Do I Get Medicare on SSDI?
If you are approved for Social Security Disability (SSD) benefits, then you have already proven to the federal government that you suffer from disabling health conditions that likely require extensive medical treatment. Health insurance plays an integral role in ensuring that disabled individuals are able to pay for the care they need. Many individuals on SSD benefits are wondering if they get Medicare as part of their benefits. The answer is often yes, but the rules are complex.
The date your disability began and the date you were approved for SSD benefits both affect the date your Medicare coverage begins. Below, we break down how the Social Security Administration (SSA) determines when you become eligible for Medicare coverage.
Your Medicare eligibility date is based on the date your disability began.
You are eligible for Medicare beginning twenty-four months after the date your entitlement to SSDI benefits began, but there are additional rules to keep in mind. Your entitlement date is not the same as the date your disability began, as there is a five-month waiting period after your disability date before your entitlement begins. Furthermore, the waiting period does not begin until the first full month after the date you became disabled. In other words, your Medicare coverage really begins twenty-nine months after the first day of the first full month following your disability date.
For example, if SSA finds that you became disabled on March 15, 2025, then your five-month waiting period begins on April 1, 2025. This means your benefit payments will begin in September 2025. Your Medicare coverage will begin twenty-four months later, in September 2027.
Not everyone has to wait two years after they are approved
Getting approved for Social Security benefits takes a long time, and sometimes that results in your Medicare coverage beginning right when you are approved. The date your Medicare coverage begins is based on the date your disability began, not the date you are approved for benefits. When you are approved for benefits, SSA might find that you became disabled sometime in the past. This past date is called your “established onset date.” If your established onset date is far enough in the past, then your Medicare eligibility could start the same month you are approved. You might even receive retroactive Medicare coverage for months past.
For example, if SSA finds that you became disabled on September 15, 2022, then your five-month waiting period began on October 1, 2022, and your back benefits began accruing in March 2023. Your Medicare coverage should have started twenty-four months later, in March 2025. Therefore, if you are approved for SSDI in June 2025, then you are immediately eligible for Medicare coverage—and you can even receive three months of retroactive coverage going back to March 2025.
If you would like assistance with your Social Security Disability Insurance application or appeal, please contact one of Hawks Quindel S.C.’s experienced disability attorneys for a free consultation. We serve clients throughout the Midwest and are ready to help you secure the benefits you deserve.