Disability health insurance: How to get insurance if you have a disability

Health insurance for disabled adults

Adults with disabilities have access to ACA Marketplace health plans, just like other consumers. The right plan depends on your medical needs, prescription drugs, income, and expected out-of-pocket costs.

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

"[The ACA provided for] 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 the ACA expanded Medicaid to more people in more states," he said.

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

"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 said.

That means there is no particular health plan for those who are disabled. You can choose from any ACA health plan you prefer. Consider coverage for your needs, such as for durable medical equipment, Fertig recommends.

"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.”

Social Security Disability Insurance and Medicare or Medicaid

If a physical or mental disability prevents you from working, and you meet Social Security's disability definition and work-credit requirements, you can apply for Social Security Disability Insurance (SSDI). Social Security evaluates your medical condition and work history when deciding whether to approve your claim.

Once you receive SSDI benefits for 24 months, you generally qualify for Medicare, regardless of age. The waiting period does not apply to people with ALS, who qualify for Medicare when their disability benefits begin. Special eligibility rules also apply to people with end-stage renal disease.

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

While it doesn't happen often, some cases meet the minimum for the person to also receive SSI. In this case, it's not as black-and-white as whether the person will receive Medicaid or Medicare.

Health insurance for disabled veterans

The Department of Veterans Affairs (VA) provides health benefits to disabled veterans based on a tiered priority 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 less 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

ACA-compliant individual and small-group health plans must cover mental health and substance use disorder services as essential health benefits. These plans must also follow applicable mental health parity requirements.

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 had to offer comparable coverage only on group plans.

FAQ: Health insurance for disabled people

Do you get health insurance on disability?

No, not automatically. 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 Social Security Disability Insurance will also qualify you for Medicare. This is generally defined as any medical condition that prevents you from doing Substantial Gainful Activity (SGA) for at least 12 months or is terminal. You can find a full list of qualifying disabilities here.

Who pays for health insurance on long-term disability?

You pay for your health insurance when you are disabled and no longer employed. If you qualify for Social Security Disability Insurance, you may pay much less for your coverage than with an ACA plan.