Health Care and Services
Medicare for People on Disability
When Do You Get Medicare on Disability, and What Does It Cost?
Medicare for disability starts automatically after you've received Social Security disability benefits for 24 months, with Part A (hospital) and Part B (medical) coverage. People with ALS get Medicare as soon as disability benefits start, and people with End-Stage Renal Disease can qualify at any age. In 2026 most people pay no Part A premium, and the standard Part B premium is $202.90 a month. If money is tight, your state's Medicare Savings Programs and Extra Help can cover premiums and drug costs.
When Medicare for Disability Starts
If you get Social Security Disability Insurance (SSDI), you don’t have to apply for Medicare separately. Your disability application also counts as your Medicare application. After you’ve received disability benefits for 24 months, you’re enrolled in Part A (hospital insurance) and Part B (medical insurance) automatically. Medicare mails you a welcome package with your Medicare card.
The 24 months are months of disability benefits, not months since you became disabled. SSDI itself has a 5-month waiting period: benefits start in the sixth full month after your disability began. So the Medicare clock starts only once that wait is over. The disability back pay guide explains how SSA sets the month your benefits start.
Medicare for disability is tied to Social Security benefits, not SSI. People who get only SSI usually get health coverage through Medicaid instead. The SSDI guide covers who qualifies for SSDI and how payments work.
Exceptions to the 24-Month Wait: ALS and ESRD
Two conditions skip the usual wait.
ALS (Lou Gehrig’s disease). With ALS, Medicare generally starts the first month you’re eligible for disability benefits. There’s no 24-month wait, and since July 23, 2020, approved ALS claims also skip SSDI’s 5-month waiting period. The neurological disorders page explains how SSA evaluates ALS.
End-Stage Renal Disease (ESRD). Permanent kidney failure is a separate route to Medicare, open at any age if you have enough work history or qualify as a spouse or child. For dialysis, coverage usually starts on the first day of the fourth month of treatment, or earlier if you train for home dialysis. For a kidney transplant, it can start the month you’re admitted to the hospital. ESRD coverage can be retroactive for up to 12 months. Kidney conditions in SSA’s listings are on the genitourinary disorders page.
| Your situation | When Medicare usually starts |
|---|---|
| SSDI for a condition other than ALS or ESRD | After 24 months of disability benefits |
| ALS | First month you’re eligible for disability benefits |
| ESRD, dialysis | First day of the fourth month of dialysis (earlier with home dialysis training) |
| ESRD, kidney transplant | As early as the month of hospital admission |
| SSI only | No Medicare from SSI alone; Medicaid in most states |
What Medicare Costs in 2026
Medicare isn’t free, but most people on disability pay no premium for Part A because they or a spouse paid Medicare taxes long enough while working.
| Medicare cost | 2026 amount |
|---|---|
| Part A premium | $0 for most people; $311 or $565 a month without enough work history |
| Part A hospital deductible | $1,736 per benefit period |
| Hospital days 61 to 90 | $434 a day |
| Hospital days 91 to 150 (lifetime reserve days) | $868 a day |
| Part B standard premium | $202.90 a month |
| Part B deductible | $283 a year |
| Part B services after the deductible | usually 20% of the Medicare-approved cost |
The standard Part B premium is higher for incomes above $109,000 for a single filer or $218,000 for a joint return. For a single sheet of every 2026 amount, see disability benefit amounts for 2026.
Enrolling and Choosing Your Coverage
Part A and Part B. Enrollment is automatic after the 24 months. Because Part B has a premium, you can decide whether to keep it. Think carefully before dropping it. If you sign up later and don’t qualify for a Special Enrollment Period, Medicare adds a late enrollment penalty of 10% for each full 12-month period you could have had Part B. Medicare’s own 2026 example: waiting 2 full years means a 20% penalty, so the premium becomes $243.50 a month instead of $202.90.
If you live in Puerto Rico or abroad. Part A is automatic, but you must sign up for Part B yourself. Your welcome package explains how.
Part D drug coverage. Part D isn’t automatic. You sign up for Part A and Part B through Social Security, and you pick a Part D plan on Medicare.gov. Each year you can join or switch plans between October 15 and December 7, and the new coverage starts January 1.
Where to get help. Your State Health Insurance Assistance Program (SHIP) or Medicaid office can answer questions about state help with Medicare costs. For your own record, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or visit an office using the Social Security office finder.
Help Paying Medicare Costs
If your income and savings are limited, two kinds of help can lower what you pay.
Medicare Savings Programs. States run four programs that pay some or all of your Medicare costs. Here are the federal limits for 2026:
| Program | What it pays | Monthly income limit (single / married) | Resource limit (single / married) |
|---|---|---|---|
| Qualified Medicare Beneficiary (QMB) | Part A and B premiums, deductibles, coinsurance and copays | $1,350 / $1,824 | $9,950 / $14,910 |
| Specified Low-Income Medicare Beneficiary (SLMB) | Part B premiums | $1,616 / $2,184 | $9,950 / $14,910 |
| Qualifying Individual (QI) | Part B premiums | $1,816 / $2,455 | $9,950 / $14,910 |
| Qualified Disabled and Working Individual (QDWI) | Part A premiums | $5,405 / $7,299 | $4,000 / $6,000 |
Income limits are slightly higher in Alaska and Hawaii. Medicare says you may qualify even if your income or resources are above these limits, because some states don’t count certain income or resources. If you’re in QMB, Medicare providers aren’t allowed to bill you for Medicare-covered services. For QI, you must apply every year to stay in the program, and it’s only for people who don’t qualify for other Medicaid. To apply, contact your state Medicaid office; your state page names it.
