Do You Get Medicare With SSDI?
People already receiving Social Security Disability Insurance benefits and those considering applying may be unaware that receiving SSDI makes them eligible for Medicare benefits. Applicants who qualify for SSDI will be eligible for automatic enrollment in Medicare following a two-year waiting period. If eligible, you may receive Medicaid to help cover medical costs while you wait for Medicare benefits.
For those with a disabling condition, applying for SSDI can provide access to much-needed Medicare benefits before they reach age 65. The process can be long and requires much work, but it can be worth it. Don’t hesitate to contact a qualified advocate for help so you don’t miss your chance at monthly benefits and health care coverage.
How Does Medicare Work With Social Security?
SSDI and Medicare eligibility criteria are different when you apply for them separately. But if you receive SSDI benefits, you don’t have to apply for Medicare. You are automatically enrolled 24 months after you receive your first disability payment. However, there is no waiting period for those with amyotrophic lateral sclerosis, or ALS.
If you are not receiving SSDI benefits yet, it can be tricky to determine how long it will take to receive Medicare. Several factors influence the timeline, including:
- Your SSDI approval time: The average processing time for a disability application in 2024 is almost eight months. The Social Security Administration, or SSA, is aiming to reduce that time to seven months in 2025.
- The rate at which initial applications are approved: Only about 20 percent of initial claims are approved. Waiting on an SSDI appeal means waiting longer for Medicare.
- The gap between SSDI approval and benefits start time: You do not receive your first SSDI benefits until the sixth full month after SSA determines your disability began.
Check to see if you still covered by an employer’s health insurance benefits during your waiting period. You can also apply for Medicaid benefits during your Medicare waiting period. Getting SSDI and Medicare can be complex and time-consuming, but don’t give up. The benefits you receive can significantly impact your quality of life.
What if I Have Previously Collected Disability?
If you have previously collected disability benefits, those months can count toward your 24-month waiting period for Medicare. That time applies if your new disability begins during one of the following three periods:
- Within 60 months after your last disability payments stopped
- Within 84 months of disabled widow, widower, or childhood disability benefits
- At any time, if your current impairment is the same or directly related to the one that entitled you to disability benefits in the past
How Much Can I Receive on SSDI and Medicare?
Your monthly SSDI payments are based on your lifetime average earnings. The maximum monthly SSDI payment in 2024 was $3,822. That number will rise to $4,018 per month in 2025. The estimated average benefit is $1,537. You can gauge your monthly SSDI benefit using our SSDI calculator.
You also have access to other programs once you begin receiving SSDI. The SSA’s Ticket to Work Program supports career development for people ages 18 to 64 who receive disability payments and want to work. This free program offers tutorials, webinars, advice on working with your disability, and other benefits.
While you do not get monthly compensation from Medicare, you get Part A hospitalization and Part B medical coverage. You can also purchase a Part C Medicare Advantage plan and Part D prescription coverage. Having Medicare can significantly reduce your medical expenses, giving you more financial freedom.
Can I Go Back to Work While Receiving Medicare and SSDI?
You can return to work and keep your SSDI and Medicare benefits—but only under certain circumstances. Keep track of your work time and salary to determine if you may lose your benefits.
Trial Period
If you start working, you have a nine-month trial period during which you keep your full benefits. These months don’t have to be consecutive, but there is a rolling five-year period. As of 2024, any month you earn over $1,110 before taxes counts toward your trial period. That amount goes up to $1,160 in 2025.
Extended Period of Eligibility
Your next three years of work are called an extended period of eligibility, or EPE. You can still receive disability benefits if you aren’t earning more than $1,550 per month, rising to $1,620 monthly in 2025. If you earn more than the maximum during your EPE, you will not receive disability payments in those months.
After Your EPE
After your EPE, you’ll lose your disability benefits if you are capable of performing substantial gainful activity, commonly known as SGA, meaning you can do work that pays over a certain level. For 2025, the monthly SGA level is $1,620. If you surpass this level and no longer collect disability, you also lose Medicare benefits if they are tied to your SSDI because you are under age 65.
If your condition improves enough that the SSA no longer deems you eligible for SSDI, you’ll also lose your Medicare benefits. Furthermore, you must report changes in your disabling condition or wages to the SSA or risk losing your disability benefits and Medicare.
Can I Receive Medicare and Medicaid While on SSDI?
You can receive Medicaid and Medicare benefits while on SSDI, known as dual eligibility. About 12 million people—or 15 percent of Medicaid enrollees—also receive Medicare benefits. Of dual enrollees, 4.8 million have disabilities. If you have both, Medicaid may cover or help pay your Medicare premiums and out-of-pocket expenses. It may also pay for services not covered by Medicare, such as nursing facility care beyond 100 days, eyeglasses, and hearing aids.
If you had Medicaid and SSDI during your Medicare waiting period, you may remain eligible even after your Medicare coverage starts.
How Do I Apply for SSDI?
If you need Medicare before age 65 and have a disability, qualifying for SSDI can help you get coverage. Qualifying for both programs means you’ll receive monthly compensation and health insurance, giving you and your family peace of mind and increased financial stability.
You must collect the necessary documentation before submitting your SSDI application. The primary reason for denials is technical, not medical. Common issues leading to denials include filling out forms incorrectly or failing to provide sufficient information.
To increase your chances of approval, create a checklist of SSDI eligibility criteria. You must then gather documentation to submit to the SSA to prove your eligibility.
Check SSDI qualifying conditions to see if your disability is listed. If it is not, that doesn’t mean you can’t get disability. If you show that your disability is equal to one on the list and you cannot work, the SSA can grant you a medical vocational allowance and approve your claim.
Once you are ready, you can apply for SSDI online, through the mail, or at your local SSA office.
Need Help Applying, or Was Your SSDI Claim Rejected?
There are many reasons why the SSA denies SSDI claims. After going through the appeals process, many applications are eventually approved. If you are disabled, you should not give up your chance to receive monthly compensation through disability and health coverage through Medicare.
You deserve to feel secure. For assistance with SSDI and receiving disability benefits, contact Disability Advice, your trusted SSDI resource. We can assist you with your initial SSDI claim or during an appeal.
- Free case evaluation
- Assist with denied claims
- Ensure you have all documents
- Make the process easy for you
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