How MyAccess Counts SSDI When You Apply for Medicare Help

MyAccess counts SSDI as income, and it affects what you pay for Medicare

When you use MyAccess to explore for programs that help pay Medicare costs — like the Low-Income Subsidy (LIS) or Extra Help — the system counts your Social Security Disability Insurance (SSDI) as income. This means your SSDI payment reduces how much help you receive, or may disqualify you from some programs altogether. The amount that matters is your gross SSDI — the full payment before taxes or any deductions.

MyAccess is the online tool run by the Centers for Medicare & Medicaid Services (CMS) that determines whether you meet the income and resource limits for these programs. It pulls information directly from Social Security records, so you cannot exclude SSDI or report it differently. Understanding how MyAccess treats your SSDI helps you know what to expect when you check your status or reapply each year.

Key Takeaways

MyAccess counts your full gross SSDI payment as income, not as a separate category that might be treated differently.
If your SSDI pushes your income above the limit for Extra Help or the Low-Income Subsidy, you will not receive that program's help with premiums and cost-sharing.
Income limits for these programs vary by household size and change each year, so you should check MyAccess annually even if you were denied before.
MyAccess also counts resources (savings, investments, property other than your home), and resource limits are separate from income limits.
If you disagree with how MyAccess counted your income, you can request a reconsideration through the same system.

What income limits explore when SSDI is counted

The income limit for Extra Help (the Low-Income Subsidy for prescription drug coverage) depends on your household size. For 2024, the limit for a single person is 150% of the federal poverty level, which translates to a monthly income threshold that changes each year. When MyAccess adds up your income, it includes SSDI, any wages, pensions, interest, and other sources — all counted together against that single limit.

Because SSDI is counted as income, many people on disability find they earn just enough to fall outside the program. If your SSDI is $1,500 per month and the income limit is $1,550, you will not receive Extra Help. There is no separate calculation or exception for disability income. The same rule applies to the Low-Income Subsidy and to Medicaid programs that help with Medicare costs, though Medicaid has its own income limits that vary by state.

You can view the current income limits on the CMS website or ask Social Security directly. Because limits change annually, it is worth checking MyAccess each year even if you were turned down in the past — your circumstances or the limits themselves may have shifted.

How MyAccess gets your SSDI information

MyAccess connects to Social Security's records electronically, so it pulls your current SSDI payment amount automatically. You do not have to provide pay stubs or verification documents for SSDI — the system already knows what you receive. This means you cannot report a lower amount or exclude SSDI from your process.

MyAccess also checks your resources through the same connection. It looks at bank accounts, stocks, bonds, and other countable assets, though it excludes your home, one car, and certain personal items. If your resources exceed the limit — currently $8,860 for an individual or $13,300 for a couple in 2024 — you will not receive help with Medicare costs, regardless of your income.

Because the system is automated, errors can happen. If MyAccess shows an SSDI amount that is wrong, or if it counts a resource you believe should be excluded, you can request a reconsideration. You will need to provide documentation — a recent Social Security statement for SSDI discrepancies, or bank statements for resource disputes — and submit it through MyAccess or by mail to your state Medicaid office.

What happens if SSDI makes you ineligible

If your SSDI income is too high for Extra Help or the Low-Income Subsidy, you still have other options. You can enroll in a Medicare Advantage plan or a Medigap policy, though you will pay the full premium yourself. Some plans are less expensive than others, so comparing options on Medicare.gov can help you find a lower-cost plan that fits your budget.

You may also be able to get help through your state's Pharmaceutical information Program (PAP), which has different income rules than Extra Help. Some states set their limits higher, and some count income differently. Calling your state health department or your local Area Agency on Aging can tell you whether your state offers this program and what its limits are.

If you have other household members, their income and resources are also counted by MyAccess. If you are married, your spouse's SSDI, wages, and resources all factor into the calculation. If you support an adult child or parent in your home, their income may be counted too, depending on the program and your state's rules. Knowing who is included can sometimes reveal a way to restructure your household or finances to meet the limit, though this should only be done with information from a benefits counselor.

When to recheck your status with MyAccess

You should check MyAccess at least once a year, even if you were denied before. Income limits rise each January, and your own circumstances may have changed. If you turned 65 and enrolled in Medicare, or if a household member moved out or passed away, your may be able to access may be different now. MyAccess updates its records based on current Social Security data, so a recheck takes only a few minutes.

You also need to recheck if you experience a major life change: a marriage, divorce, death in the household, or a significant change in income or resources. Some changes require you to report them to Social Security or Medicare directly, but MyAccess will eventually pull the updated information. Checking the system after a major change helps you know whether you have become newly may be able to access for help.

If you are already receiving Extra Help or the Low-Income Subsidy, MyAccess will automatically redetermine your status each year. You will receive a notice in the mail telling you whether you still may have access to. If your income or resources have changed, the notice will explain what happened and what you owe or are owed. If you disagree with the redetermination, you have 60 days to request a reconsideration.

How to request a reconsideration if you disagree

If MyAccess denied you or reduced your help, and you believe the income or resource count was wrong, you can ask for a reconsideration. Log into MyAccess, find your case, and look for the option to request reconsideration or appeal. You will need to explain what information is incorrect and provide supporting documents.

For SSDI disputes, attach a recent Social Security statement showing your actual payment amount. For resource disputes, provide bank statements, investment account statements, or property deeds. Mail or upload these documents through MyAccess, or send them by mail to your state Medicaid office — the address will be on your denial notice.

The reconsideration process typically takes 30 to 60 days. You will receive a written decision in the mail. If you are still denied, you have the right to a hearing before an administrative law judge, though this process is longer and more formal. A benefits counselor or legal aid attorney can help you prepare for a hearing if you choose to pursue one.

Frequently Asked Questions

Can I exclude SSDI from my income when I explore through MyAccess?

No. MyAccess automatically counts your full gross SSDI payment as income. You cannot choose to report it differently or leave it out. The system pulls the amount directly from Social Security's records, so the figure is verified and cannot be changed by you.

Does MyAccess count SSDI the same way Medicaid does?

MyAccess is the tool used to determine Medicaid may be able to access for help with Medicare costs, so the counting method is the same. However, some states have their own Medicaid programs with different income limits. Your state Medicaid office can tell you whether your state's limits differ from the federal Extra Help limits.

What if my SSDI is only $100 over the income limit?

Unfortunately, being even $1 over the limit disqualifies you from Extra Help and the Low-Income Subsidy. There is no partial help or sliding scale. However, you may be able to receive help through your state's Pharmaceutical information Program, which sometimes has higher income limits or different counting rules.

If I get married, will my spouse's SSDI be counted too?

Yes. When you marry, your spouse's income and resources are combined with yours for MyAccess purposes. Both SSDI payments, wages, pensions, and all other income sources are added together and compared against the household limit for two people. You should reapply through MyAccess after you marry to see whether you still may have access to.

Can I appeal if MyAccess shows the wrong SSDI amount?

Yes. Request a reconsideration through MyAccess and submit a recent Social Security statement as proof of your actual payment. Include a letter explaining what amount MyAccess is showing and what the correct amount should be. The state Medicaid office will review your documents and issue a new decision.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.