Medicare provides benefits to individuals who are at least 65 and also assists young adults with a disability. Social Security may also provide benefits to Medicare recipients.
Most Social Security Disability recipients qualify for Medicare 24 months following their eligibility for SSDI benefits. This period does not apply to individuals with amyotrophic lateral sclerosis or end-stage renal disease.
Medicare operates the same for people with disabilities as it does for eligible older recipients. It is unlikely that individuals must pay for Medicare Part A hospitalization coverage if they paid Medicare taxes while they worked.
However, they must pay monthly premiums for Part B physician and outpatient services and for a Part D prescription drug plan if they enroll in one. These costs may be deducted from SSDI benefits.
The Social Security Administration considers each month in which a person is entitled to receive SSDI payments toward the Medicare 24-month qualifying period.
A five-calendar month waiting period also governs after the month when the SSA finds that a disability began, or an individual is unable to work because of that condition. Usually, individuals are eligible for Medicare 29 months after the disability’s onset.
Onset dates may be set before an individual applied for SSDI or was approved for benefits. This process can last several months or longer for an appeal of an initial benefit denial. Retroactive Social Security benefits may last up to 12 months if the medical evidence indicates that the disability occurred before the application.
Months that an applicant was entitled to but not approved for SSDI may count toward the Medicare waiting period.
The time a worker had a prior disability may be credited toward the Medicare start date if the new onset takes place less than five years after the first period of SSDI benefits ends or is from the same or closely related medical condition.
Return to work
Medicare coverage accompanying SSDI ends if an individual’s condition improves and the SSA finds that the worker no longer has a disability. SSDI also ends if a recipient is able to work and their income is over the substantial gainful activity limit. The 2022 monthly SGA limit is $1,350 or $2,260 for blindness.
Social Security work incentives allow beneficiaries returning to work to continue to receive benefits. SSDI benefits, for example, continue during a trial work period that allows earnings over the SGS limit for any nine months over five years.
After this period ends, Medicare coverage continues, and a worker does not have to pay part A premiums for 93 consecutive months.
Attorneys can assist workers seek benefits. They may also represent them in proceedings.