I was approved for SSDI because of multiple sclerosis almost two years ago. I should become eligible for Medicare in early 2018. Is Medicare free for disability recipients, or will I have to pay premiums? If so, how much?
You are eligible for Medicare two years after your entitlement date for Social Security Disability Insurance (this is the date your backpay was paid from). Medicare isn’t free for most disability recipients though. There are premiums, deductibles, and copays for most parts of Medicare, and the costs go up every year. Here are the new figures for 2018, and how you can get help paying the costs.
Part A Costs
You will 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 having worked 40 quarters (the equivalent of 10 years) in a job paying FICA taxes. Many disability recipients aren't fully insured because they became unable to work before getting enough work credits. If you (or your spouse) don’t have enough work credits, you’ll pay a premium of $422 per month, or if you (or your spouse) has between 30 and 39 credits, you'll pay a premium of $232.
If you need hospital or skilled nursing care, you’ll have to pay the first $1,340 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.
Medicare can be quite expensive for those on disability who aren’t fully insured, but if you are eligible to be a Qualified Medicare Beneficiary (QMB) because of low-income, a Medicare Savings Program will pay your Part A premium, and possibly other costs as well.
Part B Costs
Most people pay a Part B premium of $134.00 each month. But some people who have been on Medicare for several years will pay slightly less if their Social Security checks are low (due to a hold harmless provision).
And soe people will pay more. If your adjusted gross income is over $85,000 (or $170,000 for a couple), the monthly premium can be over $200. The Part B deductible for 2018 is $183 per year.
Again, if you have low income, there are various programs that can pay your Part B premium and deductible, called Medicare Savings Programs.
Part D Costs
Part D premiums vary depending on the plan you choose. The maximum Part D deductible for 2018 is $405 per year (though some plans waive the deductible).
There are subsidies available to pay for Part D for those with low income (called Extra Help). See Nolo’s article on Extra Help for Part D for when you are eligible.
As for the "donut hole," when Part D helps you less, in 2018 the donut hole begins after you've spent $3,750 on prescription drugs and ends when you've spent $5,000. However, in 2018, while you are in the donut hole, brand-name drugs must be sold to you at a 65% discount and generic drugs at a 56% discount.
For more details on the 2018 costs of Medicare and Medigap plans, see Nolo’s article on Medicare premiums, deductibles, and copays in 2018.