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Illinois Life Span Program

Understanding SSDI & Medicare

Last Updated September 2023

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SSDI (Social Security Disability Income) and Medicare also play an important role in planning for transition to adult life, but are sometimes overlooked. SSDI eligibility is linked to work history and earnings. This can be the work history and earnings of the adult with a disability and/or related to their status as the “Disabled Adult Child” of a parent who is disabled, retired, or deceased. Detailed information on SSDI can be found in The Red Book from the Social Security Administration, available at https://www.ssa.gov/redbook/eng/main.htm  

Who is eligible for SSDI?

Adults with disabilities who have worked and have paid Social Security taxes for the required number of “quarters” within a required time span, and also have sufficient “recent work history” are eligible. https://www.ssa.gov/benefits/disability/qualify.html

Can an adult disabled since childhood receive benefits on a parent’s earnings record?

Yes. An adult disabled before age 22 may be eligible for child’s benefits if a parent is deceased or receiving retirement or disability benefits. This is considered to be a child’s benefit because it is paid on a parent’s Social Security earnings record. The disability determination is made using the disability rules for adults. The adult child, including an adopted child or, in some cases, a stepchild, grandchild, or step grandchild, must be unmarried, age 18 or older, and have a disability that started before age 22.

Establishing eligibility for SSDI is important, not only for the cash benefits which may be higher than those offered by SSI (Supplemental Security Income), but also because SSDI enrollees become eligible for Medicare health benefits after the first 24 months of enrollment.

It is possible for persons enrolled in Medicare to be simultaneously enrolled in Medicaid. Remember that Medicaid enrollment is mandatory for adults seeking government-funded Medicaid waiver services. People enrolled in both Medicare and Medicaid are referred to as “dual eligibles.” Some people also have private insurance in addition to their Medicare and Medicaid benefits. Having Medicare health insurance offers individuals some benefits that are not covered by Medicaid, for example:

  1. More doctors and hospitals may accept Medicare insurance.
  2. Medicare coverage is valid in all 50 states, enabling a recipient to have coverage while traveling  or studying out of state, for example.
  3. Medicare may pay providers at a higher rate than Medicaid for some services.

For differences in Medicare and Medicaid see: https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/differences-between-medicare-and-medicaid

Finding out about SSDI and Medicare eligibility is an important part of transition planning. You can contact the Social Security Administration office nearest you to find out if/when you may qualify for SSDI and Medicare.

Another resource for information about how work may affect benefits is the Work Incentives Planning & Assistance office nearest you. These federally funded programs were created to help individuals receiving SSI/SSDI make informed decisions about going to work. A Community Work Incentive Coordinator can help individuals interested in work understand how it will affect benefits, including Medicaid. For more information about the Work Incentive Planning and Assistance Program (WIPA) or to apply for services see: https://www.dhs.state.il.us/page.aspx?item=137647

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