What SSDI Recipients Need to Know About Medicare Enrollment

Medicare starts automatically for most SSDI recipients, but you still need to take action

If you receive Social Security Disability Insurance (SSDI), Medicare enrollment happens on a schedule tied to your disability approval, not your age. You do not have to submit a separate application for Medicare itself — Social Security handles that part. But you will receive Medicare Part A (hospital insurance) and Part B (medical insurance) automatically 24 months after your SSDI payments begin, and you need to understand what that means for your coverage and your costs.

The catch is that Part B has a monthly premium, and you have choices about how to structure your coverage once Medicare starts. Some SSDI recipients stay on Medicaid alongside Medicare (called "dual may be able to access"), while others transition fully to Medicare. Your state, your income, and your current coverage all affect what you should do first.

Key Takeaways

• Medicare Part A and Part B begin automatically 24 months after your SSDI approval, with no application needed from you.
• You will receive a Medicare card in the mail about three months before Part B coverage starts; check it for errors and contact Social Security if information is wrong.
• Part B has a monthly premium (currently $164.90 for most people in 2024, but this changes yearly), and you can choose to decline it during your initial enrollment period if you want to stay on Medicaid instead.
• If you decline Part B when it is first offered, you may face a permanent penalty if you enroll later, so understand your state's Medicaid rules before you decide.
• Contact your state Medicaid office before Medicare starts to learn whether you can keep both, whether your current doctors accept Medicare, and what your out-of-pocket costs will be.

When Medicare starts for SSDI recipients

The 24-month waiting period begins the month your SSDI payments start, not the month you applied. Social Security counts this time automatically — you do not have to do anything to trigger it. If your payments began in January 2023, your Medicare coverage would start in January 2025.

You will receive your Medicare card by mail approximately three months before your coverage begins. This gives you time to review it, report any errors to Social Security, and prepare for the transition. If you do not receive a card by the time your coverage should start, contact Social Security at 1-800-772-1213 to request a replacement.

Understanding Part A and Part B costs

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Most SSDI recipients pay no monthly premium for Part A because they have already paid into Social Security through payroll taxes. You will have a deductible when you use hospital services (currently $1,632 per hospital stay in 2024, though this amount changes yearly), and you may owe copayments for longer stays.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part B has a monthly premium that most people pay through a deduction from their Social Security check. The standard premium for 2024 is $164.90 per month, but the amount changes each year. If your income is higher, you may pay an additional surcharge called an Income-Related Monthly Adjustment Amount (IRMAA). Social Security will tell you your specific premium amount when your coverage is about to start.

You also have an annual deductible for Part B (currently $240 in 2024) before Medicare begins to pay its share. After you meet the deductible, you typically pay 20 percent of the cost for most services, and Medicare pays 80 percent.

Deciding whether to keep Medicaid alongside Medicare

Many SSDI recipients may have access to for both Medicare and Medicaid — this is called being "dual may be able to access." Medicaid can cover costs that Medicare does not, including long-term care, dental, vision, and hearing services (though these vary by state). If you currently receive Medicaid, you do not automatically lose it when Medicare starts, but you need to confirm this with your state Medicaid office.

Some states have programs specifically for people with both Medicare and Medicaid, such as Medicaid Buy-In programs that let you work and keep coverage. Other states have different rules about income limits or asset limits once you have Medicare. Contact your state Medicaid office at least two months before your Medicare start date to ask: Will I keep Medicaid? What are my income and asset limits now? What services does Medicaid still cover that Medicare does not?

If you decline Part B when it first becomes available because you want to stay on Medicaid only, you may face a permanent 10 percent penalty on your Part B premium if you enroll later. The only exception is if you have other health coverage (such as employer coverage) that is considered creditable. Before you decline Part B, make sure you understand your state's Medicaid rules and whether Medicaid will continue to cover you.

What to do before your Medicare start date

Start by contacting your state Medicaid office about two months before your Medicare coverage begins. Tell them your Medicare start date and ask whether your Medicaid will continue, what your new income and asset limits are, and what services Medicaid will still cover. Write down the name of the person you speak with and the date, in case you need to follow up.

Next, review your Medicare card when it arrives. Check that your name, date of birth, and Social Security number are correct. If anything is wrong, call Social Security at 1-800-772-1213 and ask them to correct it before your coverage starts. Errors on your card can cause problems when you try to use it at a doctor's office or hospital.

Then, make a list of the doctors and specialists you currently see. Call each one and ask whether they accept Medicare. Some doctors who accept Medicaid do not accept Medicare, or they accept it under different terms. If your current doctor does not accept Medicare, you will need to find a new one or pay out-of-pocket. This is worth knowing before your coverage changes.

Finally, if you want prescription drug coverage, you will need to enroll in a Part D plan. Part D is optional, but if you do not enroll when you first become may be able to access, you may pay a permanent penalty. You can enroll in Part D anytime during your initial enrollment period (which includes the three months before and after your Medicare start date). Visit Medicare.gov or call 1-800-MEDICARE to compare Part D plans in your area.

If you have questions about your specific situation

Social Security handles Medicare enrollment for SSDI recipients. You can reach them at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday, 8 a.m. to 7 p.m. Eastern time. Have your Social Security number ready when you call.

Medicare itself has a separate helpline at 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week. They can answer questions about your coverage, your costs, and your options for supplemental insurance or Medicare Advantage plans.

Your state Medicaid office can tell you about programs specific to your state. You can find your state office through the Medicaid website or by calling your state's benefits hotline (often listed on your Medicaid card).

Frequently Asked Questions

Do I have to accept Part B when it starts, or can I turn it down?

You can decline Part B during your initial enrollment period (the seven-month window that includes three months before and after your Medicare start date). However, if you decline and later want to enroll, you will likely pay a permanent 10 percent penalty on top of your regular premium for as long as you have Part B. The only exception is if you have other creditable coverage, such as employer health insurance. Before you decline, confirm with your state Medicaid office that Medicaid will continue to cover you.

What if my doctor does not accept Medicare?

You will need to find a new doctor who accepts Medicare, or you can pay out-of-pocket for visits to your current doctor (Medicare will not reimburse you). Some doctors accept Medicaid but not Medicare, or they accept Medicare only for certain services. Call your doctor's office before your Medicare start date to confirm. If you need help finding a new doctor, call 1-800-MEDICARE and they can search their provider directory for you.

Will I lose my Medicaid when Medicare starts?

Not automatically, but it depends on your state and your income. Contact your state Medicaid office before your Medicare start date to confirm. Some states have programs that let you keep both; others have income limits that change once you have Medicare. Your state office can tell you whether you will stay may be able to access and what your new limits are.

What is the difference between Medicare Advantage and Original Medicare?

Original Medicare is Part A and Part B as described above. Medicare Advantage (Part C) is an alternative offered by private insurance companies; it covers everything Original Medicare does, usually with lower out-of-pocket costs, but it typically limits you to a specific network of doctors. You can choose Medicare Advantage during your initial enrollment period, but you cannot switch back to Original Medicare without a special circumstance. If you are considering Medicare Advantage, ask whether your current doctors are in the plan's network.

Do I need to enroll in Part D for prescriptions?

Part D is optional, but if you do not enroll when you first become may be able to access, you will pay a permanent penalty if you enroll later (unless you have other creditable prescription coverage). You can enroll in Part D anytime during your initial enrollment period. Visit Medicare.gov or call 1-800-MEDICARE to compare plans and see which medications they cover.