SSDI and Medicare: 5 Things You Need to Know

March 28, 2016

by: Margie Johnson Ware, Aging and Health Specialist and Bonnie Burns, Medicare Specialist

1. How does having a disability affect my Medicare options?

This is one of the most common questions future beneficiaries ask. Although many boomers are familiar with the eligibility age for Medicare, many others do not realize that you can be enrolled automatically (earlier than age 65) if you’re approved by the Social Security Administration (SSA)to receive Social Security Disability Insurance (SSDI) benefit payments.

After drawing SSDI for 24 months (2 years), you will be automatically enrolled into both Medicare Part A and Medicare Part B (also known as “Original Medicare”) starting the 25th month, and you will receive a Medicare card in the mail. In some cases, you can receive Medicare in less than two years if Social Security determines that your disability started before your disability application date, or if you have Amyotrophic Lateral Sclerosis (ALS) or End Stage Renal Disease (ESRD).

2. What if I don’t want to be automatically enrolled in Original Medicare? Can I disenroll?

Part A is free for most people, but Part B involves paying a monthly premium. You cannot decline Part A unless you’re willing to pay back all the SSDI benefits you received, so you’ll likely need to keep it even if you are covered by your spouse’s employer insurance.

However, if you have employer coverage, you have the freedom to disenroll from Part B. It is important to check with the employer’s human resources office to find out how their plan works with Medicare Part B. Make sure the company has 100 employees or more—that means the employer insurance will be primary (i.e. that insurance is billed first, and most likely covers more of your care than Medicare Part B). If the employer has less than 100 employees, then your Medicare insurance will be primary—and you’ll therefore need to join Part B.

If you do decide you don’t need Part B, look on the back of your Medicare card for a box you can check to be removed from Part B. Then send the updated card back to the Social Security Administration (SSA). Or call SSA for help with disenrolling in Part B.

3. Will there be any copays and deductibles (out-of-pocket costs) if I am disabled?

Yes, although if you have employer insurance that is primary to Medicare, you may have fewer out-of-pocket expenses. If you don’t have employer insurance and you are enrolled in Original Medicare (Parts A and B), you may want additional coverage.

For most beneficiaries (regardless of their disability status), the choice comes down to deciding between two main options:

1. Original Medicare (Parts A and B) combined with an optional Part D plan (prescription drug coverage) and/or an optional supplemental coverage plan to cover the cost gaps in Original Medicare known as Medigap (enrollment is limited for persons under age 65 in many states).

2. A Medicare Advantage plan (a private managed health plan that usually covers all of these services).

If you are low-income you may also be eligible for Medicaid as a supplement to pay out-of-pocket costs, depending on what the rules are in your state.

Have more questions about choosing the best coverage for your needs? We recommend you try taking the free Medicare Questionnaire tool (created by nonprofit National Council on Aging) for access to free professional Medicare advice from a licensed benefits advisor. You can also check out your local SHIP (State Health Insurance Assistance Program) for further assistance, or reach out to your local Aging and Disability Resource Center.

4. How will I pay for my prescription medications on Medicare?

If you are not covered by employer insurance, and haven’t signed up for a Medicare Advantage plan that includes prescription drug coverage, you will need to sign up for a Part D (prescription drug coverage) plan to cover your medications.

In some cases you may have been automatically assigned to a Part D plan if you get Extra Help or Medicare Savings Programs. A call to 1-800-MEDICARE will allow you to find out if you have been automatically enrolled. If so, you will want to speak with the representative and make sure that all of your medications are covered in the plan they put you in. If they are not covered, you can choose another plan. You can also contact your local SHIP (State Health Insurance Assistance Program) for help with this process.

5. What if my disability responds to treatment and I am able to return to work?

First, speak to a representative at the Social Security Office about how many hours you are allowed to work and still retain your SSDI payments. If you return to what the Social Security Office considers “substantial gainful activity” (i.e. a paying job above a certain income level, depending on your disability), you are still eligible for Medicare for seven years.

If new employment provides health insurance, then the employer insurance will become the primary payer if there are more than 100 employees, and your Medicare will become secondary–but still available in case your circumstances change.

https://www.mymedicarematters.org/2016/03/social-security-disability-medicare-guide/