Eligibility For Medicare

Medicare is an important health insurance program that is available to all people who are found disabled under the SSDI program

The Medicare program is funded through a combination of payroll taxes paid by current workers as well as monthly premiums deducted from Social Security disability and retirement checks. Medicare generally covers many but not all medical expenses, and many people elect to purchase a Medicare supplemental insurance policy through a private insurance company.

Medicare has four parts: Part A, Part B, Part C, and Part D

Medicare Part A is known as hospital insurance. It covers inpatient hospital stays as well as post-hospital stays in a skilled nursing facility, and sometimes a hospice facility or home health care will be covered as well. Medicare Part A coverage is free to those who are eligible. While there are many technical requirements for Medicare Part A eligibility, in general once you have been entitled to Social Security disability benefits (SSDI) for 24 months you are eligible for Medicare Part A coverage.

What does it mean to be “entitled to” SSDI for 24 months? This does NOT mean that you must wait 24 months after being approved for SSDI. The relevant date is the date that the Social Security Administration states your disability began. So if you apply for SSDI on 1/1/2013 and receive a favorable adjudication on 1/1/2015 which states that your disability began on 1/1/2013, then you are now entitled to Medicare Part A coverage. However, if you apply for SSDI on 6/1/2013 and receive a favorable adjudication on 6/6/2014 which states that your disability began on 6/1/2013, then you will not be eligible for Medicare Part A coverage for another 12 months after your adjudication.

Medicare Part B is known as medical insurance. It covers doctor appointments, outpatient care, home health care, and medical equipment, among others. If you qualify for Medicare Part A coverage then you also qualify for Medicare Part B coverage. However, unlike Part A, Part B coverage is not free. If you request Part B coverage, a monthly premium will be deducted from your disability benefits.

Medicare Part C is known as Medicare Advantage plans. These are plans that are offered by private companies that Medicare approved. These optional Advantage plans cover additional services but also charge an additional premium.

Medicare Part D is known as prescription drug coverage. Anyone who is eligible for Part A, Part B, or Part C is also eligible for Part D. This prescription drug coverage is voluntary and will cost an additional premium.

For additional questions regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE.


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