Healthcare coverage is often just as important as the cash benefits you receive from Social Security—sometimes more so. But the rules connecting Medicaid to SSI and SSDI are confusing, and the path to coverage looks very different depending on which program you're in. Understanding how these pieces fit together can help you avoid dangerous gaps in coverage and make informed decisions about work and benefits.
In this article, we'll cover:
- How SSI connects to Medicaid coverage
- How SSDI connects to Medicare (and sometimes Medicaid)
- The Medicare waiting period and how to bridge it
- Medicaid for people who work (Medicaid Buy-In programs)
- What happens to your healthcare if you lose cash benefits
- Dual eligibility: when you qualify for both Medicare and Medicaid
SSI and Medicaid: Automatic Coverage in Most States
One of the most valuable aspects of SSI eligibility is the healthcare coverage that comes with it. In most states, if you qualify for SSI, you automatically qualify for Medicaid too. There's no separate application, no additional waiting period—your Medicaid coverage begins when your SSI begins.
This automatic connection exists in 39 states and the District of Columbia. These are called "1634 states" after the section of the Social Security Act that established this arrangement.
Eleven states use different rules. In "SSI criteria states" (California, Alaska, Nevada, Idaho, Utah, Kansas, Nebraska, and North Dakota), you still qualify for Medicaid if you get SSI, but you may need to file a separate Medicaid application. In "209(b) states" (Connecticut, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia), the state uses its own Medicaid eligibility criteria that may be more restrictive than SSI rules. Even in these states, most SSI recipients qualify for Medicaid, but it's not quite as automatic.
The bottom line: if you receive SSI, you should have Medicaid coverage. If you don't, something has gone wrong administratively and you should contact your state Medicaid office.
SSDI and Medicare: Coverage After a Wait
SSDI takes a very different approach to healthcare. Instead of connecting to Medicaid, SSDI connects to Medicare—the program typically associated with people 65 and older. But there's a significant catch: the 24-month waiting period.
Your Medicare eligibility begins 24 months after your SSDI entitlement date (which is usually five months after your disability onset date, given SSDI's five-month waiting period for cash benefits). That means you could wait up to 29 months from when you became disabled before Medicare coverage kicks in.
During this gap, you're disabled enough that Social Security has determined you can't work, but you don't yet have the health insurance that comes with SSDI. This is one of the cruelest aspects of the disability benefits system.
Once your Medicare coverage begins, you'll have Part A (hospital insurance) automatically and can enroll in Part B (medical insurance) for a monthly premium. Most people also want a Part D prescription drug plan and may consider Medigap supplemental coverage.
The exception to the waiting period is people with ALS (Lou Gehrig's disease) or End-Stage Renal Disease, who qualify for Medicare immediately upon SSDI eligibility.
Bridging the Medicare Waiting Period
If you're waiting for Medicare coverage to begin, you have several options:
Medicaid: If your income and resources are low enough, you may qualify for Medicaid even while receiving SSDI. Medicaid eligibility rules vary by state, but many SSDI recipients—especially those with lower benefit amounts—can qualify. Apply through your state Medicaid office.
COBRA: If you had employer health insurance before becoming disabled, COBRA allows you to continue that coverage for up to 18 months (and sometimes 29 months for disabled individuals). You'll pay the full premium yourself, which is expensive, but it maintains your coverage.
Marketplace insurance: You can purchase coverage through the Health Insurance Marketplace (healthcare.gov). Depending on your income, you may qualify for premium subsidies that make coverage more affordable. Losing your employer coverage qualifies you for a special enrollment period.
Medicaid Buy-In programs: If you're working despite your disability, your state may have a program that allows you to purchase Medicaid coverage. We'll discuss these more below.
Spouse's coverage: If your spouse has employer coverage, you may be able to join their plan.
The goal is to avoid being uninsured during those 24 months. Medical bills without coverage can be catastrophic, and going without necessary care can worsen your condition.
Medicaid Buy-In: Coverage While Working
Every state offers some version of a Medicaid Buy-In program for working people with disabilities. These programs recognize that many people with disabilities can work but still need Medicaid because private insurance is unaffordable or doesn't cover their needs.
Medicaid Buy-In programs typically allow higher income and resource limits than regular Medicaid. You must be working, though the number of hours and amount of income required varies by state. There's usually a monthly premium based on your income, but it's far less than private insurance would cost.
These programs go by different names depending on the state: Medicaid Buy-In, Working Disabled Program, Medicaid for Workers with Disabilities, and others. Contact your state Medicaid office to learn about your state's specific program.
For people on SSI who want to work, Medicaid Buy-In provides crucial protection. You might earn too much to keep SSI, but as long as you're working and enrolled in the Buy-In program, you can maintain Medicaid coverage.
What Happens to Healthcare When Cash Benefits Stop
This is where things get complicated and scary for many people considering work.
If your SSI stops due to earnings: You may qualify for continued Medicaid coverage under Section 1619(b). This provision protects people who lose SSI because of work but still have a disability and would be unable to afford healthcare without Medicaid. Income limits for 1619(b) vary by state and can be surprisingly high—over $40,000 per year in some states.
If your SSDI stops due to earnings: After your Extended Period of Eligibility ends and your SSDI terminates due to work, you can maintain Medicare Part A coverage for at least 93 months (nearly 8 years) after your Trial Work Period. You'll need to pay for Part B if you want it, but the hospital coverage continues.
Expedited Reinstatement: If your benefits stop because of work but you later become unable to work again due to your disability, you can request Expedited Reinstatement within 5 years. While your request is being processed, you can receive provisional benefits including Medicaid or Medicare.
These protections exist specifically to reduce the fear of losing healthcare when attempting to work. They don't eliminate the risk entirely, but they provide a substantial safety net.
Dual Eligibility: Medicare and Medicaid Together
Some people qualify for both Medicare and Medicaid simultaneously. This is called "dual eligibility" and can actually be the best of both worlds.
Dual eligibility typically happens when you receive SSDI (which provides Medicare after the waiting period) and your income and resources are low enough to also qualify for Medicaid. Many people who receive both SSI and SSDI end up as dual eligibles.
As a dual eligible, Medicaid often pays your Medicare Part B premiums and may cover cost-sharing (deductibles and copays) that Medicare doesn't. Medicaid may also cover services that Medicare doesn't, like long-term care, dental, and vision.
If you think you might qualify for both programs, apply for Medicaid through your state even if you already have Medicare. The combined coverage can dramatically reduce your out-of-pocket healthcare costs.
Your healthcare coverage depends on maintaining your benefits eligibility. Purple helps you track your finances and stay compliant with SSI rules, so you don't accidentally lose the coverage you depend on.