When Social Security approves you for Social Security disability insurance (SSDI) benefits, that means you'll eventually get access to Medicare benefits too. You'll be eligible for Medicare two years after your entitlement date for SSDI benefits. (Your entitlement date is the date that your disability backpay is paid from; see our article on when Medicare kicks in for SSDI recipients to determine your entitlement date).
But getting approved for SSDI only gets you access to Medicare. The fact that you were approved for SSDI makes you eligible for Medicare earlier than you otherwise would be (at age 65), but it doesn't pay your premiums.
Medicare isn't free for disability recipients. The program has premiums, deductibles, and copays, and the costs go up every year (more on this below).
Fortunately, anyone with low income and assets, including individuals who receive SSDI and aren't eligible for SSI disability, can receive help from their states in paying for Medicare premiums if they have low income and assets.
The state programs that help pay Medicare premiums are called Medicare Savings Programs. States pay for these programs with Medicaid money.
The most generous program, the Qualified Medicare Beneficiary (QMB) program, will pay all of your Medicare Part A and Part B premiums, deductibles, and coinsurance. Its income limits are quite low (roughly the same as the federal poverty level).
Two other programs, the Specified Low-Income Medicare Beneficiary (SLMB) and the Qualifying Individual (QI) programs, have somewhat higher income limits, and thus fewer benefits, than the QMB program. The SLMB and QI programs pay all or part of the Medicare Part B monthly premiums, but they don't pay for any Medicare deductibles or coinsurance amounts. For help determining if you might qualify for help paying Medicare costs, check with your local social service office.
Here are the Medicare costs for 2023, and how you can get help paying them.
Part A premiums. You'll have to pay a premium for Medicare Part A (hospital insurance) if you aren't "fully insured" under Social Security. Generally, being fully insured means you've worked 40 quarters (the equivalent of 10 years) in a job paying FICA taxes.
Many disability recipients aren't fully insured because they became physically or mentally unable to work before getting enough work credits. If you (or your spouse) don't have enough work credits, you'll pay a monthly premium of $506 for Part A, or if you (or your spouse) have between 30 and 39 credits, you'll pay a monthly premium of $278.
Note that people under 31 don't need to have worked 10 years to be eligible for free Part A. Young people can be fully insured for Medicare if they worked half of the time between age 21 and the age they became disabled. For example, someone who becomes disabled at age 26 must have worked at least three years (gaining 12 work credits) to be fully insured.
Part A copays. If you stick with traditional Medicare (rather than a Medicare Advantage plan), and you need hospital or skilled nursing care, you'll have to pay the first $1,600 in costs (your deductible) before Medicare will start paying anything. Once you've satisfied the deductible, the first 60 days in the hospital (or 20 days in skilled nursing care) are free. If you still need inpatient care after that, you will be responsible for the following copays:
Help paying premiums and copays. Medicare can be quite expensive for those on disability who aren't fully insured, but if you're eligible to be a Qualified Medicare Beneficiary (QMB) because your income is low, your state's Medicare Savings Program will pay your Part A premium, and possibly other costs as well.
Premiums. Part B pays for doctor's visits. Most people pay a Part B premium of $164.90 each month. If your adjusted gross income is over $97,000 (or $194,000 for a couple), the monthly premium can be over $500.
Deductibles. The Part B deductible for 2023 is $226 per year. Again, if you have low income, your state may have a program that can pay your Part B premium and deductible, called a Medicare Savings Program.
Note that you can't get Part B without being enrolled in Part A.
Premiums. Part D premiums vary depending on the plan you choose. The average Part D premium in 2023 is $31.50, but plans can charge a surcharge if you make over $97,000 per year. Some plans have no premium.
Deductibles. The maximum Part D deductible for 2023 is $505 per year, but some plans waive the deductible.
Extra help. For people with limited income and assets, Medicare offers "Extra Help" for prescription drug costs. This Extra Help covers the costs of a Medicare prescription drug plan, including monthly premiums and prescription co-pays. The application is online at www.socialsecurity.gov/prescriptionhelp. For more information, see Nolo's article on the Extra Help subsidy.
You can often save money on Medicare costs by joining a Medicare Advantage plan that offers coverage through an HMO or PPO. Many Medicare Advantage plans don't charge a monthly premium (but you still have to pay the Part B premium), and some don't charge copays for doctor visits and other services.
Medicare Advantage plans often include Part D prescription drug coverage, with small copays and a low or no drug premium. Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs. People entitled to Medicare due to a disability are allowed to join any Medicare Advantage plan.
For more details on the 2023 costs of Medicare, see Nolo's article on Medicare premiums, deductibles, and copays in 2023.
People who receive Supplemental Security Income (SSI) aren't qualified to receive Medicare insurance coverage until they reach the age of sixty-five. (Instead, they're eligible for Medicaid.)
But on turning 65, SSI recipients can receive Medicare based solely on age. How? By filing an "uninsured Medicare claim."
The SSI program actually requires SSI beneficiaries to file uninsured Medicare claims, so that some of the Medicaid burden will be taken off of the states. It's cheaper for states to pay the Medicare premiums for their Medicaid recipients rather than to continue paying for all of their medical expenses through Medicaid. By doing this, Medicare becomes the primary payer for the recipient and Medicaid becomes the secondary payer.
Learn more about the Medicare and Medicaid that comes with disability benefits.
Updated December 28, 2022
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