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How to get health insurance if you have a disability

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Disabled individuals once got declined for health insurance or paid much higher rates. The Affordable Care Act (ACA) changed that. 

Now, health insurance companies have to cover you regardless of your health history. They also can't charge you substantially more because of medical conditions or cap your benefits. 

The ACA additionally puts a limit on out-of-pocket health costs. The law also required individual health plans must cover 10 essential health benefits, including preventive care, inpatient care, pediatrics and maternity care. 

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

He said with the ACA, two important things happened: "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."

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

"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 added. 

 

Health insurance options for people with disabilities

The ACA’s leveling the playing field means there isn’t a health plan that is demonstrably better than another for a person with disabilities. 

"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 said. 

Instead, Fertig added that individual finances are a better gauge when deciding on a health plan. 

"Individual financial status will necessarily make one plan attractive to one, but not to another person," said Fertig.

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 said. 

How to qualify for SSDI and Medicare or Medicaid

If you are unable to work due to a disability -- physical or mental -- and you have worked in jobs covered by Social Security, you can apply for SSDI (Social Security Disability Insurance) benefits. 

The application is pretty straightforward. There's a form to fill out, doctor's information to provide and an interview. It takes a couple of months for the review. If you’re approved, there is a five-month waiting period when you’re not paid 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.

When applying, make sure you don't confuse SSDI with SSI. SSI -- Supplemental Security Income -- is income-based. 

Those individuals, who haven't worked or who have not earned enough work credits to draw from SSDI, will usually get approved for SSI. If approved for SSI, you will get a smaller check per month, but you’ll be 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.

 

Veterans Administration coverage

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

Those with moderate disabilities will come next, with the last of 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 legitimate health issues are covered by any ACA-compliant health plan. 

For those who suffer from these non-physical disabilities, parity in coverage is essential to their 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.

One of the biggest points the ACA helped with was requiring 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.

 

Short-term health plans and disabilities

The Trump administration expanded short-term health plan offerings. Short-term plans were once seen as a way for people to have limited health coverage between jobs. 

However, the Trump administration changed the regulations to allow people to keep short-term health plans for longer periods of time. This change made short-term plans a possible alternative to health insurance plans. 

Short-term health plans are low cost. However, they often don’t provide coverage for mental health and prescription drugs. 

These plans are likely not worthwhile if you have a disability or if you expect to need more than minimal health care. 

 

How to buy health insurance

The ACA and short-term plans mean you have many more options for health coverage. Plus, there’s employer-sponsored health coverage and other ways to get coverage, such as Medicare and Medicaid. 

When you’re finally ready to get coverage, make sure you do your research. If you want an individual or ACA plan, you’ll want to make sure you sign up during your open enrollment period. Most states’ open enrollment period is Nov. 1-Dec. 15. Some states have longer open enrollment periods. 

These open enrollments are only for ACA and individual plans. You can go directly to health insurance companies' websites or hotlines, or go online to your state's marketplace. Not all insurers sell plans through the government-run marketplaces, so you'll find more options by shopping both in and outside the marketplaces. 

Meanwhile, employer-sponsored insurance plan open enrollment varies by company. These plans are often more affordable than individual plans unless your income allows you to get government subsidies. 

Here’s what you need to know about subsidies: 

  • The only way to claim subsidies when purchasing health insurance is to do so by buying your health insurance through the state’s insurance marketplace
  • Discounts are available for premiums in the form of a tax break if your income falls below 400% of the federal poverty level (FPL).
  • If your income falls below 250% of the FPL, you will qualify for a plan with reduced out-of-pocket costs

The bottom line is just because you have a disability doesn’t mean health insurance has to be expensive or unattainable. Do your research and find a plan that works for you and your needs.

Find out more about other types of insurance and disabilities: 

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