If the Social Security Administration (SSA) approves you for disability insurance benefits (SSDI), you'll become eligible for Medicare coverage a year or two later (see our article on when disability recipients get Medicare coverage). Most people welcome Medicare coverage, but others are interested in declining the coverage so that Social Security doesn't take Medicare premiums out of their monthly SSDI benefits.
Social Security will start to automatically enroll most SSDI recipients in both Medicare Parts A and B before their 25th month of SSDI benefits. Three months before your coverage starts, the SSA will send you your new Medicare card, with your name, your Medicare number, and the dates your Part A and Part B coverage will start. The SSA will automatically deduct your monthly premiums from your Social Security check at the start of your 25th month of benefits unless you send back your Medicare card (more on this below). Then your coverage begins.
For practical purposes, you can't decline Medicare Part A, which covers hospitalization and skilled nursing stays. So Medicare Part A is mandatory if you're on disability, but Social Security doesn't usually take any money out for Part A premiums anyway.
You can decline Medicare Part B, which covers doctors' visits, x-rays, lab fees, surgery, and the like. Social Security will take money out of your SSDI check for Part B premiums, so people who are covered under their spouse's employer-based health care insurance sometimes want to decline it (but be aware of penalties that may apply if you don't enroll in Part B when you're eligible).
If you don't want Part B, send the card back to Medicare (follow the instructions that come with the card). If you keep the card, you will have Part B coverage and Social Security will take the Part B premium out of your SSDI benefits.
Social Security won't automatically enroll you in Medicare Part D (which covers prescription drug costs), and you're not required to have it. You'll need to decide whether you want to enroll. The same goes for Medicare Part C, a Medicare Advantage plan that usually operates like an HMO (note that you can't have Part C without Parts A and B). Some Medicare Advantage plans include drug coverage.
If you receive SSDI benefits, when you become eligible for Medicare, Social Security will take money out to pay for Medicare premiums, in most cases. (The fact 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.)
For most people, Social Security deducts a Part B premium of $170.50 each month. But for those whose adjusted gross income is over $142,000 (or $284,000 for a couple), the monthly premium can be double that amount. A few people who don't have enough work credits may have to pay part of the Part A premium too. Read more about how much you have to pay for Medicare when you're on disability.
Disability recipients who have low income can receive help from their states in paying for Medicare premiums, which keeps Social Security from deducting any money from their SSDI benefit. The programs that help pay Medicare premiums are called Medicare Savings Programs. You can check with your local social service offices to determine if you might be entitled to help with your Medicare premiums.
People who receive disability benefits through the Supplemental Security Income (SSI) program don't qualify for Medicare insurance coverage—at least until they reach the age of 65 years old. (Until then, SSI recipients are eligible for Medicaid.) Upon turning 65, SSI recipients can receive Medicare based on age. Learn more about the Medicare and Medicaid that comes with disability benefits.
Updated April 20, 2022