Alyssa Lane
If you have a disability, you may be eligible for health coverage through various government programs and private insurance plans. In the United States, Medicare is a health insurance program that covers people with disabilities under the age of 65, in addition to those 65 and older. People with disabilities may qualify for Medicare after receiving Social Security Disability Insurance (SSDI) benefits for a certain period, typically 24 months. Additionally, Medicaid provides health coverage for over 10 million people with disabilities, often in conjunction with Supplemental Security Income (SSI) benefits. Private health insurance options are also available through the Affordable Care Act (ACA) marketplace for those who do not qualify for Medicaid or have not yet received SSDI benefits for the required duration. Understanding these options is essential for individuals with disabilities to ensure they have access to the necessary medical care and coverage.
| Characteristics | Values |
|---|---|
| If you have Medicaid or Medicare | You're considered covered under the healthcare law |
| If you don't have health coverage | You can fill out a Marketplace application to see if you qualify for savings on a private health plan or for coverage through Medicaid |
| If you have Social Security Disability Insurance (SSDI) | You're considered covered under the healthcare law and don't have to pay the penalty that people without coverage must pay |
| If you enrolled in a Marketplace plan before getting Medicare | You can keep your Marketplace plan as supplemental insurance when you enroll in Medicare, but you'll lose any premium tax credits and other savings for your Marketplace plan |
| If you're turned down for Medicaid | You may be able to enroll in a private health plan through the Marketplace while waiting for your Medicare coverage to start |
| If you don't qualify for Medicaid through any pathways or haven't received Social Security Disability benefits for 24 months | You can purchase coverage through the Affordable Care Act (ACA) marketplace |
| If you indicate you have a disability when applying for marketplace coverage | HealthCare.gov will send the application to your state's Medicaid office to determine if you qualify for Medicaid |
| If you have high income but spend down to a state-specified medically needy income level by incurring medical expenses | You may qualify for the medically needy pathway |
| If your state has adopted the Section 1915 (i) pathway | You may qualify for Medicaid coverage if you're at risk of institutional care and meet certain financial and functional criteria |
| If you have end-stage renal disease (ESRD) | You can get Medicare the month you begin at-home dialysis treatments, the month you get a kidney transplant, or 3 months after you start outpatient dialysis treatments |
| If you have ALS (Lou Gehrig's disease) | You can get Medicare as soon as you become entitled to Disability |
| Supplemental Security Income (SSI) | Provides monthly payments of up to $967 for people with limited income and resources |
| Disability Insurance (DI) | Provides short-term benefit payments of $50 to $1,681 each week for up to 52 weeks, depending on previous wages |
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What You'll Learn
Social Security Disability Insurance (SSDI)
SSDI benefits may include not only monthly payments but also Medicare. If you have Medicare, you are considered covered under the healthcare law and are not required to pay the penalty that people without coverage must pay. You cannot enroll in a Marketplace plan to replace or supplement your Medicare coverage. However, if you enrolled in a Marketplace plan before obtaining Medicare, you may retain the Marketplace plan as supplemental insurance.
It is worth noting that SSDI is not the only option for individuals with disabilities seeking financial assistance. Supplemental Security Income (SSI) is another program that provides benefits to individuals with disabilities or those 65 or older. Unlike SSDI, SSI does not require a work history and instead provides money to cover basic needs such as food, clothing, and housing. Depending on eligibility, it is possible to receive benefits from both SSDI and SSI simultaneously, known as "concurrent" benefits.
Additionally, individuals with disabilities may explore other disability insurance options. For instance, State Disability Insurance (SDI) provides short-term benefit payments when an individual cannot work due to a non-work-related disability. The benefit amount ranges from $50 to $1,681 per week for up to 52 weeks, depending on the wages earned before the claim start date.
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Private health plans
If you have a disability and are seeking health insurance coverage, there are several options available to you. Firstly, if you already have Medicaid or Medicare, you are considered covered under the healthcare law and do not need to purchase additional insurance. However, if you are currently uninsured, you can explore the following options for private health plans:
Marketplace Plans
The Health Insurance Marketplace offers a range of private health insurance plans. These plans cover pre-existing health conditions from the first day of coverage and cannot put annual or lifetime limits on your coverage. To find out if you qualify for savings on a Marketplace plan, you can fill out a Marketplace application. It is important to note that if you receive Social Security Disability Insurance (SSDI), you may already be eligible for Medicare, or you may be in a 24-month waiting period before your coverage starts. In this case, you cannot enroll in a Marketplace plan to replace or supplement your Medicare coverage unless you had enrolled in the Marketplace plan beforehand.
