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SSI Disability & Medicare

Social Security Disability Insurance, or SSDI, is a system that operates as a safety net in case workers are ever rendered unable to work. U.S. workers pay into this system. Medicare is the federal health insurance program designed for the elderly. People with disabilities, including SSDI recipients, were added in 1972 to the roster of covered individuals.

  1. SSDI Eligibility

    • To be deemed eligible for SSDI benefits, applicants must prove they are legal U.S. citizens, that they at least 18 years old, and that they have been diagnosed with a medical condition that is terminal or will keep them out of work for at least a year. Applicants must also meet a minimum work history requirement, although younger applicants might qualify with a shorter work history.

    Medicare Eligibility

    • Once a person begins receiving SSDI benefits, he is eligible to receive Medicare upon reaching 24 months of getting benefits.

    Enrollment

    • Those who are on SSDI do not need to actively enroll in Medicare. They are automatically enrolled into Part A, the hospital benefit, and Part B, the medical benefit. Three months before they are to become qualified (their 21st month of receiving SSDI benefits), they are mailed receive packages that contain their Medicare cards and information about the benefit.

      If they would like to switch to a Medicare Advantage plan or join a Part D drug plan, they must do so during their initial enrollment period, which is the seven-month period surrounding their eligibility month (months 21 through 27). Otherwise they have to wait for another enrollment period.

    Working

    • If an SSDI beneficiary goes back to work, her Medicare benefits are not affected for the first 8.5 years as long as she is continuously considered medically disabled. After 8.5 years, she must pay a Part A premium. However, her SSDI benefits might be affected, depending on how much money is earned.

    Coordination

    • If the SSDI recipient is actively working and is on a group health plan, it is important to know how their health plan works with Medicare. If the company has fewer than 100 employees on the group health plan, then Medicare is the primary payer, meaning providers will bill Medicare first, and then the group health plan will pay for an extraneous expense such as co-insurance. If there are more than 100 employees on the group health plan, the group health plan pays primary, and Medicare pays secondary.

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