Medicare and Social Security Disability Insurance work hand in hand to help those who are disabled.
If you are collecting Social Security Disability Insurance, you may also be eligible to receive Medicare.
SSDI beneficiaries are automatically enrolled in Medicare after two years. Any American citizen over the age of 65 who is eligible for Social Security is eligible for Medicare. For those under the age of 65, you must have collected SSDI benefits for 2 years or receive benefits because of Lou Gehrig’s disease or kidney failure. Lou Gehrig’s disease and kidney failure are particularly expensive to treat, so the government wants to provide coverage for those who need it most without the two year waiting period. While Medicare is good health insurance, there are many costs it does not cover, and it is not free to use. There are four parts of Medicare:
Part A: Hospital Insurance
Cost: Most people under 65 with a disability will be fully insured for free under Social Security. Some SSDI beneficiaries do have to pay a premium for Part A if they have not paid FICA taxes for the previous ten years. Younger workers, or workers who have otherwise not been able to work for a full decade may have to pay a premium. The premium varies, but it is around $400 per month. There is also a $1,288 deductible before Medicare begins to cover costs.
Benefits: Part A covers inpatient care in a facility such as a hospital or nursing home, or home health services. For a hospital stay, after the deductible is paid, the first 60 days in the hospital are free, the 61st-90th days are $322 per day and after the 90th day, each day cost $644 (as of 2016). If you are enrolled in a program to help with your Medicare costs, these costs may be covered as well.
Part B: Medical Insurance
Cost: If you are enrolled in Part A and not paying a premium, you will be eligible to enroll in part B. The standard premium for those earning under $85,000 ($170,000 jointly) recently increased to $121.80. However, if you were on SSDI through 2015, you may be entitled to stay at your old premium. The deductible is only $166 per year and then any product or service costs 20% of a Medicare-approved rate (usually much less than the normal cost).
Benefits: Part B covers all services deemed medically necessary as well as preventive services such as vaccines. Part B also covers ambulance services and even some prescription medications. Your health care provider should be able to tell you if a specific product or service is covered under Medicare.
Part C: Medicare Advantage
Part C allows private insurers to provide Medicare. Some people chose to purchase Medicare benefits through a Part C Plan. Through the private healthcare marketplace, there are a wide variety of plans available each with different premiums, deductibles and coverage.
Part D: Prescription Drug Coverage
Cost: Part D premiums vary greatly, but are generally under $100 per month. Premiums are on the higher end for those with high incomes. No Medicare drug plan may have a deductible in excess of $360.
Benefits: Each Part D plan is different, but they all offer significant help paying for medications. In general, generic drugs will be much cheaper than brand-name drugs.
Eligibility and Costs
If you are on disability, you will become eligible for Medicare benefits 24 months after the day you became eligible to receive SSDI. For personalized information regarding eligibility and premiums, Medicare has provided a calculator.