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.
