SSDI and Other Disability Benefit Programs

Many people who get SSDI benefits also qualify for other disability benefits programs like Medicare. It’s important to understand how different programs interact, as benefits from one program may impact eligibility for another.

If you have questions about how programs interact with each other, talk to a benefits planner. You can also use the DB101 Benefits and Work Estimator for estimates on how working may impact your SSDI benefits and other benefits.

Medicare

Medicare and SSDI are linked. If you’ve been getting SSDI benefits for 24 months, you automatically qualify for Medicare. Because of the five-month waiting period when you first start SSDI, you actually have to wait 29 months from the time you meet the SSDI eligibility criteria (disability onset) to qualify for Medicare.

Learn more about Medicare in DB101's How Health Benefits Work article.

Example

Silvio became eligible for SSDI benefits on April 22, 2018, but he had to wait five months (May, June, July, August, and September) until he got his first payment. He was eligible for his first SSDI payment in October 2018, but because SSDI makes payments one month after they are due, he actually didn’t get his first payment until November 2018. He’ll have to wait another 24 months, until October 2020, to become eligible for Medicare.

While he’s waiting for his Medicare coverage to begin, Silvio should apply for health coverage on Healthcare.gov, where he might qualify for Medicaid. Once he becomes eligible for Medicare, Silvio can continue getting coverage via Medicare for at least 93 months (seven years, nine months) after his SSDI Trial Work Period ends.

Medicaid

Medicaid is Ohio’s Medicaid program. It helps pay for medical expenses for people with disabilities and others who qualify.

Remember that if you’re eligible for SSDI, you will eventually become eligible for Medicare (if you aren’t already on it). So you need to consider how Medicare and Medicaid interact when making decisions about your health care coverage.

Medicaid as a Bridge to Medicare

During the 29 months between the onset of your disability and your eligibility for Medicare, you may be able to get Medicaid coverage if your income is low enough.

Learn more about Medicaid in DB101's How Health Benefits Work article.

Medicaid Once You’re On Medicare

Once you’re on Medicare, you won’t qualify for Medicaid under income-based rules, unless you’re pregnant or caring for a child. However, since you’re on SSDI, you have a disability determination from Social Security – and may qualify for Supplemental Security Income (SSI).

If you get SSI benefits in addition to SSDI benefits, you automatically qualify for disability-based Medicaid. If you used to get SSI benefits, you may also get disability-based Medicaid if you qualify for SSI 1619(b), which gives Medicaid coverage to people who stop getting SSI benefits when their earned income goes up. If you do not get SSI benefits and do not qualify for 1619(b), you probably don't qualify for disability-based Medicaid, though there are some exceptions for people with severe mental illness.

If you get Medicaid coverage at the same time as Medicare, you automatically qualify for the Part D Low Income Subsidy, making your prescriptions very cheap. If you are in this situation, make sure to sign up for a Part D plan.

If you are getting SSDI and working, you may want to consider Medicaid Buy-In for Workers with Disabilities. It covers the same things as standard Medicaid and all you pay is a monthly premium and small copayments. Being on Medicaid Buy-In for Workers with Disabilities also automatically qualifies you for the Part D Low Income Subsidy.

If you have a lot of prescription drug costs, the Low Income Subsidy is a very important benefit. It could save you a lot of money each month in prescription drug costs.

Learn more about Medicaid in DB101's How Health Benefits Work article.

Supplemental Security Income (SSI)

Many people confuse SSI with SSDI. SSI stands for Supplemental Security Income; SSDI stands for Social Security Disability Insurance.

They’re both Social Security programs. You must pass the disability determination process from Social Security to qualify for either one.

SSI is a needs-based program. You can only qualify for SSI if your countable monthly income and total resources are below certain levels. SSDI, on the other on hand, is based on your work history. If you have worked and contributed enough money in Social Security taxes, you will qualify for SSDI (assuming you meet all other eligibility criteria).

There is nothing preventing you from being on both SSI and SSDI at the same time. However, if you are getting SSDI, the SSI program will consider your SSDI payments unearned income. This means that if your monthly SSDI benefits amount is $791 or more (the SSI countable income limit for a single person plus $20), you won't qualify for SSI benefits.

If your monthly SSDI benefits amount is less than $791 and you’re not getting income from any other source, you may qualify for SSI benefits. Typically, in this situation, you would get a total of $791 in benefits between the two programs. So if your SSDI payment was $300, your SSI benefits amount would be $491.

Section 301

Under Social Security’s Section 301 program, you can continue to get SSI or SSDI benefits even if you have medically recovered and your disability no longer meets Social Security’s disability standards.

Under Section 301, you can continue to get benefits as long as you are participating in an approved Vocational Rehabilitation (VR) program that is expected to help you become self-supporting. Note: You must have been participating in such a program before Social Security reviewed your medical situation and determined that you no longer had a disability.

Programs and providers that are usually approved for Section 301 include:

To find out if a specific provider or program is approved under Section 301, talk to a benefits planner or visit your local Social Security office. You can also call Social Security at 1-800-772-1213 or 1-800-325-0778 (TTY).