Health insurance for disabled adults
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.
Learn more about what is disability insurance and why you need it.
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.
Silver plans provide a good balance of monthly premiums with out-of-pocket costs. Coinsurance is 70% with a silver plan, meaning you will pay 30% of the costs after your deductible is met, up to the out-of-pocket limit. Silver plans are a good choice for people who are in generally good health but don't want high out-of-pocket costs if something goes wrong. Bronze plans are a popular choice with those who value low monthly premiums and are willing to pay more when they need care. Coinsurance is set at 60%, meaning you will pay 40% if you do need care, up to the out-of-pocket limit. Bronze plans are good for those who don't expect to need many services outside of preventative care throughout the year.
ACA platinum plans have the highest monthly premiums, but the lowest out-of-pocket costs. You'll pay more monthly in return for lower deductibles, copays and coinsurance amounts. Coinsurance with platinum plans is 90%, which means you pay 10% after the deductible, up to your out-of-pocket limit. Platinum plans are good for those who anticipate a lot of medical needs throughout the year.
Gold plans cost a little less than platinum plans, and come with higher out-of-pocket costs. The coinsurance amount on a gold plan is 80%, which means you pay 20% after the deductible, up to your out-of-pocket limit. A gold plan is a good idea if you think you'll need a lot of care throughout the year, but don't want to pay platinum premiums.Health insurance finder tool
COBRA
Learn more about COBRA
Medicare
Medicare costs vary depending on which option you choose.
Learn more about Medicare costs.
Medicaid
Parent's employer-sponsored health insurance
Spouse's employer-sponsored health insurance
Employer-sponsored health insurance
Preferred-provider Organization (PPOs)
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.
Find out more about the differences between plansHealth maintenance organization (HMO)
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.
Find out more about the differences between plansHigh-deductible health plans (HDHPs)
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.
Find out more about the differences between plansExclusive provider organization (EPO)
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.
Find out more about the differences between plans
Learn more about individual insurance plans
Know more individual insurance / ACA 
Know more individual insurance / ACA 
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.
