Jane Dotson
If you are disabled, there are several options for health insurance coverage. These include Social Security Disability Insurance (SSDI), Medicare, and Medicaid. If you receive SSDI, you may be eligible for Medicare, although there is a 24-month waiting period. During this time, you may be able to enroll in a private health plan through the Marketplace or apply for Medicaid. If you are turned down for Medicaid, you may still qualify for a private health plan with premium tax credits and other savings based on your income. Additionally, if you are a veteran with a service-connected disability or the spouse, dependent, or survivor of a veteran, you may be eligible for health care benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).
Characteristics and Values
| Characteristics | Values |
|---|---|
| Social Security Disability Insurance (SSDI) | Medicare coverage or a 24-month waiting period |
| Medicaid | Apply through your state agency |
| Private health plan | Apply through the Marketplace |
| Veterans Affairs (VA) | Spouses, dependents, and survivors of Veterans may qualify for CHAMPVA |
| Medicare | Eligibility for working people with disabilities falls into three time frames |
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What You'll Learn
Social Security Disability Insurance (SSDI)
To be eligible for SSDI, you must meet certain requirements based on your age, disability, and work history. You can use the Social Security benefits questionnaire to determine your eligibility. If your application is approved, there is typically a five-month waiting period before the benefits kick in.
While receiving SSDI, you are considered covered under the healthcare law and are not subject to the penalty that people without coverage must pay. You will likely have Medicare or be in a 24-month waiting period for it to start. If you are turned down for Medicaid, you may be able to enrol in a private health plan through the Marketplace while waiting for your Medicare coverage to begin.
You can apply for SSDI online, by phone, or in person. You may also be able to receive Supplemental Security Income (SSI) concurrently with SSDI, depending on your eligibility. SSI provides financial assistance for basics such as food, clothing, and housing if you are 65 or older or have a disability, regardless of your work history.
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Medicare coverage
If you are seeking Medicare coverage and are not yet 65 years old, you may still be eligible, but it is recommended to consult official sources for the most accurate and up-to-date information. There is a trial work period of nine months, during which an individual can work and still be considered disabled, receiving Social Security and Medicare benefits. This trial work period is not necessarily consecutive, and independent evidence of the individual no longer being disabled could result in the termination of benefits. After this trial period, there is a period of up to 93 months (7 and three-quarter years) where Medicare coverage can continue, even if SSDI cash benefits cease. During this time, the beneficiary pays no premium for the hospital insurance portion of Medicare (Part A), but premiums are due for the supplemental medical insurance portion (Part B).
If you are turned down for Medicaid, you may be able to enrol in a private health plan through the Marketplace while waiting for Medicare coverage to begin. Additionally, if you have a disability but do not qualify for disability benefits, you can explore options in the Health Insurance Marketplace. You can fill out a Marketplace application to determine eligibility for savings on a private health plan or for coverage through Medicaid. It is important to note that insurers offering coverage through the Marketplace cannot deny coverage or charge differently based on disability status.
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Medicaid coverage
Medicaid is the primary program that provides comprehensive health and long-term care coverage to about 10 million people with disabilities, including 2.3 million children, 8.8 million working-age adults, and 4.4 million adults aged 65 and older. This accounts for over one-third of people with disabilities, with 15 million people enrolled in Medicaid.
Medicaid provides a full range of coverage for people with disabilities, including preventive services, primary and specialty care, prescription drugs, medical equipment, and long-term services and supports. It covers people with a wide range of disabilities, including physical impairments and injuries, intellectual and developmental disabilities, mental and behavioral health disorders, and other conditions.
People with disabilities often do not have access to employer-sponsored health coverage and may have low incomes, making it difficult to cover their healthcare costs. Even with private coverage, people with disabilities may not be able to access the full range of services that Medicaid provides. Medicaid is particularly important for people with disabilities, as they tend to have higher healthcare costs.
There are various pathways through which individuals with disabilities can qualify for Medicaid coverage. These include:
- Supplemental Security Income (SSI): A federal program that provides cash assistance and monthly income to individuals with disabilities who are unable to work and have incomes and financial resources below federal limits.
