Sunday, August 14, 2022

When Can I Get Medicare After Getting Social Security Disability

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The Proving Your Disability Part Never Stops

4. What is Social Security Disability Insurance (SSDI)?

Even after you receive disability benefits, the proving part never stops. I have found myself constantly needing to provide explanations and justifications to everyone from my local SSA office to friends and others in my life to complete strangers.

In the beginning, everyone wanted to know why, as in, why did you go on disability? I heard this especially from older adults who seemingly wanted me to have a chance at life rather than succumb to receiving disability. Its not an easy decision to make, and sometimes you can feel like you gave up or are a failure in societys eyes.

Some friends would ask questions out of general concern, curiosity, and wanting to learn about the disability benefit process. Others would listen, but ultimately impart judgment and negativity focusing on how I could possibly afford certain things or question whether I was really in too much pain to work, since I could work from home part-time. If I had good days, they didnt understand that didnt mean I was okay to go back to work full-time.

Then there is a medical review that SSA requires, where you need to send in proof of your disability and be examined by a doctor they send you to . My review is every three years. The process used to make me nervous, but not as much anymore.

Part of whats made me less nervous about these reviews is that I have built up knowledge about what to expect. Plus, I have a lot more patience about navigating these roadblocks.

Returning To Work With Medicare Disability Enrollment

You are allowed to keep your Medicare coverage for as long as a medical professional deems you medically disabled.

If you under age 65 and return to work, you wont have to pay a premium for Part A for the next 8.5 years.

If youre still younger than age 65 once that 8.5-year time period as passed, youll begin paying the Part A premium. In 2021, the standard Part A premium is $259.

Your Medicare costswill depend on your specific circumstances. Its important to know that unlikestandard insurance plans, each Medicare part has its own costs and rules.

Medicare Part D For Disabled Under 65

If you choose Medicare, youll need a Part D drug plan. Youll pay a premium, and a copay or coinsurance. Many people on Social Security Disability qualify for Extra Help with Part D costs. Eligibility for Extra Help is based on income and assets. If youre on Medicaid, you automatically qualify for Extra Help.

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Qualifying For Medicare When Receiving Disability Benefits

Medicare coverage kicks in for most SSDI recipients two years after the first month they are eligible for their monthly disability benefits. However, this doesnt automatically mean that every person approved for SSDI must wait two years to get their Medicare coverage. The two-year Medicare waiting period generally gets calculated from the date of your SSDI entitlement . Normally, this is the date your disability began plus the five-month SSDI waiting period.

However, things get a little tricky depending on your disability onset date. Depending on how far back you became disabled, you may have met a good portion of the waiting period by the time you are approved for benefits. But, because Social Security only allows a maximum of 12 months of retroactive benefits, plus the 5-month waiting period for benefits, the earliest that you can become eligible for Medicare is one year after you apply for Social Security disability.

But, if you recently become disabled and were approved with an entitlement date of August 2018, you would not become eligible to receive Medicare benefits until August 2020. There are exceptions to this rule if your disabling diagnosis is End Stage Renal Disease or Amyotrophic lateral sclerosis . People with these conditions receive expedited Medicare coverage.

To Qualify For Medicare You Need To Get Disability Benefits From:

2020 SSDI Benefits Eligibility and How to Apply
  • Social Security
  • Railroad Retirement Board

Youll automatically get Part A and Part B after you get disability benefits for 24 months. Well mail you a welcome package with your Medicare card.

If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

If you live in Puerto Rico or outside the U.S.

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How Do Medicare And Social Security Work Together

Youll get Medicare automatically if youre already receiving Social Security retirement or SSDI benefits. For example, if you took retirement benefits starting at age 62, youll be enrolled in Medicare three months before your 65th birthday. Youll also be automatically enrolled once youve been receiving SSDI for 24 months.

Youll need to enroll in Medicare if you turn 65 but havent taken your Social Security benefits yet. The Social Security Administration and Medicare will send you a Welcome to Medicare packet when youre eligible to enroll. The packet will walk you through your Medicare choices and help you enroll.

SSA will also determine the amount you need to pay for Medicare coverage. You wont pay premiums for Part A unless you dont meet the coverage rules discussed above, but most people will pay a premium for Part B.

In 2020, the standard premium amount is $144.60. This amount will be higher if you have a large income. Social Security uses your tax records to determine the rates you need to pay.

If you make more than $87,000 a year, SSA will send you an Income-Related Monthly Adjustment Amount . Your IRMAA notification will tell you the amount above the standard premium you need to pay. Youll also be responsible for an IRMAA if you choose to buy a separate Part D plan and you make over $87,000.

Taking Medicare But Not Social Security

It is possible to enroll in Medicare coverage but delay taking your Social Security retirement benefits. For many workers, this strategy might be financially advantageous.

