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 $174.70 for a beneficiary who was first eligible in 2024.
• 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.