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How Social Security and Medicare Work Together
Enrollment, premium collection and more link these key programs serving older adults
7 min read
Key takeaways
- Social Security acts as Medicare’s gateway, handling enrollment for the federal health care program.
- Most Medicare beneficiaries have their Part B premiums deducted from their Social Security payments.
- People receiving Social Security Disability Insurance qualify for Medicare after 24 months.
You may know that Social Security and Medicare intersect in several ways. That’s not surprising, given that they serve roughly similar populations of older Americans and people with disabilities.
Still, their relationship can be confusing because they are distinct programs with different (albeit complementary) missions, one promising a measure of financial security to older adults and the other providing health care.
Here’s the key connection: When you sign up for Medicare, it’s Social Security that handles your enrollment. In this role, the Social Security Administration (SSA) works with the Centers for Medicare & Medicaid Services (CMS) to inform older Americans about their Medicare sign-up options, process their applications and, for many people, collect premiums.
Here’s what you need to know about how these two crucial services cooperate.
Medicare is not part of Social Security
Social Security and Medicare are run by separate government agencies, but their relationship is rooted in history. That’s reflected in the title of the legislation President Lyndon Johnson signed on July 30, 1965, to create Medicare — the Social Security Amendments Act of 1965.
The SSA spent the following months developing and implementing enrollment procedures for Medicare, which launched on July 1, 1966. More than 19 million people signed up during that start-up period. Today, Medicare serves 70 million people, 91 percent of them age 65 or older.
How Social Security handles Medicare enrollment
For most people, Medicare eligibility starts at age 65, but the sign-up process differs based on whether you are already getting Social Security payments.
Automatic enrollment for Social Security recipients: If you began collecting Social Security at least four months before turning 65, the SSA will send you a Welcome to Medicare package that includes your Medicare card.
The package will arrive at the start of your initial enrollment period, which begins three months before the month in which you turn 65 and lasts for seven months. For example, if your 65th birthday is July 15, 2026, this period runs from April 1 to Oct. 31.
On your 65th birthday, the SSA automatically enrolls you in Medicare parts A and B, which cover hospitalization and routine care, respectively. Medicare Part A costs nothing for most recipients, but Part B carries premiums.
You can opt out of Part B, but you might face a penalty in the form of permanently higher premiums if you sign up later — 10 percent more if you wait 12 months, 20 percent if you wait 24 months, and so on. Some exceptions allow you to opt out with no penalty — for example, if you still have health coverage through your job or that of a spouse.
Follow the instructions in your Welcome to Medicare packet if you don’t want to keep Part B. You’ll need to return the Medicare card that came with the package, but jot down your Medicare number before sending it back so you can use Part A while you wait for a new card from the SSA showing your limited enrollment.
Individual enrollment if you haven’t retired yet: If you are not receiving Social Security at least four months before age 65, you’ll need to apply for Medicare yourself. You can do so online at the SSA website, by phone at 800-772-1213 or in person at a local Social Security office.
You must complete the process during the seven-month initial enrollment period or face late fees in the future. As with automatic enrollment, you can opt out of Part B penalty-free if you have health insurance through a workplace (or a spouse’s workplace) that has at least 20 employees.
When that coverage ends, you have an eight-month special enrollment period to sign up for Part B, which you can also do via the Social Security site. You’ll find detailed information on enrollment options and timetables in the SSA’s Medicare booklet.
How Social Security handles Medicare premiums
The SSA is directly involved in how much you pay for Medicare, and when and how you pay it.
Withholding or direct payment: Almost all Medicare beneficiaries pay no premiums for Part A, but your Medicare Part B premiums are deducted from your monthly Social Security payments if you are drawing benefits. If you’re not getting benefits, you’ll receive quarterly bills for your Part B premiums, and you will have to pay Medicare directly.
Once you are collecting Social Security, Part B premiums will be deducted from your monthly payment. If you have Medicare Part C (also known as Medicare Advantage) or Part D (prescriptions), you can arrange with your plan provider to have the premiums deducted from your Social Security.
Higher income can equal higher premiums: The SSA uses income data from the IRS to determine if you are a “high-income beneficiary,” based on thresholds set annually by Medicare. Below the threshold, you’ll pay the standard Part B premium ($202.90 in 2026). At higher income levels — above $109,000 for an individual and $218,000 for a married couple filing taxes jointly — you will pay gradually higher premiums for Part B.
There’s a twist to this system: The income information the SSA uses is from your tax return two years ago. If a “life-changing event” caused a significant drop in income in the intervening tax year, you can ask Social Security to adjust your premium.
“Hold harmless”: Under the Social Security Act, monthly Social Security payments for most beneficiaries cannot go down because Medicare Part B premiums have gone up. This “hold harmless” provision applies to people who pay the standard Part B premium and have it deducted from their Social Security payments.
When the standard Part B rate rises, as it does most years, people in this group get what amounts to a discount on premiums if paying the full cost would reduce their Social Security payment from one year to the next. This could happen in years with low inflation if the Part B increase exceeds the Social Security cost-of-living adjustment (COLA).
“Hold harmless” does not apply if you are in your first year of Medicare coverage, pay Medicare directly for Part B or pay a higher Part B premium due to your income.
How Medicare works with Social Security disability
People younger than 65 who are unable to work due to a serious injury or illness automatically qualify for Medicare if they are also receiving Social Security Disability Insurance (SSDI). Like Social Security retirement benefits, SSDI is earned: You qualify by working and paying Social Security taxes. In addition, you must demonstrate that your medical condition largely prevents you from working and is expected to last at least one year or result in death.
Medicare coverage typically starts after you’ve received 24 months of disability benefits. The waiting period is waived for people with amyotrophic lateral sclerosis (ALS) or end-stage renal disease.
Medicare coverage linked to SSDI will end if benefits stop because your condition improves to the point that Social Security no longer considers you to have a disability. The SSA does periodic reviews to determine your medical eligibility for benefits.
SSDI can also end if, while still meeting the medical criteria for disability, you are able to work and your income exceeds an annually adjusted cap. In 2026, the limit is $1,690 per month for most SSDI recipients. (People who are blind have a higher cap —$2,830 a month.) However, in this circumstance, you may be able to extend Medicare coverage for at least seven years and nine months after your SSDI ends.
The key takeaways were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.
- 5 Things You Need to Know About Signing Up for Medicare, Centers for Medicare & Medicaid Services
- Medicare, Social Security Administration
- Premiums: Rules for Higher-Income Beneficiaries, Social Security Administration
- What You Can Do if You Think Your Medicare Income-Related Premium is Incorrect, Social Security Administration
- Original Medicare (Part A and B) Eligibility and Enrollment, Centers for Medicare & Medicaid Services
- Who Do I Contact — Social Security or Medicare?, Social Security Administration
- History of Medicare and Medicaid, Centers for Medicare & Medicaid Services
- Report on the Implementation of the 1965 Amendments, Social Security Administration
- “Increases in Part B premiums and the hold harmless provision,” Medicare Rights Center
- Monthly Medicare Enrollment, Centers for Medicare & Medicaid Services
Andy Markowitz is an AARP senior writer and editor covering Social Security and retirement. He is a former editor of the Prague Post and Baltimore City Paper.
Phil Pruitt is an AARP writer and editor focusing on Social Security. He is a former editor at Scripps News and Yahoo News and was on the start-up staff at USA Today, where he held numerous editing positions.
Stephen Richardson is a retired New England regional communications director for the Social Security Administration and AARP consultant on Social Security benefit issues. He began his career with the agency in 1982 as a claims representatives.
