Paul Sanchez
If you have a disability, there are various options for health coverage. If you have a private long-term disability plan, your best option is to get private health insurance. If your disability plan is through your employer, you may qualify to stay on their insurance while you recover. If you have Medicaid or Medicare, you’re considered covered under the health care 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. SSDI provides Medicare, while SSI recipients receive Medicaid coverage.
| Characteristics | Values |
|---|---|
| Social Security Disability Insurance (SSDI) | Includes Medicare coverage, monthly benefit checks, and monthly payments. |
| Supplemental Security Income (SSI) | Includes Medicaid coverage (for low-income recipients) |
| Medicare | Premium-free hospital insurance (Part A) and medical insurance (Part B). |
| Medicaid | Administered at the state level, covers doctor's visits, preventative care, hospital care, prescription drugs, and rehabilitative services. |
| Private health insurance | An option for those with private long-term disability plans or short-term disability benefits. |
| Employer-provided insurance | May be an option while recovering from a disability. |
| State-provided insurance | California, Hawaii, New Jersey, New York, and Rhode Island offer short-term disability insurance for up to six months or a year. |
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What You'll Learn
Medicare and Medicaid
Medicare provides health insurance for individuals with disabilities, regardless of income. Those with a disability can purchase Medicare Part A (hospital insurance) and, if they purchase Part A, they may also purchase Part B (medical insurance). Medicare Part A coverage is premium-free, while for Part B, the individual or a third party will need to pay. If an individual is receiving Social Security Disability Insurance cash benefits, medical insurance premiums will be deducted from their check. If their cash benefits stop due to work, they will be billed every three months for their medical insurance premiums.
Medicare beneficiaries with disabilities can keep their coverage for at least 8.5 years after they return to work, as long as their disabling condition still meets the rules. Additionally, Medicare covers prescription drugs for individuals who are dually eligible, meaning they have both Medicare and full Medicaid coverage.
Medicaid, on the other hand, helps cover medical costs for certain low-income individuals, families, and children, pregnant women, the elderly, and people with disabilities. Each state has its own eligibility requirements, typically based on income and resources, and may offer additional benefits such as nursing home care and personal care services. Individuals with Medicaid usually don't pay anything for covered medical expenses, but they may owe a small co-payment for certain items or services. In some states, individuals can “spend down” their income to qualify for Medicaid by paying non-covered medical expenses until their income is lowered enough to meet the state's Medicaid limit.
For those with disabilities, having either Medicare or Medicaid coverage satisfies the health care law, and they are not required to enroll in a separate Marketplace plan. However, if an individual already has a Marketplace plan before getting Medicare, they can keep it as supplemental insurance when they enroll in Medicare, although they will lose any premium tax credits associated with the Marketplace plan.
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Private health insurance
If you have a disability and require health coverage, you can explore options in the Health Insurance Marketplace. You can fill out a Marketplace application to determine your 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 or charge higher premiums based on your disability status.
If you are already enrolled in Medicare due to your disability, you may be able to keep your Marketplace plan as supplemental insurance. However, you will lose any premium tax credits and savings associated with your Marketplace plan. Alternatively, you may qualify for Medicaid based on your income or disability, which can provide health coverage while you wait for Medicare to begin.
In terms of Medicare coverage for individuals with disabilities, there are a few key points to consider. Firstly, Medicare Part A (hospital insurance) is premium-free for beneficiaries with disabilities. If you purchase Part A, you may also purchase Medicare Part B (medical insurance), but you cannot buy Part B without first purchasing Part A. During your initial enrollment period and the annual general enrollment period, you can sign up for Part B.
Additionally, beneficiaries with disabilities can keep their Medicare coverage for at least 8.5 years after returning to work, as long as their disabling condition meets certain requirements. Furthermore, beneficiaries with low incomes and limited resources may be eligible for state assistance with Medicare expenses.
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Qualifying for Medicaid
Medicaid is a joint federal and state program that, together with the Children's Health Insurance Program (CHIP), provides health coverage to over 77.9 million Americans. To be eligible for Medicaid, individuals must meet specific financial and non-financial eligibility criteria, which vary from state to state.
Financial Criteria
Medicaid is designed to help individuals with limited incomes and resources. The income threshold to qualify for Medicaid depends on the state and the individual's family size. Some states have expanded their Medicaid programs to cover all individuals below a certain income level, regardless of other factors. Additionally, states have the option to establish a "medically needy program" for individuals with significant health needs whose income is too high to qualify for Medicaid under other eligibility groups. These individuals can become eligible by "spending down" their income to meet the state's medically needy income standard.
