You pay Medicare premiums on SSDI, but the amount depends on your income

If you receive Social Security Disability Insurance (SSDI), you are enrolled in Medicare automatically after you have been on SSDI for 24 months. You do have to pay for Medicare — it is not free — but what you pay depends on your income and which parts of Medicare you use.

Most people on SSDI pay a monthly premium for Part B (doctor visits and outpatient care). Some also pay for Part D (prescription drugs). Part A (hospital care) has no monthly premium for almost everyone on SSDI. The exact amount you pay is deducted directly from your SSDI check each month, so you do not have to remember to send a payment.

If your income is very low, you may be able to reduce or eliminate your Part B premium through a program called Medicaid. Each state runs its own Medicaid program, and the rules vary by where you live.

Key Takeaways

  • You automatically enroll in Medicare after 24 months on SSDI, and premiums are taken directly from your SSDI payment each month.
  • Part B premiums in 2024 are $174.70 per month for most people, but the amount changes each year based on national averages.
  • If your income is below a certain level, your state's Medicaid program may pay your Part B premium for you through a program called may have access to Medicare Beneficiary (QMB).
  • You can choose not to enroll in Part D when you first become may be able to access, but waiting to sign up later may result in a permanent penalty on your premium.
  • Your SSDI payment is reduced by the Medicare premium amount, so your actual monthly SSDI check will be smaller than your benefit amount.

How much you pay for Part B

The standard Part B premium changes every year. In 2024, most people pay $174.70 per month. However, if your income is higher, you pay an additional amount called an Income-Related Monthly Adjustment Amount (IRMAA). This means higher-income beneficiaries can pay $244.60, $314.50, $384.40, or $454.30 per month depending on their income level.

Your income is measured using your Modified Adjusted Gross Income (MAGI) from two years before. So in 2024, Medicare looks at your 2022 income. If your income changes significantly — for example, you get a job or receive an inheritance — your premium may change the following year.

If you think your income has dropped since Medicare calculated your premium, you can request a life-changing event appeal. This allows Medicare to recalculate your IRMAA based on your current income instead of the two-year-old figure. You have 60 days from the date on your IRMAA notice to request this appeal.

Part D prescription drug coverage and late enrollment penalties

Part D is optional, but the timing of when you sign up matters. If you do not enroll in Part D when you first become may be able to access (which is when you turn 65 or when you have been on SSDI for 24 months, whichever comes later), you may owe a late enrollment penalty for as long as you have Part D coverage.

The penalty is calculated as 1% of the national average Part D premium for each month you were may be able to access but not enrolled. In 2024, the national average premium is around $34.40, so the penalty could be roughly $0.34 per month for each month you delayed. This penalty is added to your premium permanently and does not go away if you enroll later.

If you have coverage through an employer or union that is at least as good as Part D, you do not have to enroll right away. You can enroll later without penalty as long as you stay covered. You will need a letter from your employer or union plan stating that your coverage is creditable (meaning it is at least as good as Part D).

Using Medicaid to reduce or eliminate your Medicare premium

If your income and resources are low enough, your state's Medicaid program may pay your Part B premium for you. This program is called may have access to Medicare Beneficiary (QMB). To be may be able to access, your income must be between 100% and 120% of the federal poverty level, and your resources (savings, investments, property other than your home) must be below $8,550 for an individual or $12,830 for a couple in 2024.

The income and resource limits vary by state, so you need to contact your state Medicaid office to find out the exact numbers where you live. You can find your state Medicaid office through the Centers for Medicare & Medicaid Services (CMS) website or by calling 1-800-MEDICARE.

If you are approved for QMB, Medicaid pays your Part B premium directly to Medicare. You may also receive help with Part A and Part B deductibles and coinsurance. Some states also offer a program called Specified Low-Income Medicare Beneficiary (SLMB), which helps pay Part B premiums for people with slightly higher income (between 120% and 135% of poverty level).

What happens if you cannot afford your premium

If you cannot pay your Part B premium, Medicare will not automatically drop your coverage. However, if your premium goes unpaid for three months, Medicare will send you a notice. If the premium remains unpaid for a total of six months, your Part B coverage will end on the last day of that month.

If your coverage ends, you can re-enroll during the General Enrollment Period (January 1 through March 31 each year), but you will owe a permanent penalty of 10% of the standard Part B premium for each full year you were not enrolled. This penalty is added to your premium for life.

Before your coverage ends, contact Medicare or your state's Health Insurance Counseling and Advocacy Program (HICAP) to discuss your options. Some people are able to work out payment plans or find additional information programs. You can also ask about whether you may have access to for QMB or SLMB if you have not already applied.

How your SSDI check is affected by Medicare premiums

When you enroll in Medicare, your monthly SSDI payment is reduced by the amount of your Part B premium. For example, if your SSDI benefit is $1,200 and your Part B premium is $174.70, you will receive $1,025.30 in your bank account each month. The $174.70 goes directly to Medicare.

If you also enroll in Part D, the premium for that plan is added to your Part B premium and deducted from your SSDI check. Part D premiums vary by plan and by state, ranging from about $7 to $100 per month depending on which plan you choose.

You can see the exact amount being deducted from your SSDI check on your benefit statement. You can view your statement online through your my Social Security account at ssa.gov, or you can call Social Security at 1-800-772-1213 to ask what your net payment will be after Medicare premiums.

What to ask your doctor and Social Security

When you are first notified that you will be enrolled in Medicare, contact Social Security to confirm your enrollment date and ask what your net SSDI payment will be after Medicare premiums are deducted. Ask whether you should explore for QMB or SLMB based on your income.

If your income changes — for example, you start working or receive a one-time payment — contact Medicare to report the change. Ask whether your IRMAA will be recalculated and whether you can request a life-changing event appeal.

If you are prescribed new medications, ask your doctor whether the drugs are covered under your Part D plan. If they are not, ask whether there is a similar drug that is covered, or whether your doctor can request an exception from your insurance company.

Frequently Asked Questions

Do I have to take Medicare when I become may be able to access on SSDI?

You are automatically enrolled in Medicare Part A and Part B after 24 months on SSDI. You cannot refuse Part A, but you can decline Part B if you have other health insurance through an employer or union. If you decline Part B, you may owe a permanent penalty if you enroll later.

What if I am still working while on SSDI — do I still pay Medicare premiums?

Yes. Once you are enrolled in Medicare, you pay premiums regardless of whether you are working. However, if you are working and your income is high enough, you may may have access to for a life-changing event appeal to recalculate your IRMAA based on your current income rather than the two-year-old figure.

Can I switch Part D plans if my premium is too high?

Yes. You can change Part D plans during the Annual Enrollment Period (October 15 through December 7 each year) without penalty. You can also change plans if you have a may have access to life event, such as a major drop in income. Contact Medicare at 1-800-MEDICARE to learn about plans available in your area.

What if my SSDI check is so small that the Medicare premium takes most of it?

If your SSDI benefit is very low, you may be able to reduce your Part B premium through QMB or SLMB. You can also request a life-changing event appeal if your income has dropped. Contact your state Medicaid office or call 1-800-MEDICARE to find out what programs you may be able to use.

Will my Medicare premium go down if my SSDI benefit goes down?

Your Part B premium is based on your income from two years ago, not on your current SSDI benefit amount. If your income has dropped, you can request a life-changing event appeal to have your IRMAA recalculated. You have 60 days from the date on your IRMAA notice to request this appeal.