Social Security Disability Eligibility and Medicare

When a worker becomes too disabled to hold a job that supports his family, he also often loses any employee-provided health coverage. COBRA and private plans may be too expensive for a disabled worker when he is already struggling to make ends meet. This is why the government has deemed a person receiving Social Security Disability Insurance benefits to be qualified to receive Medicare health coverage. (Recipients of SSI benefits receive Medicaid coverage.)

What is Medicare?

Medicare is a federally-funded health insurance program. Its target recipients are people 65 years of age and older, some disabled people under 65 years of age, and people with end-Stage Renal Disease.

The system has two parts. Part A is hospital insurance which pays for inpatient hospital bills and follow-up care. The majority of recipients receive Part A at no charge because they paid taxes into the system while they were working. Part B is medical insurance for which most people pay a monthly fee. It helps pay doctors’ bills, outpatient hospital care and other medical services. The standard Part B premium amount in 2017 was $134 (or higher depending on your income). Although because of a lack of a cost-of-living increase, the average payment was actually $109.

A person can also apply separately for a Medicare prescription drug plan called Medicare Part D. These plans are provided by private insurance carriers, and a person can apply as early as three months before the 25th month of his Social Security disability benefits.

Coverage for SSDI Beneficiaries

When a person becomes eligible for Social Security Disability Insurance (SSDI) benefits, they are eligible for Medicare after a 24-month qualifying period. The hope is that the beneficiary is still eligible for health insurance through a former employer during this qualifying period. Enrollment is automatic. Months in previous periods of disability may be counted towards the 24-month Medicare qualifying period if the new disability begins: 1) within 60 months after the termination month of the workers` receiving disability benefits for the previous disability, 2) within 84 months after the termination of disabled widows` or widowers` benefits or childhood disability benefits, or 3) if the current disability is the same or related to the disability for which the recipient was receiving benefits during the previous period.

Medicare Coverage and Employment

Medicare allows health insurance to continue when a beneficiary goes to work and engages in substantial gainful activity. A beneficiary may receive at least 93 months of hospital and medical insurance after the trial work period as long as his qualifying disability still exists. He won’t be required to pay for hospital insurance even though his cash SSDI payments have ceased. When the free Medicare coverage ends due to employment, the beneficiary can always purchase Part A and/or Part B of Medicare if they still have a disability.

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“Medicare Information,” Social Security

“Part B Costs,” Medicare.Gov

“Disability Planner: Medicare Coverage If You’re Disabled,” Social Security

“Medicare Coverage if you are Disabled,”