Medicare as a Result of SSDI Benefits

Skilled Social Security Attorneys Serving the Boston Region

Medicare is the national health insurance program administered by the federal government. It is generally only available to individuals 65 or older. In certain circumstances, however, persons younger than 65 can receive Medicare coverage, such as those who receive Social Security benefits because they are disabled. The lawyers of Kantrovitz & Associates have more than 20 years of experience representing Social Security beneficiaries in Boston as well as other areas of Massachusetts, New Hampshire, and Rhode Island. As seasoned Social Security advocates, we have developed the skills required to navigate complex cases, appeals, and the intersection of Social Security benefits with other government programs, such as Medicare.

Pursuing Medicare Coverage as a Social Security Disability Beneficiary

A 20-year-old worker has a 25 percent chance of becoming disabled before retirement age. This means that obtaining health insurance while not working is an option that many Massachusetts residents will need to explore. If you get Social Security disability benefits, you automatically become eligible for Medicare coverage after two years of receiving benefits. The Social Security Administration (SSA) will contact you a few months before you are eligible to receive Medicare and provide further enrollment information.

Medicare itself has four parts, each of which provides a different component of health care coverage. Part C is a managed care substitute for Parts A and B, so it is not discussed here. Here are the three main parts of Medicare to know:

  • Part A: inpatient care at a hospital or skilled nursing center, including hospital stays, surgery, and rehabilitation services
  • Part B: physician and other medical services and supplies, including doctor visits, tests, and durable medical equipment, such as walkers
  • Part D: prescription drug coverage

If you have received Social Security disability benefits for two years, you are automatically eligible for Part A. If you are eligible for Part A, you are also eligible for Parts B and D. However, Parts B and D require the payment of additional monthly premiums. You also should know that Part B coverage does not begin until a patient meets his or her deductible ($147 in 2014), after which Medicare covers 80 percent of approved services.

If you are eligible for Medicare but have a low income or limited resources, you may be eligible for assistance from your state to help pay premiums for Medicare Parts B and D or to meet health care needs that are not covered by Medicare. In Massachusetts, for example, you may be eligible to enroll in MassHealth Standard if you are eligible for Medicare and also have limited income and few assets. MassHealth Standard is a comprehensive, state-run plan that provides hospital, medical, and prescription drug coverage for low-income and disabled persons. In certain circumstances, this state program will pay all Medicare premiums and provide additional benefits. Similar programs are available in other states, such as New Hampshire and Rhode Island. A variety of options may lie open to you, so you should take the time to discuss them with a knowledgeable attorney.

Consult Experienced Massachusetts Lawyers for Government Benefits Advice

If you have questions about your government benefits or eligibility for Medicare, the Massachusetts attorneys at Kantrovitz & Associates can help. We serve beneficiaries in Middlesex, Essex, Plymouth, Norfolk, and Suffolk Counties, as well as the Merrimack River area. Start a conversation with us by calling toll-free at 1-800-367-0871 or emailing us via the contact form on this site to set up a free consultation.