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If you have a disabling medical condition that qualifies you for Social Security Disability Insurance (SSDI), you do not have to pay for Medicare Part A premiums on SSDI. However, a 24-month waiting period may apply before your Medicare coverage kicks in, and you may need to pay premiums for Medicare Parts B, C, and/or D, as well as deductibles and co-pays.
Understanding how to apply for and secure SSDI and Medicare benefits can be challenging. Read on to learn more about Social Security Disability, Medicare, and how a Rutherfordton social security disability lawyer can assist you with seeking monthly payments and medical insurance.
SSDI Recipients Can Get Premium-Free Medicare Part A
The Social Security Administration (SSA) offers two separate and distinct disability benefits programs to disabled individuals in the United States:
- Social Security Disability Insurance (SSDI). Disabled workers qualify for SSDI through work credits earned via their employment. You generally need a minimum of 40 credits to become eligible, though you may need more or less depending on your age and work history.
- Supplemental Security Income (SSI). This program is for disabled individuals with limited income and resources. Eligibility is not dependent on work credits.
Only SSDI beneficiaries automatically receive Medicare Part A, which the federal government administers. However, according to the North Carolina Department of Health and Human Services and the South Carolina Department of Health and Human Services, SSI recipients in these states are automatically entitled to state-run Medicaid coverage per their state’s laws.
What does SSDI Medicare Coverage Include?
If you get SSDI benefits, your healthcare coverage may include:
Medicare Part A
Medicare Part A is hospital insurance. It covers inpatient hospital services, lab tests, surgeries, nursing facility costs, hospice, and in-home healthcare. You do not pay a premium for Medicare Part A on SSDI, though you may have deductibles and copays.
Medicare Part B
Medicare Part B is supplemental health insurance. It covers medically necessary services and preventative care, including outpatient services, mental health services, health screenings, and medical equipment.
According to Medicare.gov, SSDI recipients must pay a monthly premium of $174.70 (or more, depending on income) for Medicare Part B, which can come out of your SSDI benefit. There are also deductibles and copays. You can waive this coverage if you have a supplemental health plan through your employer.
Medicare Part C
Medicare Part C plans, also called “Medicare Advantage” plans, combine Parts A and B and are sold by private insurance companies. Monthly premiums vary.
Medicare Part D
Medicare Part D is an optional prescription drug coverage plan. If you receive SSDI, you can enroll, but you will pay a monthly premium based on your chosen plan.
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When does SSDI Medicare Coverage Start?
According to the American Association of Retired Persons (AARP), you become eligible for Medicare coverage 24 months after you qualify for SSDI. If you are entitled to SSDI back payments, every month you were eligible for SSDI will count toward the waiting period. The SSA waives the two-year waiting period for individuals with amyotrophic lateral sclerosis (ALS) or end-stage renal disease.
Our law firm’s Social Security Disability attorneys can tell you more about when your Medicare coverage starts and help you secure retroactive SSDI benefits if you qualify for these payments.
Will You Lose Your Medicare if You Go Back to Work?
If you return for a trial work period, your SSDI Medicare coverage remains in place during that time. If you reenter the workforce after the trial period and no longer qualify for monthly SSDI payments, you can still receive premium-free Medicare Part A coverage for the following 93 months, according to AARP.
Do You Qualify for Social Security Disability Insurance?
You may qualify for SSDI and Medicare if you have a disabling medical condition. The SSA maintains a list of qualifying conditions and the criteria for evaluating them in the SSA Blue Book. Listed ailments include but are not limited to the following:
- Cancer
- Chronic heart failure
- Traumatic brain injury
- Lupus
- Organ transplant
- Amputation
- Early-onset Alzheimer’s
- Spinal cord injury
- Huntington’s disease
- Chronic liver or kidney disease
- Personality disorders
In addition to meeting the medical criteria, your condition must prevent you from performing substantial gainful activity (SGA). According to the SSA, the 2024 SGA limit is $1,550 (or $2,590 for blind individuals). If you can earn more than this on average per month, you do not qualify for SSDI.
What Should You Do If Your SSDI or Medicare Benefits Get Denied or Revoked?
According to the SSA, only around 30 percent of Social Security Disability applications get approved on the first attempt. Most applicants will need to appeal the SSA’s initial determination. You can also appeal if you believe the SSA has wrongfully discontinued your SSD benefits or Medicare coverage.
You have 60 days from receiving an SSA determination to begin the appeals process. From there, you have 60 days between each appeal stage to advance your claim if you disagree with the previous ruling. The four stages of appeal are as follows:
- Reconsideration. You can request that the SSA review its initial ruling.
- Administrative Law Judge (ALJ) hearing. During this official court proceeding, you can introduce evidence, call witnesses, or undergo questioning.
- Appeals Council review. You can ask for a review of the ALJ’s ruling. The Appeals Council can reverse the decision, make its own ruling, deny your claim, or refer your case back to an ALJ.
- Federal court. If your appeal is unsuccessful in the previous three stages, you can file a civil lawsuit in U.S. District Court.
Do You Need an SSDI Attorney?
Managing an SSDI appeal is complex, and many pitfalls could threaten your pursuit of benefits and Medicare coverage. An SSDI lawyer with our firm can use their experience and legal skills to help you avoid common mistakes and build a successful claim. We can:
- Review your initial application
- Find and submit additional evidence proving your eligibility
- File your appeal and track and adhere to deadlines
- Represent you throughout the appeals process
- Take legal action if necessary
Contact Farmer & Morris Law, PLLC for Help With SSDI and Medicare Claims
You do not have to pay for Medicare Part A premiums on SSDI. However, getting coverage and SSDI benefits can be a long and confusing process. Fortunately, you do not have to navigate it alone. Contact Farmer & Morris Law, PLLC today for a free consultation and learn more about how our Social Security Disability team can fight for you.
