Social Security Disability And Medicare

If You Get Medicare For Disability And Then Return To Work

If you get Medicare due to disability and then decide to go back to work, you can keep your Medicare coverage for as long as youre medically disabled.3 And, if you do go back to work, you wont have to pay the Part A premium for the first 8.5 years.

Part A is premium-free for those with a disability and under 65 only if you get Social Security or Railroad Retirement Board benefits for 24 months or have ESRD and meet certain requirements.4

If youre 65 or older, Part A is premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years, you already get retirement benefits from Social Security or the Railroad Retirement Board, or youre eligible for these benefits but havent filed for them yet.5

Enrolling In Medicare With A Disability

Just like when you become eligible for Medicare at age 65, when you are eligible with disability, you have an Initial Enrollment Period of 7 months.

Your Initial Enrollment Period will begin after you have received either disability benefits from Social Security for 24 months or certain disability benefits from the Rail Road Retirement Board for 24 months.1 In other words, your IEP starts on the 25th month of disability benefits.

You will be automatically enrolled in Medicare Part A and Part B, but if you decide you want to get a Medicare Advantage or Part D prescription drug plan, you will need to enroll yourself directly with the private plan provider. You will need to enroll during your IEP to avoid late enrollment penalties.

NOTE: If you become eligible for Medicare because of ALS or ESRD, your situation is different. See the below special sections for eligibility and enrollment for ALS and ESRD.

Health Resources For People With Disabilities

Federal, state, and local government agencies and programs can help with your health needs if you have a disability.

• Explore the Disability and Health section of CDC.gov for articles, programs, tips for healthy living and more.

• Learn more about benefits for people with disabilities from the Social Security Administration.

• Contact your local city or county government to find out what medical and health services are available locally for people with disabilities.

• Your state social service agency can help you locate medical and health programs.

Visit USA.govs Government Benefits page to learn more about government programs and services that can help you and your family.

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Check The Status Of An Application

The Division of Family Resources provides tools to strengthen families through services that focus on prevention, early intervention, self-sufficiency, family support, and preservation.

You can check the status of your application online by clicking on your county of residence or by calling 1-800-403-0864. You will need to have your case number to check the status of your application.

Please remember that your application must be completed and all required documentation submitted before DFR can begin processing your application.

Pursuant to HIPAA and other applicable federal regulations, DFR is committed to respecting the privacy of each client. For that reason, DFR will not share or disclose information about your case without a signed release. You may download the DFR online.

Do You Qualify For Medicare Coverage With Social Security Disability Benefits

Everyone eligible for SSDI benefits is also eligible for Original Medicare Parts A and B after a 24-month qualifying period. This coverage automatically begins on the first day of the 25th month of disability. You then become eligible for Medicare Advantage and Medicare Drug coverage. SSDI and Medicare Supplement coverage is dependent upon state legislation and each state takes a different approach.

You can for information at 772-1213.

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Medicare Benefits For People With Disabilities

Whether you qualify for Medicare based on age or a disability, Medicare Part A and Part B coverage stays the same. Medicare beneficiaries have the same benefits and can access the same services. The same coinsurance and copayments also apply to Medicare beneficiaries under 65. Heres a brief rundown of what each covers:

Medicare Coverage If Youre Disabled

We automatically enroll you in Original Medicare after you get disability benefits for two years. However, if your disability results from ALS, Medicare coverage begins sooner, generally the first month you are eligible for disability benefits.

• Medicare Part A helps pay for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. The taxes you paid while you were working financed this coverage. Its provided at no cost to you.
• Medicare Part B helps pay doctors services, outpatient care, some medical supplies, and other preventive services. You will need to pay a monthly premium for this coverage if you want it.

Most people have both parts of Medicare. If you have questions about this coverage, you can contact Medicare toll-free at 1-800-MEDICARE to speak to a Medicare Customer Service Representative. TTY users should call 1-877-486-2048.

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How Much Is The Disability Benefit

The disability benefit is linked through a formula to a workers earnings before he or she became disabled. The following figures show how the disability insurance benefits compare to prior earnings for a worker who became eligible for benefits in 2014 at age 55.

*Average indexed earnings

The average benefit paid to disabled workers in June 2017 was $1,172 a month or about $14,064 a year.

Enrolling In A Medicare Advantage Plan

If you want additional benefits beyond Original Medicare coverage, you can choose to enroll in a prescription drug plan or a Medicare Advantage plan. The best time to enroll is during your seven-month Initial Enrollment Period.

