Does Medicare or Medicaid Come with Disability?

Do you get Medicaid with disability? Find out what kind of insurance you get with disability benefits: Medicare or Medicaid.

Updated by , Attorney
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Disability recipients automatically qualify for government health insurance, sooner or later.

People with disabilities who are approved for Social Security disability insurance (SSDI) benefits are entitled to Medicare (though not usually right away). Those who are approved for Supplemental Security Income (SSI) will receive Medicaid. SSI recipients don't have a waiting period before they can receive Medicaid, but in some states, SSI recipients have to fill out a separate application for Medicaid.

Are SSDI Recipients Automatically Eligible for Medicare?

Yes, Social Security disability recipients receive Medicare as an extra benefit. SSDI recipients are eligible to receive Medicare benefits two years after their "date of entitlement," or DOE (the date that Social Security starts owing you monthly SSDI payments). Most people don't receive Medicare until 24-29 months after becoming disabled. For more information on how the date of entitlement is calculated, see our article on how long it takes to receive Medicare benefits.

Do SSI Recipients Automatically Get Medicaid?

Yes, most people automatically qualify for Medicaid once they get disability benefits through SSI. In most states, when a disabled person is approved for SSI, they're also automatically approved for Medicaid benefits. Some states make it more difficult. A handful of states guarantee you Medicaid if you're approved for SSI, but you have to sign up for it separately. Still other states have a slightly different income or asset limit for the Medicaid program than the SSI program, so they make their own Medicaid determinations. In these states, SSI recipients have to file a separate application to get their Medicaid coverage to start, but most people who get SSI are still eligible.

SSI and Medicare: Can SSI Recipients Get Medicare?

Do you get Medicare coverage if you were approved for SSI only? No, disability applicants who are approved for disability through SSI only receive Medicaid coverage.

Can you ever get Medicare if you get SSI? SSI recipients can get Medicare coverage when they turn 65 (or if they have end-stage renal disease or if they're also approved for SSDI benefits—see below). At the age of 65, SSI recipients are able to file an "uninsured Medicare claim," which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be on Medicare so that their state doesn't have to pay their health care costs through Medicaid.

SSDI and Medicaid: Can SSDI Recipients Get Medicaid?

Some disability recipients are approved for both SSDI and SSI disability benefits. This arrangement is called getting concurrent benefits, and it usually happens if someone's SSDI payment is lower than the SSI maximum. Applicants who are approved for concurrent benefits can generally receive Medicaid for the first two years and then will become eligible for Medicare and have their premiums paid through Medicare Savings Programs. Applicants who are approved for concurrent disability benefits should ask a field representative at their local Social Security office about their Medicare/Medicaid eligibility.

Medicare vs. Medicaid

Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions. Like SSI, Medicaid is subject to income and asset limitations, and there are no age requirements.

Medicaid generally covers doctor visits, lab work, x-rays, hospitalization, and, in some states, optometrist and dental appointments. Services are generally free, but in some states, patients must pay copays for some services.

Medicare is a federal insurance program that is partly paid for with payroll taxes, and it has no income or asset limits. Medicare covers hospitalization and skilled nursing stays (Part A), doctors' visits (Part B), and medications (Part D). Medicare Advantage (Part C) is an alternative to Parts A and B (and sometimes Part D), where services are usually provided through an HMO at a low cost. Medicare does require monthly premiums (and sometimes deductibles and copays), but Medicare Savings Programs can help pay the premiums for those with low income and low assets.

Not all doctors take Medicare or Medicaid patients, but substantially more doctors accept Medicare than Medicaid.

Updated April 19, 2022

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