Fact Sheet: Medicare and Social Security Disability

SWSCHP members who are under age 65 and are pre-Medicare retirees (not working with active employer coverage) who are receiving Social Security Disability Benefits must pay close attention to Medicare eligibility and primary health insurance. That’s because after a 24 month waiting period while you collect SSDI benefits, Medicare will become your primary insurance even if you are not 65 years of age. Please read through the following facts and follow the prompts if you have questions.

When You Qualify for Medicare

  • Eligible after a 24-month waiting period from the first month you receive SSDI benefits.

  • Exceptions: ALS (Lou Gehrig’s disease) and End-Stage Renal Disease (ESRD) may provide earlier eligibility.

When Medicare Becomes Your Primary Insurance

  • Once eligible and enrolled in Medicare, Medicare becomes your primary health insurance.

  • For SWSCHP members, Aetna retiree coverage will coordinate with Medicare.

Enrollment Steps

  • Automatic enrollment: If your are on SSDI, you are typically enrolled in Medicare Parts A & B after 24 months.

  • Part A (Hospital Insurance): Usually premium-free if enough work credits.

  • Part B (Medical Insurance): Monthly premium deducted from SSDI unless declined.

  • Optional: Part C (Medicare Advantage) or Part D (Prescription Drug Coverage).

Special Considerations

  • Delaying Medicare Part B can lead to penalties and coverage gaps.

  • At age 65, you move into age-based Medicare (coverage continues with new plan choices).

SWSCHP’s SPD (Summary Plan Document) states the following:

  • For members of the State-Wide Schools Cooperative Health Plan (SWSCHP), failure to enroll in Medicare when first eligible will result in benefits being reduced by the amounts payable by Medicare Parts A & B. This can result in higher out of pocket costs for the member.

Aetna Medicare Advantage Plan

  • Aetna offers a Medicare Advantage (Part C) plan for SWSCHP members once eligible for Medicare.

  • Medicare Advantage combines Part A (Hospital), Part B (Medical), and often Part D (Prescriptions) into one plan.

  • Aetna coordinates with Medicare for you to receive your benefits

  • Advantages include:

    • Integrated coverage

    • Predictable costs

    • Extra benefits (dental, vision, hearing, gym, telehealth)

    • Coordinated retiree plan benefits

Key Takeaways

  • 24 months after SSDI benefits begin, you generally get Medicare, even if you are not 65.

  • Aetna coordinates with Medicare for your retiree coverage.

  • SWSCHP members have the option to use Aetna Medicare Advantage for integrated coverage.

  • Enroll promptly to avoid penalties or gaps in coverage.

  • SWSCHP members must enroll in Medicare to avoid significant out-of-pocket costs.

Action Step

If you are approaching the 24-month mark on SSDI, watch for your Medicare enrollment package in the mail and review how it coordinates with retiree, COBRA, or SWSCHP coverage (Aetna becomes secondary).

Contact Medicare

If you have questions about your eligibility, enrollment, or coverage, please contact Medicare directly:
📞 1-800-MEDICARE (1-800-633-4227) – Representatives available 24/7


🌐 www.medicare.gov

For Aetna Medicare Advantage details, contact Aetna Member Services at the number provided in your enrollment materials.
🌐 www.aetnamedicare.com