For most older people, it is a good idea to enroll in all parts of Medicare coverage they plan to use as soon as they are eligible at age 65. If you delay enrolling, Medicare Part D may become more expensive. If you delay signing up for Part B, you may also experience a gap in your coverage or have to pay a late enrollment penalty.

However, if you can afford to, it is often a smart financial decision to delay receiving Social Security benefits until at least your full retirement age in order to increase the benefit you receive. This may mean that there are several years during which you are enrolled and covered by Medicare but not yet receiving your monthly Social Security benefit.

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Want To Get More Involved With Patient Advocacy

The 50-State Network is the grassroots advocacy arm of CreakyJoints and the Global Healthy Living Foundation. It is comprised of patients with chronic illness who are trained as health care activists to proactively connect with local, state, and federal health policy stakeholders to share their perspective and influence change. If you want to effect change and make health care more affordable and accessible to patients with chronic illness, learn more here.

Medicaid In The Interim

Can you work if you are receiving Social Security Disability benefits?

Those with low income and low assets may qualify for the Medicaid program during the two-year waiting period for Medicare. States set their own rules regarding Medicaid eligibility, but those granted SSI at the same time as SSDI automatically qualify for Medicaid.

While Medicare covers hospice for those who are expected to pass within six months, the waiting period prevents many with a terminal illness from using Medicare for hospice needs. However, all 50 states’ Medicaid programs cover hospice for those with low income and low assets. States may vary on the length of hospice coverage they provide and the amount of inpatient care that’s covered.

For more information on Medicaid eligibility, see the Medicaid section on

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Can You Get Social Security And Not Sign Up For Medicare

Yes, many people receive Social Security without signing up for Medicare.

Most people arent eligible for Medicare until they turn 65. As you can start collecting Social Security retirement benefits at 62, individuals may have Social Security without Medicare for several years.

Most people enroll in Part B once they turn 65, but you may decide to delay enrolling in Part B if you or your spouse has health insurance through an employer. Be sure to learn more about how Medicare enrollment works in your specific case, though. If you delay enrollment in Medicare Part B when youre first eligible and you dont have other creditable coverage, you could face late enrollment penalties for the rest of the time that you have Part B once you sign up.

As most people dont pay a premium for Part A, theres no reason to cancel the coverage, even if you dont think you need it. You are free to decline other Medicare plans, such as Parts B and D, though again you should make sure you wont cause yourself to go without coverage or have to pay late enrollment penalties in the future.

The Exception To The Rule

You may be able to get both benefits if you opted for early retirement before you received disability benefits. These are also known an concurrent benefits. This exception would be applicable in a situation where an individual retired early due to serious medical conditions. If that individual can prove that they developed the disability prior to receiving early retirement income, theyll be able to earn both benefits.

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How Does Automatic Enrolling In Medicare Work

Most people who collect Social Security benefits automatically receive Original Medicare coverage once they’re eligible.

If you receive benefits through the Railroad Retirement Board , youll receive the same Medicare coverage.

Youll become eligible for Medicare when one of the following events occur:

  • You turn 65
  • You have end-stage renal disease
  • You have Lou Gehrig’s Disease, amyotrophic lateral sclerosis
  • You have been on Social Security disability insurance for 24 months and have a qualifying condition. These include heart and lung issues, neurological disorders, cancer, kidney dysfunction and other severe health problems.

If you live in Puerto Rico and receive Social Security or RRB benefits, youll only become automatically enrolled in Medicare Part A. If you want Medicare Part B, youll need to apply for coverage.

Those receiving Social Security benefits who also qualify for both Medicare and Medicaid will also be awarded Medicare Part D prescription drug coverage automatically. If you don’t qualify for Medicare and Medicaid, you’ll need to compare Part D prescription drug plans or Medicare Advantage plans that include Part D coverage and enroll in a plan available where you live.

Who Is Eligible For Medicare

Can I Get Medicaid If I Am Approved For SSI?

Most people enroll in Medicare when they turn 65. You can enroll as early as three months before your 65th birthday or as late as three months after. Youll need to be a United States citizen or have been a permanent legal resident for at least five years. In order to get full coverage, you or your spouse need to meet a work requirement. Meeting the work requirement verifies that youve paid into the system.

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Who Is Eligible For Ssdi

The rules are different when youre applying for SSDI. Youll need 40 work credits if youre applying at age 62 or older.

To qualify for SSDI, you must:

  • be unable to work because of a medical condition that will last at least 12 months, or is terminal
  • not currently have a partial or short-term disability
  • meet SSAs definition of a disability
  • be younger than full retirement age

You must be able to prove you meet these criteria, and this process can be difficult. Once you qualify for SSDI, the amount of disability youll receive may be based on your age and the amount of time youve worked and paid into Social Security.

