Health insurance for disabled people

Thanks to the ACA, there isn’t a particular health plan that is better than another for a person with disabilities.

Bill Fertig, director of the Spinal Cord Injury Resource Center, said the current health insurance market has never been better for disabled people seeking coverage.

With the ACA, two important things happened to make disabilities and insurance less complicated: "the inclusion of people with pre-existing conditions that were either previously excluded from obtaining insurance or were only offered insurance rates that were too high to afford. And many more people were insured than before ACA expanded Medicaid to more people in more states," he says.

It's now hard for insurers to discriminate against anyone with a disability, Fertig says.

"The ACA prohibits consideration of pre-existing conditions when offering or assigning rates to health insurance. If the ACA is overturned and replaced with language allowing insurers not to offer or offer at higher rates if you have a pre-existing condition, that will be the law of the land. I don't believe a separate discrimination effort could be successful,” Fertig says.

That means there is no particular health plan for those who are disabled. You can choose from any ACA health plan you prefer.

"I am not aware of any specific ACA plans that are known as being better for people with disabilities. Because each individual's specific needs are so variable, so different from another person, no one plan fits everyone. Thus, no one plan fits everyone's situation, even if they share a certain injury or diagnosis with others,” Fertig says.

Instead, he says individual finances are a better gauge when deciding on a health plan. His advice? Do your homework.

"Every different plan has different coverage levels, including for DME (durable medical equipment). A smart consumer will take stock of what equipment they use, what medicines and monthly medical supplies they require and purchase an insurance plan that covers those things. It's very important to know what the coverage is for what you require before you choose your insurance plan, not after,” he says.

Social Security Disability Insurance and Medicare or Medicaid

If you're unable to work due to a disability -- physical or mental -- and have worked long enough to pay into social security, you can apply for SSDI (Social Security Disability Insurance) benefits.

Once approved, you’re eligible for Medicare coverage. The caveat, however, is that those Medicare benefits don't kick in until you've been on disability for two years. You might qualify for Medicaid during your two-year wait, so definitely apply.

Those who haven't worked or who have not earned enough work credits to draw from SSDI will usually get approved for Supplementary Security Income (SSI). If approved for SSI, you get a smaller check per month, but you’re automatically approved for Medicaid.

While it doesn't happen often, there are cases in which the SSDI amount meets the minimum for the person to also receive SSI. In this case, it's not as black-and-white as to whether the person will receive Medicaid or Medicare.

Health insurance for disabled veterans

The Veterans Administration (VA) provides health benefits to disabled veterans that are granted based on a priority, tiered system. Those veterans with the most severe service-related disabilities see the highest amount of coverage and benefits from the VA.

Those with moderate disabilities will come next, with the last on the priority list being veterans without a disability.

Those toward the end of the list will receive fewer benefits and coverage. The first step is to enroll in the VA. The administration will take it from there and let you know where you fall on their priority-tiered list.

Mental health coverage

Mental health and substance use disorders are covered by any ACA-compliant health plan.

For those with these non-physical disabilities, coverage parity is essential to quality of life. The ACA provided an expansion of mental health and substance use disorder coverage by building on the Mental Health Parity and Addiction Equity Act.

The ACA requires individual and small group health insurance plans to cover mental health and substance use disorders with the same parameters and financial standards as medical and surgical benefits. Before the ACA, insurers were only required to offer comparable coverage on group plans.

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COBRA

Consolidated Omnibus Budget Reconciliation Act
People who lose their employer-sponsored health insurance may qualify for a COBRA plan. COBRA lets you keep your former employer's health plan, but you're responsible for paying all of the costs, including your former employer's portion.
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Medicare

People who are 65 and over qualify for Medicare. You can choose Original Medicare (also called Parts A and B), which is offered by the federal government, or Medicare Advantage (also called Part C), which private insurers provide. The average annual premium for Original Medicare is about $1,600. Medicare Advantage's average yearly premium is $336, but you may have higher out-of-pocket costs than Original Medicare.
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Medicaid

Low-income Americans qualify for Medicaid. Thirty-eight states expanded Medicaid eligibility, so lower-middle-class Americans may also be eligible in those states. Medicaid offers comprehensive benefits, but at little to no cost depending on your income. Each state has its own eligibility. Some states are flexible with Medicaid eligibility for people who are pregnant, a parent or disabled. If your household income is below 138% of the federal poverty level, you're likely eligible for Medicaid if you live in a Medicaid expansion state. That level is $17,609 for an individual, $23,791 for a family of two, $29,974 for a family of three and $36,156 for a family of four. Non-Medicare expansion states have stricter income guidelines. Check with your state's Medicaid program to see if you qualify.
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Parent's employer-based health insurance

The Affordable Care Act lets children stay on a parent's health plan until the age of 26. Having a child on a parent's health plan may or may not increase premiums. It depends on whether you already have family coverage when adding the child to the plan. If a parent already has family coverage, adding a child won't likely increase premiums. However, going from single or couple to family coverage could cause premiums to skyrocket. The average single coverage employer-sponsored plan premium is $1,186. The average family plan is $5,447.
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Spouse's employer-based health insurance