Medicaid
Medicaid is a federal and state program that provides health coverage for individuals with low income and assets. If you have a disability, you may qualify for Medicaid coverage. You can apply directly to your state Medicaid agency or through the Marketplace. Some states have expanded their Medicaid programs to cover all adults below a certain income level, so it is worth checking the specific criteria in your state.
Private Insurance Plans
In addition to Marketplace plans, there are private insurance plans offered outside of the Marketplace. These plans may also cover pre-existing conditions and provide comprehensive coverage. However, they may have different enrollment processes and eligibility criteria, so it is important to research and compare plans to find one that meets your specific needs.
It is important to carefully review the terms and conditions of any insurance plan you consider to ensure that it provides the coverage you require and that you understand any exclusions or limitations. Additionally, if you have specific healthcare needs related to your disability, ensure that any plan you consider provides adequate coverage for those needs.
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Medicaid
If you have a disability, you have several options for health coverage. Medicaid is one such option. Medicaid is a federal program that provides health coverage to those who meet certain requirements. These requirements vary by state, but generally, you must have a low income and limited resources to qualify for Medicaid. In addition, some states require that you be a resident of that state to qualify for their Medicaid program.
If you have a disability and are working, you may be able to get Medicaid through the Medicaid Buy-In for Adults program. This program allows adults with disabilities who have income and assets that are too high to qualify for traditional Medicaid to "buy-in" to Medicaid coverage. The specific rules and requirements for the Medicaid Buy-In program vary by state, so be sure to check with your state's Medicaid agency to see if you qualify.
If you have a child with a disability, you may be able to get coverage for them through the Medicaid Buy-In for Children program. This program allows families of children with disabilities to make monthly payments to get Medicaid coverage. Again, the specific rules and requirements for this program can vary by state.
It's important to note that if you currently have Medicaid, you are considered covered under the health care law and do not need to enroll in a Marketplace plan. However, if you are turned down for Medicaid, you may be able to enroll in a private health plan through the Marketplace while waiting for your Medicare coverage to start. You may qualify for lower costs on Marketplace coverage based on your income and household size.
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Medicare
For those with long-term conditions, Medicare coverage may be denied if the care is not deemed necessary by Medicare criteria. Physical therapy and other services may be covered, even if they are only expected to maintain or slow the deterioration of a person's condition, rather than improve it. If Medicare coverage has been denied, individuals can ask their doctor to help them appeal the decision.
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Disability benefit amounts
In the US, disability benefits may include a monthly payment and Medicare health insurance. The monthly payment amount is based on your work history. If you get Social Security Disability Income (SSDI), you may already have Medicare or be in a 24-month waiting period before it starts. You are considered covered under the healthcare law and don't have to pay the penalty that people without coverage must pay.
If you already have Medicaid or Medicare, you are considered covered under the healthcare law and don't need a Marketplace plan. If you don't have health coverage, you can fill out a Marketplace application to find out if you qualify for savings on a private health plan or for coverage through Medicaid.
Supplemental Security Income (SSI) provides monthly payments of up to $967 for individuals with limited income and resources. The maximum monthly SSI payment for 2025 is $967 for an individual and $1,450 for a couple. Your amount may be lower based on your income, certain family members' income, your living situation, and other factors. For every $2 you earn from work, your SSI payment is reduced by about $1. If eligible, you may be able to get Disability and SSI at the same time.
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Frequently asked questions
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-stage renal disease. It has two parts: hospital insurance (Part A) and medical insurance (Part B).
Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. You can also qualify for Medicare if you have end-stage renal disease or amyotrophic lateral sclerosis (ALS).
If you don't qualify for Medicare, you may be able to enroll in a private health plan through the Marketplace while waiting for your Medicare coverage to start. You may also qualify for Medicaid or Supplemental Security Income (SSI) based on your income and household size.
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