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Prior to the ACA, people with disabilities were declined or charged higher health insurance rates.

Now, health insurance companies have to cover you regardless of your health history, and health insurance for a disabled person can’t cost more, either. Disability health insurance is the same as for anyone else.

Insurance for people on disability, however, might be different in the sense that you may be eligible for government programs. Health insurance for disabled people under 65 is available through Medicare.

Below we’ll discuss the health insurance options for anyone who is disabled, including ACA plans and private health insurance.

KEY TAKEAWAYS
  • The ACA prohibits insurance companies from denying coverage or increasing rates due to a disability.
  • If you qualify for Social Security Disability Income, you can apply for Medicare.
  • Disabled veterans can obtain coverage through Veteran’s Affairs.

Health insurance for disabled people

The ACA’s rules mean 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 individuals, 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.

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.

Frequently asked questions

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.