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). And applicants 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.
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.
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.
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.
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.
If the Social Security Administration (SSA) terminates your SSDI benefits because you've gone back to work and are making too much money, your Medicare benefits will eventually end. But you actually get to keep Medicare for 93 months (almost eight years) after your SSDI ends, including:
The 93-month period begins after your 9-month trial work period and at the beginning of your "extended period of eligibility."
If, however, your SSDI benefits ended because your medical condition improved and the SSA no longer considers you disabled, your Medicare benefits will end sooner. You can become eligible for Medicare again when you reach age 65.
If you lose your SSI benefits because you go back to work, but you're still disabled, your Medicaid can continue while you work in many cases. Section 1619(b) of the Social Security Act requires states to use more generous calculations in deciding whether you're still eligible for Medicaid while you're working. But the amount of money you can make and still receive Medicaid varies by state.
If the SSA stops your SSI payments because you have too much income and you're no longer disabled, you might lose your Medicaid coverage—depending on your state. About 40 states have the same income and asset requirements as the SSI program, so if you no longer qualify for SSI, you might not qualify for Medicaid either. The rest of the states have different income and asset limits, so you could still qualify for Medicaid even if you no longer receive SSI.
Some states allow you to "spend down" your income on your medical expenses. For example, if in April, your income is $200 more than the state's maximum for Medicaid eligibility, you could still qualify for Medicaid for the month of April if you had to pay at least $200 in medical expenses during the month.
And in the states that have expanded Medicaid eligibility, you can qualify for Medicaid based on a higher income, even if you're not disabled. Everyone's situation is different. Contact your state's Health and Human Services agency to see whether you'll lose Medicaid if you lose your SSI.
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 health insurance 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 health 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 March 13, 2023