Proper and affordable health insurance can be incredibly difficult to secure for individuals who are considered to be disabled or for those with certain medical conditions. Fortunately, the federal government and most states have made sure that everyone is able to receive health insurance, in some way, regardless of one’s illnesses, diseases and physical or mental impairments.

Disability Qualifications

If traditional health insurance will not cover you due to disabilities or specific conditions and symptoms, you still have options. For people who suffer from certain intellectual, cognitive, physical or mental health disabilities, you might be able to qualify for a variety of health insurance programs and providers. To be qualified as disabled, you will have to meet specific criteria, such as:

  • Blindness
  • Concentration Issues
  • Deafness
  • Difficulty with Errands
  • Hard of Hearing
  • Hard or Incapable to Walk or Climb Stairs
  • Inability to Live Independently
  • Memory Issues
  • Mood Disorders
  • Slipped Discs
  • Slurred Speech
  • Trouble Making Decisions
  • Visual Restrictions

These are only a few examples of various conditions that could qualify as disabilities as described by the Social Security Administration (SSA). If you already qualify for programs such as Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits, you might already be qualified as disabled and be eligible for Medicare, Medicaid or additional state health insurance programs.

Employer Requirements

Generally speaking, if you have a full-time job with an employer that has more than 50 full-time employees, you should be entitled to employee health insurance. Typically you must work at least 30 hours each week to qualify, and keep in mind that you may have to pay a portion of the insurance costs out of your paycheck each week to make up the difference between employer contributions and the full cost of insurance. The type of insurance offered must also include specific health benefits that help individuals manage their disabilities, including physical therapy, mental health services, management for chronic diseases and more.

Disability Insurance

Insurance you receive through an employer or that you pay for on your own will typically offer short-term and long-term disability insurance as part of your plan. These types of disability plans are designed to assist with the replacement of lost wages due to injury or illness. It is possible to receive up to 70% of wages with the right healthcare disability insurance plan. Most plans offer significantly less coverage. A short-term policy is typically only available for three to six months; whereas, a long-term policy can potentially last for up to 20 years or until retirement. Each plan will be different, and plans with better coverage are often more expensive.

Medicaid

Medicaid was created to provide health insurance and reduce overall healthcare expenses for individuals who have limited financial resources and low annual income earnings. Both state and federal programs are available for those who qualify. These plans offer a wide array of services that help people with impairments, such as free mobile phones, transport to and from doctor appointments, in-home care and others. Those receiving SSDI who are waiting for Medicare coverage to begin can often qualify for Medicaid during this waiting period. Medicaid can be free or offered at a discounted price based on annual income.

Medicare

Medicare is most common for individuals who are 65 or older and for people of all ages who have specific qualifying disability factors. Plans cover hospital insurance, which is also called Part A, and medical insurance, which is referred to as Part B. The Part C plan typically combines Part A, Part B and Part D. Part D is the prescription drug coverage. Some people may have to pay for at least some portion of one or all parts of this type of insurance. Individuals who qualify for SSDI will likely eventually qualify for Medicare, as well. It is possible to supplement your Medicare policy if you enroll in a Marketplace plan before you apply for Medicare. However, you may lose certain benefits by doing so. If you have a Medicare plan before you enroll in a Marketplace plan, you may not be able to supplement the plan with alternative options through the Marketplace.

Affordable Care Act Marketplace

The Marketplace was established as part of the Affordable Care Act for people who require affordable healthcare insurance, including those with disabilities, those who do not qualify for disability benefit programs and those who simply need health insurance for any reason. The plans available in the Marketplace should not be able to discriminate against you for having disabilities. They also typically have a cap on out-of-pocket expenses and restrictions on the amount you can spend throughout the calendar year. Tax credits and savings programs are also available based on annual income and the size of your household.

VA Health Care

Individuals who are veterans and have disabilities in any way may qualify for VA health care. To qualify, your injury or illness typically has to be proven to be the result of your service or that your preexisting conditions were made worse because of active duty requirements. These benefits are tax-free and are provided as a monthly benefit. It is possible to supplement this health care with Medicare, health savings accounts, TRICARE and more. TRICARE is yet another health insurance program for uniformed service personnel, their families and those who have retired.

The Self-Employed

If you are self-employed or own your own small business, you might be eligible for any and all of these options, as well. Many people who are disabled with either physical or mental limitations choose to be self-employed rather than to work for an employer. In this case, you have the same options as anyone else in a similar condition. You might qualify for SSI and SSDI benefits as well as Medicaid, Medicare and others.

Save on Prescriptions

If you do have to pay for prescriptions either full price or on a sliding scale, there are a number of ways to save money on prescriptions. Several apps have been developed that will tell you where to find the cheapest prescription prices. All pharmacies negotiate their own prices, so it is best to do a price comparison when possible. You can always ask for samples from your doctor.

Speak with your doctor or pharmacist about using generic brands rather than more expensive name brands. Consider ordering your prescriptions online. Reach out to pharmacies and local and state agencies directly to apply for pharmaceutical financial assistance. Look for coupons, coupon codes and instant savings. Remember that you might qualify for Medicare’s Part D prescription drug health plan even if you do not qualify for the other parts. And it might be less expensive to pay out of pocket rather than through your insurance company so be sure to check.


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About Citizens Disability, LLC:

Since 2010, Citizens Disability has been America’s premier Social Security Disability institution. Our services include helping people in applying for SSDI benefits, managing the process through Reconsideration, and representing people in person at their Hearing, and if necessary, bringing their case to the Appeals Council. Our mission is to give a voice to the millions of Americans who are disabled and unable to work, helping them receive the Social Security Disability benefits to which they may be entitled. Learn more about us and disability benefits like SSDI & SSI or give us a call at (800) 492-3260.


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