by private companies) to cover costs that Original Medicare does not pay, such as copayments and coinsurance. Medigap policies have their own monthly premiums, which are not deducted from your SSDI payment — you pay them separately to the insurance company.

In 2020, Medicare Advantage plans often had $0 premiums for beneficiaries on SSDI, though you still paid the Part B premium to Social Security. Medigap premiums varied widely depending on your age, location, and the plan you chose. You can enroll in a Medicare Advantage plan or switch between plans during the annual enrollment period (October 15 to December 7 each year).

Frequently Asked Questions

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

You must take Medicare Part A, but you can decline Part B. If you decline Part B and do not have other creditable coverage, you will pay a permanent 10 percent penalty on your premium if you enroll later. Part A has no premium for most SSDI beneficiaries, so there is no financial reason to decline it.

What if I go back to work and my SSDI stops — does my Medicare stop too?

No. Once you have been on SSDI for 24 months and become may be able to access for Medicare, your Medicare coverage continues even if your SSDI payment stops. You will still owe the Part B premium each month, but you can pay it directly to Medicare instead of having it deducted from your SSDI payment.

Can I switch from Original Medicare to a Medicare Advantage plan in 2020?

Yes. You can enroll in a Medicare Advantage plan during the annual enrollment period (October 15 to December 7) or during your initial enrollment period when you first become may be able to access for Medicare. Some plans allow you to switch at other times if you have a may have access to life event.

What if my income was high in 2018 — will I pay more for Medicare in 2020?

Possibly. Medicare uses your income from two years prior to calculate the Income-Related Monthly Adjustment Amount (IRMAA). If your 2018 income was above the threshold, you paid a higher Part B premium in 2020. You can appeal this amount if your income decreased significantly between 2018 and 2020.

How do I know if my SSDI payment is correct after Medicare premiums are deducted?

Social Security sends a benefit statement each year showing your payment amount and any deductions. You can also view your account online at ssa.gov using your personal my Social Security account. If the amount seems wrong, contact Social Security to request a detailed explanation of the deduction.