SSDI and Other Disability Benefit Programs

Many people who are on SSDI benefits are also eligible for other disability benefits programs like Medicare or Medi-Cal. It’s important to understand how these different programs interact as benefits from one program may impact eligibility for another program.

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 Calculator 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 (2 years), you automatically qualify for Medicare Parts A, B, and D. Because of the 5-month waiting period when you first start SSDI, you actually have to wait 29 months (2 years and 5 months) from the time you’re found eligible for SSDI to become Medicare eligible.

Example

Silvio became eligible for SSDI benefits on April 22, 2011, but he had to wait 5 full months (May, June, July, August, and September) until he got his 1st payment. He was eligible for his 1st SSDI payment in October 2011, but because SSDI makes payments 1 month after they are due, he actually didn’t get his 1st payment until November 2011. He’ll have to wait another 24 months, until October 2013, to become eligible for Medicare.

While he’s waiting for his Medicare coverage to begin, Silvio might consider applying for Medi-Cal. Once he becomes eligible for Medicare, Silvio can continue getting coverage via Medicare for at least 93 months (7 years and 9 months) after his SSDI Trial Work Period ends.

Medicare Part A

Medicare Part A is that part of Medicare that helps pay for medical care you get while you are in the hospital. If you’re on SSDI, you won’t have to pay a premium for Medicare Part A, but there may be other expenses associated with it. For example, if you’re admitted to the hospital, you will have to pay a $1,364 deductible each benefit period before Part A will begin paying your hospital expenses. And if you’re in the hospital for more than 60 days, you may be charged $341 per day or more. For more information on Part A hospitalization costs, click here.

Medicare Part B

Medicare Part B is the medical portion of Medicare. If you choose to keep your Part B coverage, you'll have to pay a monthly premium for it. You may also have to pay an annual deductible of $185 and 20% coinsurance.

Unlike with Medicare Part A, SSDI beneficiaries are not exempt from paying a Part B premium. For most people, the Medicare Part B premium in 2019 is $135.50 per month or a bit less.

You may be able to get help paying your Part B premium if you qualify for a Medicare Savings Program or if you’re enrolled in Medi-Cal.

If you’re on SSDI benefits and have to pay a Medicare Part B premium, it will be automatically deducted from your monthly SSDI benefits amount.

Medicare Part D

Medicare Part D supplies prescription drug coverage. Like Medicare Parts A and B, the costs associated with Part D can be substantial.

For some Part D plans, you’ll have to pay a $415 annual deductible.

You may also have to pay for 25% of your drug costs until your total drug costs reach $3,820. At that point, you will be responsible for paying for paying 37% of the costs of your generic drugs and 25% of the cost of your brand-name drugs until the total cost of your prescriptions reaches $7,653.75 .

There are many different Part D plans that vary in the premiums they charge and the coverage they supply. You should pick a plan that works best for you.

Note: If you’re enrolled in Medi-Cal or Medi-Cal's Working Disabled Program and Medicare Parts A or B, you automatically qualify for the Medicare Part D Low Income Subsidy. This is a tremendous advantage—one that you should take advantage of.

With the Low Income Subsidy, all you have to pay for your medications is a copayment of $1.25 – $8.50 per prescription. You avoid the annual deductible and the other Part D expenses mentioned above.

To learn more, read the DB101 article on Medicare or talk to a Benefits Planner.

Medi-Cal

Medi-Cal is California’s Medicaid program. It helps pay for medical expenses for people with disabilities and others who qualify.

If your monthly SSDI cash benefits are more than $1,242 per month for a person, $1,682 for a couple, you may not qualify for Medi-Cal. If you’re working and you don’t qualify for Medi-Cal because of your combined work and SSDI income, you should consider the Working Disabled Program.

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

  1. Medicare Parts A and B are usually considered cost-effective by the state, which means Medi-Cal may pay your Part B premium for you. If you’re on SSDI benefits, you won’t have to pay a Medicare Part A premium.

  2. If you are eligible for Medi-Cal and Medicare, you will automatically be enrolled in Medicare Part D.

    You could decide to opt out of Part D, but that would be a mistake. By enrolling in Medi-Cal and Medicare Parts A or B, you automatically qualify for the Part D Low Income Subsidy, which means all you would pay for your prescription drugs is a copayment of $1.25 – $8.50 per prescription. If you decline Part D coverage, Medi-Cal will not supply you with prescription drug coverage.

    Bottom Line: If you're on both Medi-Cal and Medicare, enroll in Medicare Part D.

  3. If you are getting SSDI benefits and you are working, you may want to consider the Working Disabled Program. It covers the same things as Medi-Cal and all you pay is a monthly premium and small copayments.

    Being on the Working Disabled Program 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.

To learn more, read the DB101 articles about Medi-Cal and Medicare.

State Disability Insurance (SDI)

A SSDI beneficiary may qualify for other public benefits, such as California State Disability Insurance, a benefit that provides up to 12 months of help to people with disabilities who used to work.

If you get SDI and haven't yet applied for SSDI, you should do so as soon as possible -- don't wait for your SDI benefit to end. That way, you'll still have some income during the 1-6 months Social Security is making a decision on your disability claim.

SSDI benefits will be reduced if the combination of the SSDI benefit plus SDI or any other disability benerfit exceeds 80% of what SSA considers average current earnings. For more information about how SSA calculates this, see How Workers' Compensation And Other Disability Payments May Affect Your Benefits.

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 $951.72 or more (the maximum SSI benefit plus $20), you won't qualify for SSI benefits.

If your monthly SSDI benefits amount is less than $951.72 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 $951.72 in benefits between the 2 programs. So if your SSDI payment was $300, your SSI benefits amount would be $651.72.

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 no longer meet Social Security’s criteria for being disabled.

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.

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).