SSDI Medicare Eligibility: What are the requirements for Medicare if you have SSDI, and how much do you have to pay?

According to Marca, “If you’re already on SSDI and have Medicare, you’re good to go under the health care law. No need to worry about any penalties for not having coverage,” assures the Social Security Administration (SSA). Once you’re on Medicare, you can rest easy knowing you’ve fulfilled your health coverage requirements.

Adding Marketplace Plans

If you’re considering adding a Marketplace plan to supplement your Medicare, be aware that this isn’t allowed. However, if you enrolled in a Marketplace plan before your Medicare coverage began, you can keep that plan as supplemental insurance. Just note that maintaining this plan will mean forfeiting any premium tax credits or savings you previously received.

Medicaid Eligibility During the Waiting Period

For those in the 24-month waiting period before Medicare starts, there’s some good news: you might qualify for Medicaid. You can apply through the Marketplace or directly with your state’s Medicaid agency. The SSA states, “Just answer ‘yes’ when asked if you have a disability, and we’ll forward your application to your state Medicaid agency.” If approved, your Medicaid coverage may continue even after your Medicare begins, ensuring you’re covered during the transition.

Exploring Your Coverage Options

What if you don’t qualify for Medicaid? Don’t worry—you can still enroll in a private health plan through the Marketplace while waiting for Medicare. Depending on your income and household size, you may qualify for lower premiums and reduced costs on Marketplace coverage.

“It’s important to explore all your options and see what works best for your situation,” says healthcare advocate Sarah. “Whether it’s Medicaid, Medicare, or a private plan through the Marketplace, there are plenty of choices to help you get the coverage you need.”

Also Read: “Natural Disasters in New Mexico: Thunderstorms, Floods, Tornadoes, and More”

Exceptions to the Waiting Period

If you’re receiving SSDI, there are exceptions to the typical 24-month waiting period for Medicare. For instance, individuals with amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD) can access Medicare coverage more quickly. With ALS, you’re enrolled in Medicare the first month you receive SSDI. For ESRD, Medicare generally starts three months after you begin dialysis.

Maintaining Coverage While Working

Additionally, if you’re working while receiving SSDI, you can retain your Medicare coverage for at least 93 months (almost eight years), as long as your disabling condition persists. This allows many SSDI recipients to work without the fear of losing their health insurance.

“Medicare is a lifeline for many older adults and people with disabilities,” shares a Medicare beneficiary. “It’s a huge relief to know that we have this kind of support when we need it.” Another beneficiary added, “I was worried about losing my health insurance when I went back to work, but knowing I can still get Medicare coverage for at least 93 months really eases my mind.”

Understanding Medicare Costs

The cost of Medicare disability coverage varies based on the part of Medicare and individual circumstances.

In 2024, Medicare Part A has a $1,632 deductible per benefit period. After that, days 1-60 of hospitalization are fully covered. For days 61-90, you’ll pay $408 per day, and $816 per day after day 91 until you exhaust your 60 lifetime reserve days. After that, all costs are out-of-pocket.

For Medicare Part B, the standard premium is $174.70 per month, deducted from your SSDI check, with a $240 deductible. After meeting this deductible, some services are fully covered, while others require a 20% co-pay.