If you receive SSDI, you'll eventually qualify for Medicare—but there's a waiting period. Here's everything you need to know about Medicare and SSDI.
In this article, we'll cover:
- What Medicare is
- The 24-month waiting period
- Medicare parts explained
- Costs and coverage
1. What Medicare Is
The basics:
- Federal health insurance program
- Originally for people 65+
- Also for people on SSDI after waiting period
- Also for people with certain conditions (ALS, ESRD)
How it differs from Medicaid:
- Medicare: Earned through work history
- Medicaid: Need-based
- Medicare has premiums and co-pays
- Can have both (dual eligible)
The parts:
- Part A: Hospital insurance
- Part B: Medical insurance
- Part C: Medicare Advantage (alternative)
- Part D: Prescription drugs
2. The 24-Month Waiting Period
How it works:
- Must receive SSDI for 24 months
- Waiting period starts with SSDI eligibility
- Not from application date
- Not from approval date
Counting the months:
- Start from your "established onset date"
- Add the 5-month SSDI waiting period
- Then 24 months after SSDI payments begin
- Total: 29 months from onset to Medicare
Example:
- Disability onset: January 2024
- 5-month SSDI wait: June 2024 first payment
- 24 months from June 2024
- Medicare starts: June 2026
Exceptions:
- ALS (Lou Gehrig's disease): No waiting period
- End-Stage Renal Disease (ESRD): Starts after dialysis begins
- These conditions have special rules
Important: The 24-month wait can be challenging. Explore Medicaid, COBRA, or marketplace options in the meantime.
3. Medicare Parts Explained
Part A (Hospital Insurance):
- Inpatient hospital care
- Skilled nursing facility
- Hospice care
- Some home health care
- Usually premium-free
Part B (Medical Insurance):
- Doctor visits
- Outpatient care
- Preventive services
- Medical equipment
- Monthly premium required
Part C (Medicare Advantage):
- Alternative to Parts A & B
- Offered by private insurers
- May include drug coverage
- May have additional benefits
- Network restrictions apply
Part D (Prescription Drugs):
- Prescription coverage
- Offered by private insurers
- Separate premium
- Various plan options
- Must enroll when eligible
4. Costs and Coverage
2026 costs (estimated):
- Part A: Usually $0 (if enough work credits)
- Part B: ~$174.70/month (can be higher based on income)
- Part D: Varies by plan
- Co-pays and deductibles apply
What's covered by Part A:
- Hospital stays (after deductible)
- Skilled nursing (up to 100 days)
- Home health care
- Hospice care
What's covered by Part B:
- Doctor services
- Outpatient procedures
- Lab tests
- Preventive care
- Durable medical equipment
What's NOT covered:
- Long-term care
- Most dental care
- Eye exams for glasses
- Hearing aids
- Routine foot care
Filling the gaps:
- Medigap (supplemental insurance)
- Medicare Advantage plans
- Medicaid (if eligible)
- Employer coverage
Managing Medicare Costs
Low-Income Subsidies:
- Extra Help with Part D
- Medicare Savings Programs
- Reduced premiums and co-pays
- Based on income and resources
If you have both SSI and SSDI:
- May qualify for Medicaid
- Medicaid can pay Medicare premiums
- Called "dual eligible"
- Best of both programs
Premium deduction:
- Part B premium usually deducted from SSDI
- Reduces your net payment
- Shows on benefit statement
- Automatic enrollment
During the Waiting Period
Healthcare options:
- Medicaid (if you qualify by income)
- COBRA (expensive but comprehensive)
- Marketplace plans (may qualify for subsidies)
- State high-risk pools
- Community health centers
Don't go without coverage:
- 24 months is a long time
- Medical emergencies happen
- Explore all options
- Healthcare.gov may help
How Purple Helps
- Track SSDI payments
- See Medicare premium deductions
- Understand your net benefit
- Clear payment history
- Early access to deposits