Haris Ashley
Medicare is the United States' federal health insurance program for people aged 65 or older, or those with permanent kidney failure or receiving disability benefits. It is divided into four parts, with Part A covering hospital insurance and Part B covering medical insurance. While most people do not pay for Part A, Part B requires monthly payments from most beneficiaries, with the government covering about 75% and the beneficiary covering the remaining 25%. For higher-income beneficiaries, additional premium amounts are required for Medicare Part B and prescription drug coverage. Those under 65 who are disabled are eligible for HI if they have received Social Security disability benefits for over 24 months.
How much is medical insurance for people on social security?
| Characteristics | Values |
|---|---|
| Medicare program | Established in 1965 as Title XVIII of the Social Security Act |
| Medicare coverage | 4 types of coverage, known as "parts" |
| Medicare enrollment periods | 3 |
| Medicare Part A | Hospital insurance; premium-free |
| Medicare Part B | Medical insurance; most people pay monthly |
| Medicare Part B coverage | Doctors' services, outpatient care, physical and occupational therapy, and some home health care |
| Medicare Part B cost | 75% paid by the government, 25% paid by the beneficiary |
| Medicare Part B for higher-income beneficiaries | Pay a larger percentage of the total cost of Part B based on income reported to the IRS |
| Medicare Part B for beneficiaries with Medicare prescription drug coverage | Pay monthly premiums plus an additional amount |
| Medicare Part B for beneficiaries with limited resources and income | May be able to get Extra Help with costs like monthly premiums, annual deductibles, and prescription copayments |
| Medicare eligibility | Age 65 or older; permanent kidney failure; receive Disability benefits; end-stage kidney disease and meet special insured status requirements under Social Security; disabled beneficiaries entitled to Part A |
| Social Security Disability Insurance (SSDI) | Eligible for Medicare after a 24-month qualifying period |
| Medicare Part B enrollment | General enrollment period (January 1st through March 31st of each year) or a special enrollment period |
| Medicare Part B cost for beneficiaries who work | Billed every 3 months for medical insurance premiums |
| Medicare Part A cost for uninsured eligible retired beneficiaries | $437.00 per month for 2019 or $240.00 per month with 30 quarters of coverage |
| Medicare Part A cost for beneficiaries aged 65 or older who are not eligible for benefits | $187 per month with 30-39 quarters of Social Security coverage; $311 per month with less than 30 quarters of coverage |
| Medicaid | Established by Title XIX of the Social Security Act in 1965; provides medical and health-related services for individuals and families with low incomes |
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What You'll Learn
Medicare Part A and Part B
Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services. About 99% of Medicare beneficiaries do not pay a premium for Part A because they or their spouse have had at least 40 quarters of Medicare-covered employment. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD).
Part B helps pay for doctors' services and outpatient care. It also covers other medical services, such as physical and occupational therapy, and some home health care. For most beneficiaries, the government pays about 75% of the Part B premium, and the beneficiary pays the remaining 25%. The standard monthly premium for Medicare Part B enrollees was $174.70 in 2024 and will be $185.00 in 2025. If you are a higher-income beneficiary, you will pay a larger percentage of the total cost of Part B based on the income you report to the Internal Revenue Service (IRS). The annual deductible for all Medicare Part B beneficiaries will be $257 in 2025, an increase of $17 from the annual deductible of $240 in 2024.
Individuals already receiving Social Security or RRB benefits at least four months before being eligible for Medicare and residing in the United States (except residents of Puerto Rico) are automatically enrolled in both premium-free Part A and Part B. People who are automatically enrolled have the choice of whether they want to keep or refuse Part B coverage. People living in Puerto Rico who are eligible for automatic enrollment are only enrolled in premium-free Part A; they must actively enroll in Part B to get this coverage. Individuals who are not receiving a Social Security or RRB benefit are not automatically enrolled. You can pay your Medicare premium using a check, money order, credit card, debit card, or Health Savings Account (HSA) card. All Medicare bills are due on the 25th of the month. Most people get their Medicare Part B premium deducted automatically from their Social Security benefit payment.
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Medicare costs for higher-income beneficiaries
Medicare is the health insurance program for people aged 65 or older in the US. It also covers people with permanent kidney failure or those receiving Disability benefits. Medicare beneficiaries with higher incomes are required to pay higher premiums for Medicare Part B and Part D. The amount paid depends on the beneficiary's modified adjusted gross income (MAGI) from their most recent federal tax return.
If you are a higher-income beneficiary with Medicare prescription drug coverage, you will pay monthly premiums plus an additional amount. This additional amount is determined using a base premium and is tied to the base beneficiary premium, not your own premium amount. The higher your income, the higher your premium for Part B and prescription drug coverage. For instance, if you file your taxes as "married, filing jointly" and your MAGI is greater than $212,000, you will pay higher premiums. If you file your taxes using a different status and your MAGI is greater than $106,000, you will also pay higher premiums.
The Social Security Administration determines your income-related premium using information from your tax return filed two years prior to the current year for the tax year one year prior. For example, to determine your 2025 income-related premium, Social Security will use information from your tax return filed in 2023 for the tax year 2022. If your income has decreased since filing your tax return, you should contact Social Security and provide documentation of this change. You can also request a reduction in your income-related monthly adjustment amount by filing Form SSA-44.