Most employers allow employees to add spouses to their health insurance. Going from single health coverage to a family plan may triple or quadruple your premiums. The average single coverage employer-sponsored plan premium is $1,186. The average family plan is $5,447. Not all jobs allow for spouse's coverage, so you'll want to check with your employer to make sure it's an option.
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Employer-based health insurance

Most people with private health insurance get their coverage through a job. employer-sponsored health insurance is usually cheaper than individual health insurance unless you qualify for Affordable Care Act subsidies. Job-based plans are generally less expensive because businesses often pick up more than half of employer-sponsored health insurance premiums. Kaiser Family Foundation estimates the average premiums for a single coverage employer-sponsored health plan is $1,186 and the average family plan is $5,447 annually.
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Employer plans are often one of these types of four plans. Click on each one to find out more.
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Preferred-provider Organization (PPOs)

  • Pay higher premiums with a lower deductible
  • You have access to more providers, but pay much more for health insurance
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You want the ability to get out-of-network care
Preferred-provider organization (PPOs) plans are the most common type of employer-based health plan. PPOs have higher premiums than HMOs and HDHPs, but those added costs offer you flexibility. A PPO allows you to get care anywhere and without primary care provider referrals. You may have to pay more to get out-of-network care, but a PPO will pick up a portion of the costs.
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Health maintenance organization (HMO)

  • Pay higher premiums with a lower deductible
  • Restricted network of providers with lower premiums
  • You want to choose a primary care physician
  • You don't mind getting a referral
  • You don't care about the ability to get out-of-network care
Health maintenance organization (HMO) plans have lower premiums than PPOs. However, HMOs have more restrictions. HMOs don't allow you to get care outside of your provider network. If you get out-of-network care, you'll likely have to pay for all of it. HMOs also require you to get primary care provider referrals to see specialists.
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High-deductible health plans (HDHPs)

  • Pay lower premiums with a higher deductible
High-deductible health plans (HDHPs) have become more common as employers look to reduce their health costs. HDHPs have lower premiums than PPOs and HMOs, but much higher deductibles. A deductible is what you have to pay for health care services before your health plan chips in money. Once you reach your deductible, the health plan pays a portion and you pay your share, which is called coinsurance.
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Exclusive provider organization (EPO)

  • Restricted network of providers with lower premiums
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You don't care about the ability to get out-of-network care
Exclusive provider organization (EPO) plans offer the flexibility of a PPO with the restricted network found in an HMO. EPOs don't require that members get a referral to see a specialist. In that way, it's similar to a PPO. However, an EPO requires in-network care, which is like an HMO.
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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
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People who would prefer to pay lower premiums with a higher deductible may want the below plans
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Silver is the second most popular plan in the ACA exchanges, with 35% of people with a Silver plan. Silver has lower premiums than any plan except for Bronze. However, it has lower out-of-pocket costs than Bronze. Silver plans pick up 70% of the costs, while members pay 30% The average single coverage in a Silver plan is $481 monthly and $1,179 for a family plan.

Bronze is the most popular type of plan in the ACA exchanges, with 41% of members with a Bronze plan. These plans have the lowest premiums, but also the highest out-of-pocket costs in the exchanges. Bronze plans pick up 60% of the costs, while members pay 40%. The average single coverage monthly cost in a Bronze plan is $440 and $1,080 for a family plan.

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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
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People who would prefer to pay higher premiums with a lower deductible may want the below plans
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Platinum plans have the highest premiums but the lowest out-of-pocket costs. So, you pay more for the coverage initially but less than other plans when you need health care services. Platinum plans pick up 90% of the costs, while members pay 10%, Not many health insurers offer Platinum plans. Only 2% of members in ACA plans have a Platinum plan, so you may have trouble finding one. The average monthly premiums for single coverage in a Platinum plan is $706 and the average family coverage costs $1,460.

Gold plans have lower premiums than Platinum, but higher premiums than Silver and Bronze. Gold also has lower out-of-pocket costs than Silver and Bronze, but higher than Platinum. Gold plans pick up 80% of the costs, while members pay 20%. The average monthly premium for a single Gold plan is $596. Family coverage averages $1,426 per month.

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Health insurance FAQs

Do you get health insurance on disability?

Once your employer terminates your employment (when it’s determined you’re unable to return to work) you’ll no longer be eligible for their health insurance plan. You’ll have to look into an ACA plan or apply for Medicare once you qualify for SSDI.

What disabilities qualify you for Medicare under 65?

Any disability that qualifies you for SSDI will also qualify you for Medicare.

Who pays for health insurance on long-term disability?

Unless you are staying on as an employee, you’ll no longer have your employer’s health insurance while on long-term disability. That means you’ll have to pay your premiums until you can get on SSDI and apply for Medicare.