- Special income level: States can cover institutionalized individuals with incomes up to 300% of the SSI benefit rate, and they may also extend eligibility to those receiving home and community-based waiver services.
- Working people with disabilities: States must cover certain qualified, severely impaired individuals whose earnings would otherwise disqualify them from Medicaid, and they can allow other working people with disabilities to buy into the program.
- Home and community-based services (HCBS): States may extend eligibility to individuals who require an institutional level of care or meet other needs-based criteria.
- Affordable Care Act (ACA) expansion group: Many individuals qualify for Medicaid through this pathway, which has expanded access to healthcare for many people with disabilities.
It is important to note that eligibility criteria and specific coverage details may vary by state, and individuals should refer to their state's Medicaid program for precise information.
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Private health plans
Private health insurance plans are available for people with disabilities in the United States. These plans are offered through the Health Insurance Marketplace, also known as Healthcare.gov. To access these plans, individuals can create an account and fill out a Marketplace health coverage application. This application will determine eligibility for a private health plan with premium tax credits and other savings based on income.
Private insurance plans in the Marketplace cover pre-existing health conditions from the first day of coverage. This includes all Medicaid programs. Additionally, Marketplace plans cannot put annual or lifetime limits on coverage. It is important to note that insurers offering coverage through the Marketplace cannot deny coverage or charge higher premiums based on disability status.
For individuals who indicate they have a disability when applying for Marketplace coverage, their application will be forwarded to the state's Medicaid office to determine eligibility for Medicaid. Medicaid provides free or low-cost health coverage to individuals with disabilities, and many states have expanded their Medicaid programs to cover all adults below certain income levels.
Private insurance is less common among people with disabilities due to the availability of public coverage options, such as Medicaid and Medicare. However, disability insurance benefits are typically included in employer-sponsored health plans, ensuring continued income if a disability prevents an individual from working.
It is worth noting that individuals with Supplemental Security Income (SSI) Disability may automatically qualify for Medicaid coverage in some states, while in other states, they may need to apply. Additionally, individuals enrolled in a Marketplace plan before receiving Medicare can keep their Marketplace plan as supplemental insurance when enrolling in Medicare, although they will lose any premium tax credits associated with the Marketplace plan.
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Veterans Affairs health benefits
In the United States, the Department of Veterans Affairs (VA) offers health care to eligible veterans and their dependents. The benefit amount and type of care each veteran receives can vary depending on their service history, income, and whether they have a disability. Veterans Affairs health benefits can include:
- Regular checkups with a primary care provider and appointments with specialists, such as cardiologists, gynecologists, and mental health providers.
- Home health, residential, or geriatric (elder) care, as well as assisted living.
- Medical equipment, prosthetics, and prescriptions.
- Tests to diagnose health conditions, including blood work, X-rays, and ultrasounds.
- Therapy and rehabilitation services, such as physical therapy, vision rehab, and therapy for traumatic brain injury.
- Additional services like audiology (hearing care) and radiation oncology (cancer care).
- Beneficiary travel benefits, caregiver support, and veterans transportation services.
- Dental care, in some cases.
Veterans can apply for health benefits online, by phone, by mail, or in person. They can also learn about their basic rights and responsibilities when receiving care at a VA health facility and review the eligibility requirements for different benefit programs. Additionally, veterans can explore options for life insurance, disability compensation, and burial benefits.
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Frequently asked questions
Some health coverage options for people with disabilities include:
- Social Security Disability Insurance (SSDI)
- Medicare
- Medicaid
- Private health plans through the Marketplace
- Disability Insurance (DI)
- Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
Yes, you can get Medicare coverage if you are disabled and under 65. However, there is usually a 24-month waiting period before it starts.
To be eligible for Medicare coverage, an individual must meet the medical standard for being considered disabled under Social Security rules.
If you don't qualify for disability benefits, you may still qualify for a private health plan through the Marketplace with premium tax credits and other savings based on your income. Many states have expanded their Medicaid programs to cover all adults below certain income levels.
Yes, disability insurance provides short-term benefit payments when you can't work due to a non-work-related illness or injury. The benefits range from $50 to $1,681 each week for up to 52 weeks, depending on your previous wages.