• Your enrollment period starts three months before your Medicare coverage begins. You can start looking for plans in month 21 of receiving SSDI, once you have your Medicare ID card.
• Your enrollment period includes the first month your Original Medicare coverage starts. This is usually month 25 of your SSDI.
• Your enrollment period ends three months after your Original Medicare coverage begins. This is usually in month 28 of receiving SSDI.

As soon as you get your Medicare ID card in the mail, you can enroll in a plan that provides additional services. Medicare Advantage plans often include benefits such as dental and vision coverage, as well as prescription drug coverage. Part C plans also have a yearly cap on out-of-pocket spending to help keep your healthcare costs affordable.

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How Do People Under Age 65 With Disabilities Qualify For Medicare

People under age 65 become eligible for Medicare if they have received SSDI payments for 24 months. Because people are required to wait five months before receiving disability benefits, SSDI recipients must wait a total of 29 months before their Medicare coverage begins. People under age 65 who are diagnosed with end-stage renal disease or amyotrophic lateral sclerosis automatically qualify for Medicare upon diagnosis without a waiting period.5 Of those who were receiving SSDI in 2014, 34% qualified due to mental disorders, 28% due to diseases of the musculoskeletal system and connective tissue, 4% due to injuries, 3% due to cancer, and 30% due to other diseases and conditions.6

The Disability Application Process

Whether you apply online, by phone, or in person, the disability benefits application process follows these general steps:

• You gather the information and documents you need to apply. We recommend you print and review the . It will help you gather the information and documents you need to complete the application.
• You complete and submit your application.
• We review your application to make sure you meet our for disability benefits.
• We confirm you worked enough years to qualify.
• We evaluate any current work activities.
• We process your application and forward your case to the Disability Determination Services office in your state.
• This state agency makes the disability determination decision.

To learn more about who decides if you have a disability, read our publication .

Once You’ve Applied

Once we receive your application, well review it and contact you if we have questions. We might request additional documents from you before we can proceed.

Look For Our Response

When the state agency makes a determination on your case, youll receive a letter in the mail with our decision. If you included information about other family members when you applied, well let you know if they may be able to receive benefits on your record.

Check The Status

You can check the status of your application online using your personal mySocial Security account. If you are unable to check your status online, you can call us 1-800-772-1213 from 8:00 a.m. to 7:00 p.m., Monday through Friday.

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My Medicare Hmo Has Discontinued My Coverage What Do I Do

A. You have 63 days from the time your HMO coverage ends to purchase supplemental insurance and be guaranteed coverage. During that period, no insurance company may deny you Medigap coverage based on your age or health status. However, prices may vary. For more information on Medigap, call Medicare at 1-800-633-4227.

Additionally, you may want to contact the Area Agency on Aging at 1-800-852-7795.for assistance with exploring your options.

Get Proof Of Benefits

If you need proof of your Social Security benefits, you can get a Benefit Verification letter by logging into my Social Security. The letter serves as proof that you get retirement, disability, Supplemental Security Income or Medicare benefits. You can use it for loan, housing assistance, mortgage and other income verification purposes.

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You Automatically Get Medicare

• You should already have Part A and Part B , because you have ALS and youre already getting disability benefits.
• We mailed you a welcome package with your Medicare card.

Sign up for Part B if you live in Puerto Rico or outside the U.S.

• Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.

Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months after your Part A starts, you might have to wait to sign up and pay a monthly late enrollment penalty.

• Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.

Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.

What Disabilities Qualify Someone For Medicare Coverage

If you have a disability, the costs of healthcare can add up quickly, especially if youre no longer working. Thats why Medicare provides healthcare coverage for adults with qualifying disabilities.

When you have Social Security disability, Medicare eligibility is not based solely on the disability you have. Instead, your eligibility is determined by the Social Security Administration. If you receive Social Security Disability Insurance , youre eligible for Medicare coverage even if youre younger than 65.

This is how Social Security defines disability:

• You cannot keep working because of your health condition.
• You cannot adjust to a new job because of your health condition.
• Your disability is expected to last for one year or more.

Conditions such as heart failure, cancer and musculoskeletal problems may qualify as a disability, as well as numerous other conditions that affect your daily life.

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Social Security Benefits In 2023 Will Rise The Most In 40 Years How Much Will I Get

Social Security recipients will get a hefty raise in 2023, with benefits rising 8.7%, the most in four decades.

The inflation-related bump may coax some retirees into tapping their benefits early, before they reach full retirement age. It also may spark a few questions.

