You Get Medicare, Not Medicaid, When You Receive SSDI

If you receive Social Security Disability Insurance (SSDI), you are automatically enrolled in Medicare after you have been on SSDI for 24 months. This is a federal rule that applies to everyone on SSDI, regardless of age or income. You do not choose between Medicare and Medicaid — the law puts you on Medicare.

Medicaid is a separate program run by individual states for people with low incomes. Some people on SSDI may also may have access to for Medicaid depending on where they live and how much money they have, but Medicaid is not automatic. Medicare is the health insurance you receive straightforward because you are on SSDI long enough.

The 24-month waiting period starts from the month you first receive an SSDI payment, not from the month you applied. If you were approved in June and received your first check in July, your 24 months begins in July. You will be enrolled in Medicare automatically — you do not need to do anything or submit paperwork to Social Security.

Key Takeaways

  • Medicare enrollment is automatic after 24 months on SSDI; you receive it because of your disability status, not because of your income.
  • The 24-month countdown starts from your first SSDI payment, not your approval date.
  • You may also may have access to for Medicaid depending on your state and your assets, but Medicaid is separate from and not may provide by SSDI.
  • Medicare Part A (hospital insurance) and Part B (medical insurance) both begin at month 25 of SSDI, and you pay a monthly premium for Part B.
  • Some states offer programs that help SSDI recipients pay Medicare premiums and cost-sharing if their income is very low.

What Medicare Covers When You Are on SSDI

Medicare has two main parts: Part A and Part B. Part A covers hospital stays, skilled nursing care, hospice, and some home health services. Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Both parts begin at the same time — month 25 of your SSDI.

You pay a monthly premium for Part B, which is deducted from your SSDI check. The premium amount changes each year. You also pay a deductible before Medicare begins to pay, and you share the cost of services with Medicare (called cost-sharing). These costs can add up, especially if you have ongoing medical needs.

Medicare does not cover dental, vision, or hearing care, and it has limits on prescription drugs. Many people on SSDI add Medigap (supplemental insurance) or Medicare Advantage (Part C) to fill some of these gaps, though both have their own costs and rules.

When You Might Also may have access to for Medicaid

Medicaid rules vary by state, but in most states, having SSDI does not automatically make you Medicaid-may be able to access. Some states use SSDI as a pathway to Medicaid — if you are on SSDI, you may be able to get Medicaid with little additional paperwork. Other states have stricter income or asset limits that many SSDI recipients exceed.

A few states have programs specifically for people on SSDI with low incomes. These programs help pay your Medicare premiums and your share of costs. To find out whether your state offers this, contact your state Medicaid office or call 211 and ask about programs for SSDI recipients.

If you do may have access to for both Medicare and Medicaid, Medicaid becomes your "secondary payer" — it covers some costs that Medicare does not pay. This can significantly reduce your out-of-pocket expenses, especially for prescription drugs and long-term care.

The Difference Between Medicare and Medicaid

Medicare and Medicaid are federal programs, but they work very differently. Medicare is based on your work history or disability status — you earn it through contributions or by meeting disability rules. Medicaid is based on income and assets — it is for people with very low resources, regardless of how they became low-income.

Medicare is the same in every state. Medicaid rules, income limits, and covered services change from state to state. Medicare is run by the federal government. Medicaid is run by each state with federal funding and oversight.

Because you are on SSDI, you are in the Medicare system. Whether you also get Medicaid depends on your state's rules and your personal income and assets. Many people on SSDI have both, but it is not automatic.

What Happens to Your Coverage if You Return to Work

SSDI has a trial work period that lets you test returning to work without losing your benefits right away. During this period, you can earn money and still receive your full SSDI check. The trial work period lasts nine months (not necessarily consecutive).

After the trial work period ends, SSDI has a grace period where you can still work and receive benefits if your earnings stay below a certain amount. Once your earnings go above that amount for nine months, your SSDI payments stop. However, your Medicare coverage continues for at least 93 months (about 7.5 years) after your payments end, even if you are working and earning above the limit.

This means you keep Medicare coverage while you are testing work, and you keep it for years afterward. Medicaid coverage, if you have it, may end sooner — it depends on your state's rules about income limits for people no longer on SSDI.

How to Prepare for Medicare When Your 24 Months Are Almost Up

About three months before your 24-month mark, Social Security will mail you information about Medicare enrollment. You do not need to do anything — enrollment is automatic. However, you should read the materials so you understand what Medicare covers and what your costs will be.

Before month 25 arrives, review your current medications and doctors to see whether they are covered by Medicare. If you take many prescription drugs, look into Medicare Part D (prescription drug coverage) plans in your area, because coverage varies by plan. You can enroll in Part D during your initial enrollment period without penalty.

If your income is very low, ask Social Security or your state Medicaid office about programs that help pay your Medicare costs. These programs have names like may have access to Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or state-specific programs. explore early means you get help from the month you turn 25 on SSDI, not months later.

Medicare Costs You Should Know About

Your Medicare Part B premium is deducted from your SSDI check each month. The amount depends on your income from two years ago — if your income was higher in the past, you may pay a higher premium now. This is called Income-Related Monthly Adjustment Amount (IRMAA), and it can surprise people whose income has dropped since they went on SSDI.

You also pay a Part A deductible if you are hospitalized, and a Part B deductible before Medicare starts paying for doctor visits and outpatient care. After you meet the deductible, you typically pay 20 percent of the cost of services, and Medicare pays 80 percent. For hospital stays, you pay a different amount per day.

If you add Medigap or Medicare Advantage, you pay an additional monthly premium for that coverage. These premiums vary widely depending on the plan and your location. Some plans are cheaper but cover less; others cost more but have lower out-of-pocket costs.

Frequently Asked Questions

Do I have to do anything to get Medicare after 24 months on SSDI?

No. Medicare enrollment is automatic. Social Security will send you information about three months before your coverage begins, but you do not need to submit forms or call anyone. Your Medicare card will arrive in the mail before month 25.

Can I turn down Medicare and stay on Medicaid instead?

You cannot turn down Medicare — it is automatic after 24 months on SSDI. However, you can have both Medicare and Medicaid at the same time if your state and income allow it. If you have both, Medicaid helps pay costs that Medicare does not cover.

What if I live in a state that does not have Medicaid expansion?

Some states have not expanded Medicaid, which means fewer people on SSDI may have access to. You will still get Medicare automatically after 24 months. Contact your state Medicaid office to learn what programs exist for people on SSDI with low incomes — some states have alternatives to full Medicaid.

Will my Medicare premium change if my SSDI payment changes?

Your Part B premium is based on your income from two years ago, not your current SSDI payment. If your income drops significantly, you can ask Social Security to recalculate your premium, but the change usually takes several months to process.

Does Medicare cover the same things in every state?

Yes. Medicare coverage is the same nationwide. However, the doctors and hospitals that accept Medicare vary by location, and prescription drug plans (Part D) have different coverage in different areas. You should check which plans and providers are available in your state.