How Social Security Disability and Medicare Benefits Work Together
You can get financial help from Social Security and Medicare if you're permanently disabled or if you have Lou Gehrig's disease or kidney failure. To be considered "permanently disabled," your doctor must confirm that you are unable to work for at least 12 consecutive months. Being "unable to work" means you cannot perform your job functions because of the disability, and you cannot find a new line of work because of age, education, or impairment. You must follow your doctor's prescribed treatment plan to continue to qualify. It's a good idea to keep up-to-date medical records.
Qualified disabled individuals can apply for Social Security Disability or Railroad Retirement Board (RRB) disability to recover lost wages. Once you qualify for Social Security Disability or RRB benefits, you can also apply for Medicare Disability benefits to cover your hospital, medical, and/or prescription drug expenses.
Who qualifies for Medicare Disability?
To be eligible for Medicare Disability benefits you must:
- Be approved for Social Security Disability benefits because of your permanent disability.
- Have end-stage renal disease (ESRD or kidney failure).
- Have amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease).
Who is automatically enrolled in Medicare Part A and Part B?
If you are approved for Social Security Disability or RRB benefits because of your permanent disability, Medicare Disability may be automatic. Once you have been collecting Social Security Disability or RRB benefits for two years (24 consecutive months), you will be automatically enrolled in Medicare Part A (hospital insurance). If you live in any of the 50 United States or the District of Columbia, you will also be automatically enrolled in Medicare Part B (medical insurance).
If you have Lou Gehrig's disease, you will be automatically enrolled in Medicare Part A and/or Part B as soon as you start collecting your Social Security Disability or RRB benefits.
If you have ESRD, you will have to sign up for Medicare Disability Parts A, B, and D manually.
Who needs to enroll manually for Medicare Disability?
Even with automatic enrollment in Medicare Part A, some will need to enroll manually for Medicare Part B (for example, if you live in Puerto Rico). You can also enroll in Medicare Part D for prescription drug insurance.
If you are permanently disabled or if you have ESRD, you are eligible for Medicare Disability in the 25th consecutive month after you begin collecting Social Security Disability benefits. You can begin the enrollment process anytime from three months before your eligibility through four months after your eligibility for Medicare Disability.
For example, if you began collecting Social Security Disability benefits in April of 2012, your 25th month would be May of 2016. You could enroll in Medicare Disability as early as February of 2016. Your Initial Enrollment Period lasts seven months, though it is best not to wait until the last minute. Your coverage will begin in July of that year, unless you enroll too late.
If you have Lou Gehrig's disease, you can get Medicare Disability beginning the first month you get Social Security Disability benefits. Enroll in Medicare Disability at the same time as you apply for Social Security Disability benefits.
How to apply manually for Medicare Disability
Here's how to enroll in Medicare Disability Parts A, B and/or D:
- Apply online at www.socialsecurity.gov/medicareonly/.
- Call 1-800-772-1213 Monday through Friday between the hours of 7AM and 7PM to make an appointment. TTY users should call 1-800-325-0778.
- Visit your local Social Security office.
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare and provide Medicare Part A and Part B coverage. Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the "gaps" in original Medicare coverage.
Medicare has neither reviewed nor endorsed this information.
To learn about Medicare plans you may be eligible for, you can:
- Contact the Medicare plan directly.
- Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
- Contact a licensed insurance agency such as PlanPrescriber's parent company, eHealth.
- Call eHealth's licensed insurance agents at , TTY users 711. We are available . You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
- Or enter your zip code where requested on this page to see quote.