347 N. Pottstown Pike, Suite 200 | Exton, PA 19341

Roadmap to Medicare SSDI

Customized Roadmap Report

Click on the image to download your 1 page Roadmap

Enrolling in Medicare

You will be automatically enrolled in Medicare Parts A and B effective after 24 months of SSDI.

Since you are collecting SSDI (Income), you are required to keep your Medicare Part A.  You will have the option to keep or return your Medicare Part B.  In your circumstances, it is advised that you Keep Part B.

To avoid potential gaps in coverage, penalties, and/or deadlines, you may want to...

You will automatically be enrolled in both Medicare Parts A and B.  Simply, do nothing to keep Medicare Part B.

Your Roadmap is based on…

  • You are under age 65, but qualifying for Medicare due to SSDI
  • You have Individual Health Insurance or you do/will not have any other coverage

Do I need Medicare to have full coverage?

Yes.  Medicare will become your Primary Insurance once you are eligible.  

Medicare “Who Pays First” Law states that Medicare is your primary insurance when you are on Medicare due to SSDI you have individual coverage or you are coming off your group coverage.

Will I receive a penalty if I don’t enroll now?

Yes.  Assuming you do not have creditable large group coverage.

Part A: Is required since you are collecting SSDI.

Part B: You will receive a Part B Late Enrollment Penalty if you do not have Creditable Coverage.

  • Creditable Coverage is group health insurance coverage while the Primary Insured is actively working for the employer providing the Group Health Plan.
    • Severance, COBRA and/or Retiree Plans are not creditable for avoiding the penalty.
    • Those who have Medicare based on disability can enroll later under an SEP if they, their spouse, or their family member is working, and have coverage by an employer or union GHP (with at least 100 employees – also known as a Large GHP) based on that employment.  For reference, see heading titled Enrolling with a Special Enrollment Period.

A 10% penalty added for every 12 months you go without Creditable Coverage. Months need not be consecutive. See Details on how the penalty is calculated.

  • The penalty will be assessed on the Base Medicare Premium ($144.60/month in 2020) for as long as you are enrolled in Medicare.

Part D: You will receive a Part D Late Enrollment Penalty if you do not have Creditable Prescription Coverage.

  • Creditable Prescription Coverage is drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

A 1% penalty added for every 1 month you go without Creditable Prescription Coverage. Months need not be consecutive.

  • The penalty will be assessed on the Average Medicare Part D Premium ($32.74/month in 2020) for as long as you are enrolled in Medicare Part D.

Penalty Reset: Everything changes when you reach 65. At the end of the month before the month in which you turn 65, you lose your entitlement to Medicare based on disability. At the beginning of the month you turn 65, your entitlement to Medicare based on becoming 65 begins. In other words, you get a second initial enrollment period.  At that point the clock is reset, and Medicare coverage begins anew as though you’d never had it before.  Any penalties that were assessed will be removed.

What is my deadline to enroll?

It is advisable keep your Medicare Part A and Part B when it is automatically issued to you (after 24 months of SSDI).  

Part A: You will be automatically enrolled in Medicare Part A after 24 months of SSDI.  You will be required to keep Part A since you are collecting SSDI.

Part B-SEP: You will be automatically enrolled in Medicare Part B after 24 months of SSDI.  It does not appear that you will have an 8 month Special Enrollment Period if you return your Part B and want to apply later.

  • Those who have Medicare based on disability can enroll later under an SEP if they, their spouse, or their family member is working, and have coverage by an employer or union GHP (with at least 100 employees – also known as a Large GHP) based on that employment.  For reference, see heading titled Enrolling with a Special Enrollment Period.

Part B-GEP: If you miss your Initial Enrollment Period, you will be able to enroll annually during the General Enrollment Period (however, penalties may apply).

  • The General Enrollment Period is from January 1st to March 31st each year. Your Part B effective date will be July 1st following your enrollment.

Secondary Insurance Options

You have the option to purchase secondary coverage to supplement your Medicare A and B.  You will have the option to choose a Medicare Advantage Plan or Medicare Supplement Insurance and a Medicare Prescription Drug PlanFor under age 65, options vary by state.

Premiums, Benefits and Networks may vary by insurance company.  We represent over 30 different insurance carriers to help you review and evaluate which options are most appropriate for your situation.

In addition, you can also voluntarily elect Dental, Vision, Hearing, Cancer and/or Hospital Indemnity coverage.

Please contact us for quotes and benefit information.

Underwriting Considerations

Once you enroll in Medicare Part B, you will have an Open Enrollment Period/Special Election Period to choose your secondary coverage without having to medically qualify.

When under age 65 and on SSDI, plan availability is state specific.  Please see HTA for plan options.

Additional Considerations

Spouse Under Age 65- If you have a Spouse under age 65, not yet qualified for Medicare, and relies on your group health plan for benefits, please be mindful that if you come off your group plan, your spouse will have to go on COBRA, seek benefits through their respective employer, or purchase individual health insurance until they become Medicare eligible.