How Health Insurance Affects SSDI

How Social Security Disability Insurance (SSDI) and health insurance affect one another is one of the more confusing aspects of disability coverage. In general, SSDI provides benefits when you have lost income because of a qualifying disability. It is income replacement, not health care insurance, and it coordinates with Medicare and with private or employer health insurance.

Qualifying for Medicare Insurance Coverage is not Automatic

Medicare Part A is a hospital insurance plan and Part B is medical insurance. Part A is usually free for people with qualifying disabilities, but Part B costs a monthly premium. Medicare coverage is not automatic with SSDI benefits. To qualify for Medicare when you are younger than 65, you must fall within certain categories, such as:

  • Received SSDI benefits for the waiting period
  • Receive disability benefits for ALS/Lou Gehrig’s disease
  • Kidney dialysis or transplant patients with End-Stage Renal Disease (ESRD)

Medicare Waiting Period

Unfortunately, when you qualify for Medicare based on an SSDI-covered disability, your coverage does not start immediately. There is a 24 month waiting period. Each month that you receive Social Security disability benefits counts as one month toward this qualifying period. The months do not have to be all consecutive. Months of previous disability may be counted in certain situations, such as when the current disability is the same as or directly related to the previous one.

After receiving SSDI benefits for about 22 months, you should receive a Medicare package. Once you receive it you choose what coverage you need, including whether you want Medicare Part B, prescription drug coverage, or Medigap supplemental coverage.

How SSDI, Medicare, and the Health Insurance Marketplace Interact

Once you are eligible for Medicare, it is important to understand how SSDI and Medicare affect other health insurance plans:

  • New Marketplace enrollment: You cannot enroll in a private Health Insurance Marketplace plan to replace your Medicare plan or to supplement it.
  • Prior Marketplace enrollment: If you were already enrolled in a Marketplace plan before qualifying for Medicare, you can keep your plan, but you will likely lose your premium tax credits and savings.
  • Employer Insurance: If you have employer-provided insurance and qualify for Medicare, one plan will be your primary insurance and the other will be secondary.
  • Medicaid: If you are currently in the Medicare waiting period and do not have insurance, you may qualify for Medicaid if you meet the requirements. In certain cases, Medicaid coverage may even continue after you qualify for Medicare.
  • Waiting period coverage: If you are not eligible for Medicaid, you may qualify for a Marketplace plan for the duration of the Medicare qualifying period, possibly at a reduced rate.

Contact an Experienced Colorado SSDI Lawyer

Navigating Social Security Disability benefits, SSI, Medicare, Medicaid, and other insurance can become overwhelming, especially when your health is already suffering. At the Law Office of John A. Anderson, Jr., LLC, you can rely on our experienced attorney to guide you through the system and help you obtain the benefits to which you are entitled. Call our Brighton, Colorado office today at (303) 880-7994 or contact us online to schedule a free consultation.