Medicare vs. Medicaid Disability Benefits for SSDI and SSI

Medicare With SSDI

If you are under age 65 and receive SSDI, SSDI Medicare eligibility begins after 24 months of entitlement, except in cases of amyotrophic lateral sclerosis (ALS) and end-stage renal disease (ESRD), which get Medicare earlier.

The Social Security Administration (SSA) counts entitlement months, not the number of months after your approval notice arrives. Check your SSA award notice for your entitlement month. Medicare starts on the first day of your 25th entitlement month unless you have an ALS or ESRD case. 

For ALS cases, Medicare starts when SSDI benefits start. For ESRD cases, when Medicare begins depends on your treatment. It often starts the fourth month of dialysis, earlier when you get home dialysis training, or in the month(s) before a kidney transplant.

Confirming your entitlement month is important for tracking SSDI Medicare eligibility. It often takes months to over a year to be approved for SSDI and you can get retroactive benefits for up to 12 months before you applied if your records show you met the SSA’s disability rules then. That means some of your Medicare waiting months may have already passed. If you have questions, contact the SSA. This article explains the timeline and possible delays after you apply.

Medicare Enrollment, Costs, and Plan Choices With SSDI 

You will be automatically enrolled in Medicare and get a welcome packet and your card three months before coverage starts. When you get SSDI, your Part A hospital insurance is free, but you have a fee for Part B medical coverage. That fee is deducted from your monthly SSDI benefit unless your payment doesn’t cover the fee or you choose another payment option. Medicare bills you when your SSDI payment doesn’t cover the Part B premium.

Before your Medicare coverage starts, you need to research Part C Medicare Advantage and Part D prescription drug coverage. You may want one or both depending on your health care needs. Medicare can answer questions about your enrollment choices, plan coverage, enrollment and covered services. Learn more about your Medicare options.

Medicaid With SSI

When you get approved for SSI, you typically qualify under your state’s SSI Medicaid eligibility rules. The enrollment process depends on your state. In many states, your SSI application also serves as your Medicaid application. Other states require you to apply through the state Medicaid agency. A few states use separate SSI Medicaid eligibility rules rather than SSI criteria. 

Medicaid coverage and available services also differ by state. Your state decides which services are covered, how enrollment works, and whether you need to complete renewals or provide more information. Contact the agency directly if you are unsure whether your Medicaid coverage has started.

Concurrent Benefits and Dual Coverage

You can get SSDI and SSI at the same time (concurrent benefit) if your SSDI payment is low enough for you to qualify for SSI. You may also become dual eligible for Medicare and Medicaid in those cases. When you have dual insurance coverage, coordination of benefits determines how the programs share costs. 

Medicaid Eligibility While Receiving SSDI

Medicaid income and resource limits differ depending on where you live. Receiving SSDI does not block you from Medicaid, but your SSDI payments count as income. 

If you live in the 50 states, Puerto Rico, Guam, the District of Columbia, or the U.S. Virgin Islands, a state health insurance assistance program (SHIP) counselor can help you understand Medicaid programs and eligibility. That includes Medicaid programs that help pay for Medicare costs.

Medicare and Medicaid Costs

When you are dual eligible for Medicare and Medicaid, Medicare generally pays first for services both programs cover. Medicaid can then pay some remaining costs under state rules. Full Medicaid can also cover certain services that Medicare does not fully cover.

Medicaid Savings Programs (MSPs) can also help you pay Medicare premiums, deductibles, coinsurance, and copayments. The amount of help available depends on your eligibility category and state rules. Full Medicaid and an MSP aren’t the same benefit. You can get Medicare cost help through an MSP even if you don’t qualify for full Medicaid. Your state Medicaid agency handles applications for these programs.

The four main MSPs are the:

• Qualified Medicare Beneficiary (QMB) program
• Specified Low-Income Medicare Beneficiary program
• Qualifying Individual program
• Qualified Disabled and Working Individual program 

The QMB program provides the broadest cost help of the four programs. It can pay Part A premiums when required, Part B premiums, and Medicare deductibles, coinsurance, and copayments for covered services. Providers cannot bill you for Medicare-covered deductibles, coinsurance, or copayments while you are enrolled in this program.

Insurance Options Before Medicare Starts

You likely need health care coverage before the SSDI Medicare waiting period is over. As mentioned above, you may be able to get Medicaid if your SSDI payment falls within your state’s Medicaid income and resource limits.

Other options depend on your personal situation, how recently you worked, and if you served in the military. If you are a veteran, you can get health care through the Department of Veterans Affairs (VA). Veterans typically get health care without a monthly premium.

You may also be eligible for a continuation of coverage through a recent employer under the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA may be available for 18-36 months, depending on your situation.

Sometimes you can join a spouse’s employer plan because losing other health coverage often creates a limited enrollment opportunity. The employer’s benefits office can explain the deadline and required documents.

If none of these options work for you, explore the health insurance plans offered on then Health Insurance Marketplace. These plans meet the requirements of the Affordable Care Act (ACA), and you may be able to get financial assistance depending on your income.

Confirm Your Coverage With the Right Agency

If you have questions about your disability insurance or health coverage, ask the correct agency for help. For questions about SSDI, SSI, or when Medicare starts with SSDI, contact the SSA.

If you need help enrolling in Medicaid or an MSP, contact your state’s Medicaid agency. A SHIP counselor can also explain enrollment notices, coverage choices, and coordination of benefits between Medicare and other insurance. 

If you aren’t approved for SSDI or SSI yet or were denied, Advocate can help. Our disability specialists can check your eligibility, help you apply, or help you improve your claim. We know what it takes to get an approval for disability benefits and how to avoid common mistakes.

The disability benefits process can be overwhelming, especially when you aren’t well. Advocate can lower your burden and frustration.

Frequently Asked Questions

Can you receive Medicare on SSI?

Typically, when you get SSI, you qualify for Medicaid through your state. You’re eligible for Medicare when you’re 65 and may have dual enrollment.

Does Medicaid end when Medicare starts?

Medicaid does not automatically end when Medicare begins. You can keep it if you still meet your state’s rules or qualify for a Medicare Savings Program.

Does Medicare continue after SSDI ends?

Medicare continues during SSDI trial work periods and for at least 93 months after SSDI ends if you go back to work. Medicare and SSDI benefits are paused if you are incarcerated.