Medicare & Medicare Savings Programs
SSDI beneficiaries qualify for Medicare automatically
- After a person is first eligible for Social Security Disability Insurance (SSDI) payments, a 24-month waiting period begins. When the waiting period is over, Medicare can begin.
- A person can be eligible for SSDI as early as age 18 and eligible for Medicare as early as age 20 (after the 24-month waiting period).
Medicare Part A—Hospital Insurance
- SSDI beneficiaries get Part A automatically and do not owe a premium.
Medicare Part B—Supplemental Medical Insurance
- SSDI beneficiaries are automatically enrolled in Part B, though it is an optional benefit.
- If beneficiary does not want Part B, they must opt out of it.
- The monthly premium is $164.90 for a beneficiary who was first eligible in 2023.
- Part B benefits include physician services, mental health services, durable medical equipment, and home health services.
- When Medicare pays for a Part B service, the beneficiary faces a 20% copayment.
- If beneficiary qualifies for a Medicare Savings Program, through their state Medicaid agency, Part B premiums will be covered and possibly copayments and deductibles.
Medicare Part C—Medicare Advantage Plan
- Part C is Medicare’s managed care option (run through private insurance companies).
- Part C is available in most parts of the country.
- Part C offers everything traditional Medicare provides under Parts A and B, and most plans also provide Part D prescription drug coverage.
- A person using Part C must still pay the premiums and other out-of-pocket expenses associated with traditional Parts B and D, subject to help with those costs. Help can come in the form of a Medicare Savings Programs and the Extra Help program for Part D.
- A range of Plan C plans provide more than what is available through traditional Medicare for an extra fee.
- If a beneficiary is dually eligible for Medicare and Medicaid, they may find there is not enough extra benefit from a Medicare Advantage Plan to justify paying any extra premiums to get it.
Medicare Part D—Prescription Drug Benefit
- Part D is optional, and SSDI beneficiaries must enroll to get coverage.
- If a beneficiary is eligible for Medicare and Medicaid, they are not eligible for prescription coverage through Medicaid. They must use Medicare Part D.
- A beneficiary will face out-of-pocket expenses for premiums, deductibles, and copayments.
- If a beneficiary qualifies for Extra Help (the Low-Income Subsidy), most out-of-pocket expenses could be covered.