What You Pay for Medicare on SSDI

If you receive SSDI, you are enrolled in Medicare automatically after you have been on SSDI for 24 months. You do have to pay for most of it, but the cost depends on which parts of Medicare you use and your income level.

Part A (hospital insurance) is free for nearly everyone on SSDI. Part B (medical insurance) costs money — the standard premium in 2024 is $174.70 per month, though this amount changes each year. Part D (prescription drug coverage) also costs money and varies by plan. Part C (Medicare Advantage) is optional and replaces Parts A and B; it may cost nothing or may charge a monthly premium depending on the plan you choose.

The premiums are usually taken directly from your SSDI payment each month. If your SSDI payment is small, you may owe money out of pocket instead. Some people with very low income may be able to reduce or eliminate their Part B premium through a program called Medicaid Buy-In, which varies by state.

Key Takeaways

  • Part A of Medicare is free when you are on SSDI; Part B costs a monthly premium that is deducted from your SSDI payment.
  • The Part B premium changes each year and is currently around $174.70 per month, but you may pay more or less depending on your income.
  • If your income is very low, your state's Medicaid program may help pay your Part B premium through a Buy-In program.
  • You must enroll in Part D (prescription drugs) during specific windows or pay a penalty if you go without coverage and later sign up.

How Part B Premiums Work on SSDI

Part B premiums are deducted from your SSDI check before you receive it. This means you see a smaller payment each month. The amount you pay depends on your income from the previous year — the Social Security Administration uses your tax return or other income records to calculate what you owe.

If your income is higher, you may pay an Income-Related Monthly Adjustment Amount (IRMAA), which is an extra charge on top of the standard premium. This happens when your income exceeds certain thresholds, which change each year. For example, in 2024, if you are single and earned more than $97,000 in the previous year, you would pay more than the standard rate.

If your SSDI payment is very small — smaller than your Part B premium — Social Security will still deduct the premium, and you will owe the difference. This is rare but does happen. Contact Social Security directly if your payment is less than $174.70 and you want to understand what you owe.

Part A, Part C, and Part D Costs

Part A covers hospital stays, skilled nursing care, and hospice. You pay nothing for Part A premiums when you are on SSDI. You do pay deductibles and coinsurance when you actually use hospital services — for example, you pay $1,632 toward your first hospital stay in 2024 — but there is no monthly premium.

Part C (Medicare Advantage) is an alternative to Parts A and B. Private insurance companies offer these plans, and some charge no monthly premium at all. Others charge $10 to $50 per month. Part C plans often include prescription drug coverage (Part D) built in. If you choose a Part C plan, you do not pay the standard Part B premium; instead, you pay whatever the plan charges.

Part D (prescription drugs) is optional but important. If you do not enroll when you first become may be able to access and later want coverage, you pay a late enrollment penalty for as long as you have Medicare. The penalty is roughly 1 percent of the national average Part D premium for each month you were without coverage. This adds up quickly, so most people enroll even if they do not take many medications.

Income-Related Premiums and IRMAA

If your income is above a certain level, Medicare charges you more for Part B and Part D. This extra amount is called an Income-Related Monthly Adjustment Amount. Social Security uses your income from two years before to calculate it — so in 2024, they look at your 2022 income.

The income thresholds change each year. In 2024, for a single person, the thresholds start at $97,000. If you earned between $97,000 and $123,000, you pay about $61 extra per month on top of the standard Part B premium. If you earned more, the extra amount increases. Married couples filing jointly have higher thresholds.

If your income drops — for example, because you stopped working or had a major life change — you can request that Social Security recalculate your IRMAA. You must file a form called the Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event (form SSA-44). Social Security will review your current income and may lower your premium.

Medicaid Buy-In Programs for SSDI Recipients

Some states run Medicaid Buy-In programs that let people on SSDI keep working and stay on Medicaid without losing coverage. These programs also sometimes help pay your Medicare Part B premium. The rules and costs vary widely by state — some states charge nothing, others charge a small monthly fee.

To learn about your state has a Buy-In program and whether it covers Part B premiums, contact your state Medicaid office. You can find your state office through the Centers for Medicare & Medicaid Services (CMS) website or by calling 1-800-MEDICARE. A representative can tell you whether your state offers this program and what it costs.

If you are in a state with a Buy-In program and your income is low enough, the program may pay your entire Part B premium. This is one of the few ways to reduce what you owe for Medicare while on SSDI.

What Happens If You Cannot Afford Your Premiums

If you cannot afford your Part B premium, do not straightforward skip it. Unpaid premiums can lead to a gap in your coverage, and you may have to pay back premiums later. Instead, contact Social Security or Medicare directly to discuss your situation.

You have a few options. First, ask Social Security whether you may have access to for premium-free Part B based on your income — this is rare but possible in some cases. Second, look into whether your state has a Medicaid program that can help pay premiums. Third, contact your local Area Agency on Aging or a benefits counselor through the State Health Insurance information Program (SHIP) to explore other options.

If your SSDI payment is very small and your Part B premium is being deducted, you may also be able to request a review of your situation. Social Security can sometimes adjust how much is deducted or work out a payment plan.

Frequently Asked Questions

Do I have to take Medicare when I become may be able to access on SSDI?

You are automatically enrolled in Medicare Part A and Part B after 24 months on SSDI. You cannot decline Part A, but you can decline Part B if you are still working and have health insurance through your employer. If you decline, you must sign up later during the General Enrollment Period (January 1 to March 31 each year), and you will pay a late enrollment penalty.

Can I switch from Original Medicare to Medicare Advantage to save money?

Yes. You can switch to a Medicare Advantage plan (Part C) during the Annual Enrollment Period (October 15 to December 7 each year). Some Advantage plans charge no monthly premium, though you may pay more when you use services. Compare plans in your area to see what is available and what each plan covers.

What if my income changes after I start Medicare?

If your income drops significantly — for example, you stop working or have a major life event — you can request that Social Security recalculate your IRMAA. File form SSA-44 and include proof of the change. Social Security will review your current income and may lower your premiums going forward.

Will my Part B premium come out of my SSDI payment automatically?

Yes, in almost all cases. Social Security deducts your Part B premium directly from your monthly SSDI payment before you receive it. If your SSDI payment is smaller than your premium, you will owe the difference, though this is uncommon.

How do I know if I may have access to for Medicaid to help pay Medicare costs?

Contact your state Medicaid office to ask about programs that help pay Medicare premiums. Many states have programs for people with low income on SSDI. Your state office can tell you the income limits and what documents you need to provide.