Does Social Security Disability Include Health Insurance?

If you cannot work because of a disability or chronic illness, the benefits provided by federal programs like Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) can make a huge difference. In addition to monthly benefit checks, SSDI and SSI provide health insurance coverage. In some cases, recipients must complete additional requirements and applications to obtain healthcare coverage but the end result is free or low-cost insurance for you and potentially your family. 

In this article, you’ll learn how health insurance — Medicare and Medicaid — works for SSDI and SSI recipients.

What insurance do you get with Social Security?

Social Security Disability Insurance and Supplemental Security Income include free or low-cost health insurance coverage. SSDI provides Medicare, while SSI recipients receive Medicaid coverage.

How Medicare works 

Medicare is a type of federal health insurance that covers people who are 65 or older or who qualify for SSDI. The parts of Medicare include: 

Medicare Part A

This hospital insurance covers inpatient hospital care, skilled nursing facility care, hospice care, home health care, and medical care, including lab tests and surgery. Typically, Medicare Part A comes at no additional cost to SSDI recipients, so long as you paid Medicare taxes when you worked. (Most people who qualify for SSDI have paid Medicare taxes.) 

Medicare Part B

This medical insurance covers outpatient care, health care provider’s services, preventative services, medical equipment, and home health care.  Expect to pay monthly premiums for Medicare Part B, which are automatically deducted from your benefits checks. 

Medicare Part C

Medicare Part C, also known as Medicare Advantage, offers Medicare Part A and Part B to individuals through private insurance companies. As part of this plan, beneficiaries can get additional benefits, like prescription drug coverage.

Medicare Part D

Medicare Part D offers coverage for prescription drugs through private insurance companies. Medicare categorizes prescriptions into different tiers, and each tier determines the cost of prescriptions for the beneficiary. 

Medicare premiums and deductibles in 2023

How Medicaid Works

Medicaid is a joint federal and state insurance program administered at the state level that offers coverage for low-income recipients at no cost. Medicaid eligibility and benefits vary from state to state. Typically, Medicaid covers doctor’s visits, preventative care, hospital care, prescription drugs, and rehabilitative services. 

How to get health insurance on SSDI

SSDI benefits include Medicare coverage but most people have to go through a 24-month waiting period before they can actually receive Medicare coverage. This waiting period may be shorter for people with amyotrophic lateral sclerosis (ALS), end-stage renal disease, or a condition on the compassionate allowance list.

Can you get Medicaid on SSDI?

During the 24-month waiting period, you can apply for Medicaid coverage by applying through healthcare.gov or directly to your state Medicaid agency.

Can you get private health insurance?

If you receive a denial for Medicaid or need healthcare coverage before your SSDI Medicare plan begins, you might be able to enroll in a private health plan in the interim.

For additional help, Atticus also has a list of resources that offer free or low-cost help with housing, food, and legal assistance.

How to get health insurance on SSI

In most states, SSI recipients are automatically eligible for Medicaid. In those states, your SSI application doubles as your Medicaid application, and getting approved means you’ll receive both types of benefits. However, some states require SSI beneficiaries to file a separate application with the state Medicaid agency. The state might be non-restrictive and follow the same eligibility criteria as SSI, or it might be more restrictive and require more criteria.

Medicaid enrollment and eligibility for SSI recipients

Health insurance on long-term disability

If you have a private long-term disability plan (which lasts for two years or more), your best option is to get private health insurance. But you generally need to pay for all of your health insurance. Medicaid may also be an option if your income is below a certain threshold, but you’ll need to apply through your state.

SSDI could also be an option if you’re on a long-term disability plan. Your private plan may require you to apply for SSDI if your medical condition will keep you out of work for more than one year. 

SSDI coverage includes monthly benefit checks and Medicare coverage, but you’ll need to submit an application and have medical records proving to the SSA that your condition will last at least one year. If your condition improves and you return to work, your Medicare coverage will stop. 

Health insurance on short-term disability

The main option if you’re receiving private short-term disability benefits is a private health insurance plan. If your disability plan is through your employer, you may qualify to stay on their insurance while you recover. Otherwise, you will have to pay for health insurance yourself. 

Five states also offer short-term disability for up to six months or a year: California, Hawaii, New Jersey, New York, and Rhode Island. Unfortunately, these state benefits do not include health insurance. 

You may qualify for Medicaid if your income is below a certain level or if you’re age 65 or older. If you get injured or sick at work and need to miss work, you could also qualify for workers’ comp, which offers wage replacement and medical coverage.

If you remain unable to work for at least a full year because of your medical condition, applying for SSI or SSDI is your best option. SSDI is available if you’ve worked and paid taxes for at least 10 years, while SSI is designed for low-income recipients who haven’t worked much or at all.

Learn more about whether SSI or SSDI is a better fit for you.

How to apply for SSDI or SSI

Whether you’re applying for SSDI or SSI (or both at the same time), you’ll start by filling out Form SSA-16, which asks for more information about your work history and daily functioning. You can submit this form online, over the phone, or in person.

The Social Security Administration rejects most initial applications for disability benefits. If this happens to you, don’t get discouraged! It is your right to appeal the decision — and you should. If you get rejected a second time, your case will move to a hearing in front of a judge. Hearings offer the best chance of approval and applicants get approved for benefits in more than half of all hearings. But it’s extremely helpful to have a lawyer who can help you prepare for the hearing. Applicants with lawyers are three times more likely to win benefits.

How to get help applying for benefits

No matter what stage you are at in the application process, Atticus can help. We have experience helping applicants with their initial SSDI and SSI applications and all types of appeals. We can also connect you with a high-quality disability lawyer who will treat your case as a priority so you can get the benefits and health insurance coverage you deserve. Get started by taking our short disability benefits quiz for professional help.

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Related resources:

Resources for People With Disabilities: Housing, Healthcare, Legal Help and More

By Sydney Hershenhorn

A Guide to Medicaid and Medicare for People With a Disability

By Jackie Jakab