If you disagree with the decision made about your income-related monthly adjustment amounts, you have the right to appeal. You can file an appeal online or request one in writing by completing a Request for Reconsideration (Form SSA-561-U2) or by contacting your local Social Security office. If you disagree with the MAGI amount received from the IRS, you must correct the information with the IRS. If you are determined to pay a higher amount for Medicare prescription drug coverage and you do not have this coverage, you must call the Centers for Medicare & Medicaid Services (CMS) to make a correction.
Understanding Medicare Medical Insurance Coverage and Benefits
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Medicare and Social Security Disability Insurance
Medicare is the United States' federal health insurance program for people aged 65 or older. However, individuals under 65 can also qualify for Medicare if they have permanent kidney failure, receive disability benefits, or have a qualifying disability.
Social Security Disability Insurance (SSDI) is a federal program administered by the Social Security Administration (SSA) that provides monthly income to people unable to work due to a disability. In 2021, 13 million people under the age of 65 received income through the SSDI program. Qualifying for SSDI also makes individuals eligible for health insurance coverage through Medicare.
If you receive SSDI, you likely already have Medicare or are in a 24-month waiting period before it starts. During this waiting period, you may be able to enroll in a private health plan through the Marketplace or apply for Medicaid coverage. If you already have Marketplace coverage, you can keep it as supplemental insurance when you enroll in Medicare, but you will lose any premium tax credits and savings associated with the plan.
Medicare has four types of coverage, known as "parts." Medicare Part A, or hospital insurance, is premium-free. However, Medicare Part B, or medical insurance, requires beneficiaries to pay monthly premiums. The government pays about 75% of the Part B premium, while the beneficiary pays the remaining 25%. Higher-income beneficiaries will pay an additional premium amount for Medicare Part B, known as the "income-related monthly adjustment amount." If you have limited income and resources, you may qualify for Extra Help with the costs associated with Medicare prescription drug coverage.
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Medicare and Marketplace plans
Medicare is a federal health insurance program for people aged 65 and older and certain younger people with disabilities. It also covers people with permanent kidney failure or End-Stage Renal Disease (ESRD).
There are four types of Medicare coverage, known as "parts". Most beneficiaries with Medicare have both Parts A and B and do not have other private health insurance. Part A covers hospital insurance, while Part B covers medical insurance, including doctors' services, outpatient care, and other medical services such as physical therapy. For most beneficiaries, the government pays about 75% of the Part B premium, while the beneficiary pays the remaining 25%. If you are a higher-income beneficiary, you will pay an additional premium amount for Part B, based on your income reported to the IRS.
If you have a Marketplace plan and become eligible for Medicare, you can keep your Marketplace plan until your Medicare coverage starts, and then cancel it without penalty. However, it is against the law for someone who knows that you have Medicare to sell you a Marketplace plan. If you had a Marketplace plan before getting Medicare, you can keep it as supplemental insurance, but you will lose any premium tax credits and savings for that plan.
If you have limited resources and income, you may be able to get Extra Help with the costs related to Medicare prescription drug coverage, such as monthly premiums and annual deductibles.
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Medicare and Medicaid
Medicare is the United States' federal health insurance program for people aged 65 or older. It is also available to those with permanent kidney failure or those receiving disability benefits. There are four types of Medicare coverage, known as "parts". Medicare Part B (medical insurance) and Medicare prescription drug coverage premiums vary depending on income. Higher-income beneficiaries pay monthly premiums plus an additional amount. The government pays about 75% of the Part B premium for most beneficiaries, while the beneficiary pays the remaining 25%. If you receive Social Security Disability Income (SSDI), you may have to wait 24 months for Medicare coverage to begin.
Medicaid, on the other hand, is a joint federal and state program that helps cover medical costs for certain low-income people, families, children, pregnant women, the elderly, and people with disabilities. Each state has its own Medicaid program, and eligibility requirements and benefits can vary. Generally, eligibility is determined by income, resources, and residency. Medicaid offers benefits that Medicare does not, such as nursing home care and personal care services. People with Medicaid usually do not pay anything for covered medical expenses but may owe a small co-payment for some items or services. If you have both Medicare and full Medicaid coverage ("dual eligibility"), your state will pay your Medicare Part B monthly premiums, and Medicare will cover your prescription drugs.
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Frequently asked questions
If you are on Social Security Disability Insurance (SSDI), you are eligible for Medicare after a 24-month qualifying period. During this period, you may be eligible for health insurance through a former employer. Medicare Part A is premium-free, while most people pay a monthly premium for Medicare Part B. The cost of Part B is based on your income and ranges from $187 to $437 per month.
Medicare Part A is hospital insurance.
Medicare Part B is medical insurance that helps pay for doctors' services, outpatient care, and other medical services such as physical and occupational therapy.
If you have limited resources and income, you may be able to get Extra Help with the costs of Medicare prescription drug coverage. You can also apply for Medicaid coverage, which provides medical and health-related services for individuals and families with low incomes.
