What You Need to Know About Medicare and SSDI Benefits

What You Need to Know About Medicare and SSDI Benefits

SSDI and Medicare

Medicare Open Enrollment is October 15 – December 7, 2020. If you are applying for Social Security Disability Insurance (SSDI) benefits and are wondering when your new health insurance will kick in, now is the best time to learn how Medicare works, who it benefits, and how Medicare and SSDI benefits can work together. Social Security Disability Advocates USA explains what beneficiaries need to know about getting the most out of their disability benefits and healthcare coverage.

What Is Medicare? Who Qualifies For It?

Before we delve into the intricacies of SSDI and Medicare, let’s take a moment to go over what Medicare is and who benefits from it. Medicare is a federal insurance program established in 1965 that is designed to provide health coverage for the following individuals:

  • People who are 65 years old or older
  • Persons with qualifying disabilities who are under the age of 65
  • People diagnosed with end-stage renal disease

Medicare is split into four parts: 

  • Medicare Part A is hospital insurance that covers any inpatient hospital stays, skilled nursing facility stays, and some types of home healthcare.
  • Medicare Part B is medical insurance that covers preventative care, routine doctors’ visits, outpatient appointments, and medical supplies.
  • Medicare Part D is prescription drug coverage that helps beneficiaries pay for the cost of their prescribed medications, shots, and vaccines.
  • Medicare Part C is private health insurance (also called a Medicare Advantage Plan) that has been approved and partially paid for by Medicare. This includes HMOs and PPOs. Medicare Part C often combines Medicare Parts A, B, and D, plus extra coverage options like dental, vision, and hearing.

Is Medicare Free If You Are Disabled?

The cost of Medicare depends on several factors and varies from Part A, B, C, and D. In most cases, as long as you or a spouse has paid sufficient Medicare taxes and amassed enough work credits*, Medicare Part A will be free of cost to you, if you are under the age of 65 and have a disability. This is often referred to as “premium-free” Part A. 

*If you do not have enough work credits to qualify for SSDI benefits and are under age 65, you may still qualify for Supplemental Security Income (SSI) and Medicaid.

While Part A Is Usually Free, Part B Requires a Monthly Premium

For Medicare Part B, you’ll likely pay a monthly premium. If you receive Social Security benefits of any kind, your Medicare Part B premium will be automatically deducted from your monthly benefit amount. 

Just how much will your monthly premium be? The standard monthly cost of Medicare Part B in 2020 is $144.60. In 2021, that cost will rise slightly to $148.50 per month. If, however, you earned more than $87,000 two years prior to enrolling ($174,000 for tax returns filed jointly), you will pay an additional fee for Part B called Income Related Monthly Adjustment Amount (IRMAA). In addition to monthly premiums, you’ll also be subject to variable deductible and coinsurance costs.

Part D Premiums Are Determined by Private Health Insurance

Similar to Medicare Part C, Medicare Part D is administered by private health insurance companies that are approved and partially funded by Medicare. As a result, how much you’ll pay for your premium, deductible, and other costs will vary depending on the Medicare drug plan you select. 

That being said, the Centers for Medicaid and Medicare Services (CMS) announced that the  national average monthly cost for 2021 will be $43.07. This is in addition to your deductible costs and any coinsurance included in your plan.

How Long Do I Have To Be On SSDI Before I Get Medicare?

SSDI and Medicare often go hand in hand, but unfortunately there is a waiting period before you can start receiving both Medicare and SSDI benefits. Once you begin receiving monthly SSDI benefits, you must wait 24 months before qualifying for Medicare. Considering how long it often takes just to qualify for and begin receiving disability benefits, this can leave some disabled workers with no healthcare and little to no income.

Although the Social Security Administration does not automatically offer any interim financial aid while waiting for disability, other resources may be available to help you stay afloat until your SSDI and Medicare benefits go into effect. 

Contact your local Department of Social Services or Department of Health and Social Services to find out what kind of interim assistance may be available to you, including programs like Medicaid, Temporary Assistance for Needy Families (TANF), and the Supplemental Nutrition Assistance Program (SNAP).

In some cases during your Medicare waiting period, you may be eligible for healthcare coverage through a former employer. If you are able to work in some capacity, you can also qualify for a trial work period which won’t affect your benefits as long as you earn less than what is considered Substantial Gainful Activity (SGA).

Where Can I Get Help Applying for SSDI Benefits and Medicare?

Filing for disability benefits can be a frustrating, drawn-out process—but it doesn’t have to be. With proficient legal counsel at your side, you can ensure that you get the maximum disability benefits amount and minimize the amount of time spent waiting for Medicare eligibility. Whether you’re considering applying or dealing with the frustration of a denied claim, a Social Security disability attorney can help.

At Social Security Disability Advocates USA, we offer free consultations to all disability claimants. We believe that everyone should be aware of all their legal options before hiring a lawyer. To get in touch with our team and claim your complimentary no obligation review, call us at 602-952-3200. We also have LiveChat agents standing by to answer your questions, or you can go ahead and request your free case review using this form.

This is attorney advertising. SSDA, LLC is a group of attorneys that pursues claims for Social Security Disability benefits on behalf of its clients against the Social Security Administration. SSDA, LLC is in no way a part of the Social Security Administration. Further, the information on this blog is for general information purposes only. Nothing herein should be taken as legal advice. This information is not intended to create, and receipt or viewing does not constitute, a representative-client relationship.

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