Non-Financial Criteria
In addition to financial criteria, there are several non-financial eligibility criteria for Medicaid. Firstly, individuals must be residents of the state in which they are receiving Medicaid. They must also be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. Furthermore, some eligibility groups are limited by age, pregnancy or parenting status, and disability status. For example, in all states, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. Similarly, some states cover pregnant individuals through CHIP.
Application Process
To apply for Medicaid, individuals can create an account with the Health Insurance Marketplace and fill out an application form. The information provided will be sent to the individual's state agency, which will make the final eligibility decision. It is important to note that Medicaid benefits differ in each state, and coverage generally stops at the end of the month in which an individual no longer meets the eligibility requirements.
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SSDI and SSI
If you have a disability, you have several options for health coverage. If you have Medicaid or Medicare, you are considered covered under the health care law and don't need a Marketplace plan. 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.
Social Security Disability Insurance (SSDI) provides monthly payments to people who have a disability that stops or limits their ability to work. SSDI is tied to your work history, and the payment amount is based on your work history before your disability began. If you are receiving SSDI, your spouse or former spouse and your children may also be eligible for benefits.
Supplemental Security Income (SSI) is for people who have little to no income. SSI provides money to cover basics like food, clothing, and housing if you are 65 or older or have a disability. To get SSI, you must live in one of the 50 states, the District of Columbia, or the Northern Mariana Islands and be a U.S. citizen or national.
Depending on your eligibility, you may be able to collect SSDI and SSI benefits at the same time, known as "concurrent" benefits. You can apply for both benefits together, and the Social Security Administration will tell you if you qualify for one or both programs.
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Applying for coverage
If you are on disability benefits, you may be eligible for Social Security Disability Insurance (SSDI) or "Disability", which provides monthly payments to people who have a disability that impairs their ability to work. You may also be eligible for Medicare, which is a form of health insurance coverage for people with disabilities.
If you are applying for health insurance coverage while on disability, there are a few options available to you. Firstly, if you are enrolled in a Marketplace plan before acquiring Medicare, you can retain your Marketplace plan as supplemental insurance when you enrol in Medicare. However, you will lose any premium tax credits and savings associated with your Marketplace plan. Alternatively, you can apply for Medicaid coverage while you wait for your Medicare coverage to begin. To apply for Medicaid, you can create an account and complete an application online, answering "yes" to the question about having a disability. Your application will then be forwarded to your state Medicaid agency. Another option is to apply directly to your state Medicaid agency, which you can select from the menu on the Medicaid webpage. If you are deemed eligible for Medicaid, your coverage may continue even after you enrol in Medicare. In the event that your Medicaid application is rejected, you may be able to enrol in a private health plan through the Marketplace while awaiting your Medicare coverage.
If you are seeking coverage through Medicare, you will need to apply for premium Medicare Part A (hospital insurance) once your premium-free coverage ends. You will receive a notice informing you when you can file an application to purchase Medicare coverage. If you purchase Part A, you may also buy medical insurance (Part B). However, you cannot acquire Part B without also purchasing Part A. If you did not initially sign up for Part B when it was offered, you can enrol during the general enrolment period (January 1st to March 31st annually) or during a special enrolment period.
If you are employed, you should contact your employer to enquire about health insurance coverage options. Additionally, if you are seeking short-term benefit payments while unable to work due to a non-work-related disability, you may be eligible for Disability Insurance (DI) benefits. To apply, you must meet certain criteria, including having lost wages due to your disability and having earned a minimum amount of State Disability Insurance (SDI) during your base period.
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Frequently asked questions
SSDI stands for Social Security Disability Insurance, which provides monthly benefit checks and Medicare coverage to people with disabilities that limit their ability to work. SSI, or Supplemental Security Income, is designed for low-income recipients and provides Medicaid coverage.
SSDI includes Medicare coverage, which consists of hospital insurance (Part A) and medical insurance (Part B). Part A is premium-free as long as you paid Medicare taxes when you worked. Part B requires payment, which is typically deducted from your SSDI cash benefits.
You can apply for Medicaid coverage during the 24-month SSDI waiting period. If you are denied Medicaid, you may be able to enroll in a private health plan or receive workers' comp if you got injured or sick at work.
Medicare is a federal health insurance program that covers people who are 65 or older or who qualify for SSDI. Medicaid is a joint federal and state insurance program that offers coverage for low-income recipients at no cost.
If your disability plan is through your employer, you may be able to stay on their insurance while you recover. Contact your employer for specific information about health insurance coverage during disability leave.