• How do you apply for Social Security?

• How are benefits calculated?

• Are they taxable?

The cost-of-living adjustment, or COLA, will boost the average retirees monthly payment by $146 to $1,827 next year, according to the Social Security Administration . Yet for 70 million retirees, disabled people and others, the increase will simply help them catch up to inflation that hit a 40-year high of 9.1% earlier this year, outpacing the 5.9% COLA they received in 2022, says Mary Johnson, a policy analyst for the Senior Citizen League, an advocacy group.

Heres what you need to know:

Under Age 65 And Receiving Social Security Disability Benefits

If this is your personal situation, after you receive 24 months of Social Security Disability Income benefits, Medicare automatically enrolls you in both:

• Medicare Part A , which is premium-free.
• Medicare Part B , which has a premium.

However, if you receive SSDI due to a specific disability, such as End-Stage Renal Disease or Lou Gehrig’s disease , you’re automatically enrolled in Medicare without the 24-month waiting period.

In either case, you’ll receive your Medicare card in the mail. If Medicare enrolls you after 24 months of receiving SSDI, you’ll get your card about three months before your 25th month of disability benefits. If you don’t want Part B, follow the instructions that come with the card.

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How Do Sources Of Supplemental Coverage And Prescription Drug Coverage Differ For Medicare Beneficiaries Under Age 65 With Disabilities And Older Beneficiaries

Supplemental coverage

Most Medicare beneficiaries, including those under age 65 with disabilities, have public or private supplemental insurance to help cover Medicares cost-sharing requirements.9 A much larger share of beneficiaries under age 65 with disabilities than older beneficiaries rely on Medicaid to supplement Medicare because of their relatively low incomes .10 Medicaid helps with Medicare premiums and cost-sharing requirements, and covers services needed by many people with disabilities that are not covered by Medicare, particularly long-term services and supports.

Figure 3: Supplemental Coverage Among Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older in 2012

Just over 1 in 5 beneficiaries under age 65 has no supplemental coverage, compared with 12% of those age 65 or older. Lack of supplemental coverage among Medicare beneficiaries is associated with higher rates of access problems, but rates of access problems are higher among younger beneficiaries with disabilities who lack supplemental coverage than among older beneficiaries, including not seeing a doctor for a health problem when they think they should and having trouble getting needed health care .12 Regardless of whether or not they have supplemental coverage, however, a larger share of younger beneficiaries with disabilities than older beneficiaries experience access and cost-related burdens .

Prescription drug coverage

The Other Parts Of Medicare

• Medicare Advantage Plan people with Medicare Parts A and Part B can choose to receive all of their health care services through plans that are offered by private companies and approved by Medicare. For more information, we recommend you read Medicare’s How do Medicare Advantage Plans work?
• Medicare Part D helps pay for medications doctors prescribe for treatment. For more information on the enrollment periods for Part D, we recommend you read Medicare’s How to get prescription drug coverage page.

If you receive Medicare and have limited resources and income, you may be eligible for Extra Help with Medicare Prescription Drug Plan Costs.

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Exceptions And More Information

An exception to Medicare due to disability applies if you have been diagnosed with Amyotrophic Lateral Sclerosis also known as Lou Gehrigs disease. If you have ALS, Medicare begins the first month you are entitled to Social Security disability benefits.

Generally, enrollment in Medicare Part A and Part B is automatic. If you are receiving disability benefits, you will receive a Medicare card showing the date your Medicare benefits begin.

Click the link below to view and download our factsheet, or call SHIIPSMP at to have a copy sent to you.

Can Ssi Recipients Receive Medicare

People who receive disability benefits through the Supplemental Security Income program don’t qualify for Medicare insurance coverageâat least until they reach the age of 65 years old. Upon turning 65, SSI recipients can receive Medicare based on age. Learn more about the Medicare and Medicaid that comes with disability benefits.

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Other Ways You Can Apply

Apply With Your Local Office

You can do most of your business with Social Security online. If you cannot use these online services, your local Social Security office can help you apply. You can find the phone number for your local office by using our Office Locator and looking under Social Security Office Information. The toll-free Office number is your local office.

Apply By Phone

If You Do Not Live in the U.S. Or One of Its Territories

Contact the if you live outside the U.S. or a U.S. territory and wish to apply for retirement benefits.

Mailing Your Documents

If you mail any documents to us, you must include the Social Security number so that we can match them with the correct application. Do not write anything on the original documents. Please write the Social Security number on a separate sheet of paper and include it in the mailing envelope along with the documents.