Extra Help with drug costs. Extra Help lowers Part D premiums, deductibles and copays. If you qualify for a Medicare Savings Program, you get Extra Help too, and in 2026 you pay no more than $12.65 for each covered drug. If you get SSI and have Medicare, you qualify for Extra Help without a separate application. Everyone else can apply with Social Security online or by phone, any time before or after joining a Part D plan. Before you start, gather bank statements and tax returns, any IRA or 401(k) balances, and statements for pensions, veterans’ benefits, annuities or Railroad Retirement benefits, for you and your spouse.
Medicaid. If you get SSI and Medicaid and also qualify for Medicare, your state pays your Medicare premiums. The Medicaid for people with disabilities guide explains how to qualify, including workers’ buy-in programs.
Keeping Medicare When You Go Back to Work
Going back to work doesn’t mean losing Medicare right away.
The trial work period. SSDI gives you 9 months, within a 60-month window, to test your ability to work while keeping full benefits. In 2026, any month you earn more than $1,210 before taxes counts as one of those months.
The extended period of eligibility. When the trial work period ends, a 36-month re-entitlement period begins. SSA pays your benefit for any month your earnings fall below the substantial gainful activity level, and the first time you earn above it, SSA still pays that month and the next 2. If your earnings drop again within the 36 months, SSA can restart your checks without a new application.
Extended Medicare coverage. After the trial work period ends, most people who keep working keep Medicare for at least 93 more months, which is 7 years and 9 months. That includes premium-free Part A, and Part B and Part D if you’re enrolled. It applies even if your cash benefits stop because you earn above $1,690 a month, the 2026 substantial gainful activity level, as long as you still have a disabling condition.
Buying Medicare after that. When extended coverage ends because of work, you can keep Medicare by paying for it, if you’re under 65 and still have a disability:
- Part A costs $565 a month in 2026 if you have fewer than 30 quarters of coverage. You may get a 45% reduction with 30 or more quarters, or through a current, deceased or former spouse with 30 or more quarters.
- Part B costs $202.90 a month in 2026, or more with a higher income. You can buy Part A alone, but you can’t buy Part B without Part A.
- Your state may pay the Part A premium through the QDWI program if your income and resources are limited and you don’t qualify for Medicaid.
You can sign up in the month you’re told your premium-free coverage is ending and the 7 months after it, during the general enrollment period from January 1 through March 31, or at any time while you’re working and covered by an employer group health plan.
The full set of work rules, including Ticket to Work, is in working while on disability. Your state’s vocational rehabilitation agency can help you plan a return to work, and an ABLE account lets you save up to $100,000 without it counting against SSI. Not sure whether you qualify for SSDI at all? Start with the disability eligibility screener or how to apply for disability benefits.
Frequently Asked Questions
Do I Have to Sign Up for Medicare if I Get SSDI?
No. If you get Social Security disability benefits, you're enrolled in Part A and Part B automatically after 24 months, and Medicare mails you a welcome package with your card. If you live in Puerto Rico or outside the U.S., Part A is automatic but you must sign up for Part B.
Can I Turn Down Part B?
Yes. Because Part B has a monthly premium, you can choose whether to keep it. Medicare warns that if you drop it without other qualifying coverage and sign up later, you may pay a late enrollment penalty of 10% of the premium for each full 12-month period you could have had Part B.
Does SSI Give Me Medicare?
Not by itself. SSA says Medicare is linked to Social Security benefits, while Medicaid is linked to SSI in most states. You can have both. If you get SSI and Medicaid and also qualify for Medicare, your state pays your Medicare premiums. See the SSI guide.
Is Part D Drug Coverage Automatic?
No. You sign up for Part A and Part B through Social Security, and you choose and join a Part D drug plan through Medicare.gov. Each year you can join or change plans from October 15 through December 7, with coverage starting January 1.
Can I Apply for Extra Help Before I Join a Part D Plan?
Yes. SSA says you can apply for Extra Help any time before or after you enroll in Part D, online or by calling 1-800-772-1213. Have bank statements, tax returns, retirement account balances and pension or veterans' benefit statements ready.
Where Can I Get Help With Medicare Questions?
SSA points people with questions about state help with Medicare costs to their local State Health Insurance Assistance Program (SHIP) or Medicaid office. For questions about your own Medicare enrollment, call Social Security at 1-800-772-1213. Family caregivers looking for paid care programs can start with the paid family caregivers guide.
More on Health Care and Services
- MedicaidHow people with disabilities qualify for Medicaid: SSI links, working-disabled buy-in and home and community waivers
- ABLE AccountsABLE accounts: eligibility (including the 2026 age change), contribution limits and SSI and Medicaid rules
- Vocational RehabilitationState vocational rehabilitation agencies: who qualifies, services and how to apply
- SSDIHow Social Security Disability Insurance works: work credits, the disability test, the waiting period, amounts and Medicare
- SSIHow Supplemental Security Income works: income and resource limits, the 2026 federal payment, state supplements and Medicaid
- SSDI vs SSIThe differences between SSDI and SSI, side by side, and when you can get both
This guide explains official rules in plain language. It isn't legal advice, and only the agency that runs a program can decide your case.