This table explains what benefits are offered based on your age and number of years worked:

Does Medicare Or Medicaid Come With Disability Benefits

Home » Frequently Asked Questions » Does Medicare or Medicaid Come with Disability Benefits?

You are eligible for enrollment in Medicare coverage 2 years after the first month that you are eligible for Social Security Disability Insurance . Eligibility is determined by your onset date for benefits plus the required 5 month waiting period for benefits.

This does not necessarily mean you have to wait an additional 2 years from your decision date to be eligible for Medicare. Your Medicare coverage enrollment date depends on your disability onset date plus the mandatory 5 month waiting period for benefits.

The Social Security Administration may award you retroactive or back benefits up to a maximum of 12 months prior to the date of filing for benefits. The number of months of back benefits you may be awarded can reduce your wait time for Medicare eligibility. The date that you became disabled and the date you applied for benefits can impact the date you will become eligible for Medicare benefits.

The application and appeals process for Social Security Disability benefits can take many months. Unfortunately, a favorable decision does not mean you are immediately eligible for Medicare coverage.

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Medicare Supplement Plans For Disabled Under 65

Medicare pays a large portion of the cost, but not all of it. Medigap can help cover what Medicare doesnt cover. But if youre under 65, it can be hard to find an affordable Medigap plan.

While some states require companies to offer at least one Medigap plan to people under age 65, others do not. In some states, Medigap plans are only available to certain types of beneficiaries, such as people with end-stage renal disease.

In several states, you cant buy a Medigap plan at all if youre under 65. And rates tend to go up from one year to the next. So, Medigap can be both hard to get and expensive if youre under 65. Often, the best solution is an Advantage plan.

When you turn 65, youll qualify for the Medicare Supplement Open Enrollment Period. Then, you can get a policy without having to answer any questions about your health.

Medicare & Social Security Disability Benefits

How Does Social Security Disability Work With Long-Term Disability?

We have mostly discussed thebasics of Medicare as it relates to retirees and Social Security retirement benefits. However, you can also qualify for Medicare when you receive Social Security disability insurance benefits from the Social Security Administration . When receiving disability benefits, you will be automatically enrolled in Medicare once you have received disability benefits for a 24-month period. There is a 24-month waiting period before your Medicare benefits begin. However, that waiting period does not apply to some individuals with certain conditions.

If you have been diagnosed with end-stage renal disease , you will qualify for Medicare benefits right away. Similarly, those with amyotrophic lateral sclerosis or Lou Gehrigs disease will be eligible for immediate Medicare benefits. These diagnoses will qualify you for immediate benefits, but you must still apply for the benefits. You will not be automatically enrolled in coverage. You can contact your local Social Security office or Centers for Medicare & Medicaid Services office to apply for coverage. You can alsoapply for Medicare online through, or you can call Social Security at 1-800-772-1213.

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Who Is Eligible For Ssi

You can qualify for SSI if you:

  • are over 65
  • are legally blind
  • have a disability

As with all Social Security benefits, youll also need to be a United States citizen or legal resident and have limited income and resources. However, to apply for SSI, you dont need work credits.

You can receive SSI in addition to SSDI or retirement benefits, but it can also be a standalone payment. The amount you receive in SSI will depend on your income from other sources.

Social Security Disability Insurance is a type of Social Security benefit for those with disabilities or health conditions that prevent them from working.

Medicare Enrollment For Social Security Beneficiaries

Whether or not you are automatically enrolled in Medicare depends on the timing of your Social Security benefits. Remember that you can start your Social Security retirement benefits at age 62 . So, when are you eligible for Medicare? You do not becomeeligible for Medicare until age 65. So, if you are already receiving your Social Security benefits or Railroad Retirement Board benefits when you get Medicare eligibility, you will be automatically enrolled in Original Medicare. This means that you will receive both Medicare Part A and Medicare Part B. If you live in Puerto Rico, you will only be automatically enrolled in Part A coverage.

Most people receive premium-free Part A coverage, although there is a monthly premium associated with Part B coverage. Remember thatMedicare is funded with taxes you pay while working. As long as you have sufficient work history, you wont need to pay a monthly premium for Part A coverage. For this reason, some people choose to opt out of their Part B benefits. Others choose to opt out because they are still working and are covered by a health plan through their employer. We will discuss this situation in more detail later in this article.

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How The Age You Retire Affects Your Benefits

You can apply for Social Security retirement benefits once youve turned 62. However, youll receive more money per month if you wait a few years. People who start collecting retirement benefits at 62 will receive 70 percent of their full benefit amount. You can receive 100 percent of your benefit amount if you dont start collecting until full retirement age.

The full retirement age for people born after 1960 is 67. If you were born before 1960, refer to this chart from Social Security to see when youll reach full retirement age.

You can qualify for additional benefits if you have a limited income. Known as Supplemental Security Income , these benefits are for people with limited income who qualify for Social Security because of age or disability.

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