It’s an issue millions of Americans face each year. You recently became too disabled to work, yet you still need to go to the doctor. The problem is that you may not have health insurance anymore because most plans are still designed as employer-based coverage. This issue may be particularly acute for your family if you live in a state that didn’t expand Medicaid in recent years, such as Texas, Florida, or Wisconsin.
Fortunately, there are steps you can take TODAY to get health insurance coverage as you wait for Social Security disability approval. Healthcare.gov provides the information you need to move forward. Don’t wait to visit and get covered.
Step 1: Apply for Medicaid or a Reduced Cost ACA Marketplace Health Insurance Plan
To do this, you have two options. One: create an account at Healthcare.gov and complete an application. You’ll find out if you qualify for premium tax credits and lower costs on a private health plan based on the household size and income information you’ll enter during this process.
Keep in mind as you do so that it will take an unknown period of time to get a decision about your disability status from the Social Security Administration. Also, you don’t yet know what their decision will be. So, when you are estimating your income on the Marketplace application, do not include SSDI payments you think you may get.
You’ll find out if you qualify for Medicaid coverage as you fill out the application.
IMPORTANT: When you fill out your Marketplace application, answer “yes” when asked if you have a disability. This will result in your application being automatically forwarded to your state Medicaid agency. If you qualify, they’ll help you enroll.
The second option is to apply for Medicaid coverage directly through your state agency. Select your state from the menu on this Medicaid page for contact information.
Step 2: Wait for Security Disability Insurance (SSDI) Approval
Once you submit an application for disability benefits, several things need to happen. These all take time:
- The SSA reviews your application to make sure you meet some basic requirements for disability benefits.
- They check whether you worked enough years to qualify and evaluate any current work activities you are able to do.
- The SSA processes your application and forwards your case to the Disability Determination Services office in your state.
- Your state’s DDS agency makes the disability determination decision.
Once your application for disability payments via the Social Security Administration succeeds, you may have to wait 24 months before Medicare coverage starts. Because of this delay, it is wise to fill out the ACA application and enroll in a private plan as you wait. The SSDI program pays benefits to you only if you are “insured,” meaning that you worked long enough (and recently enough) to qualify. You can also only qualify if you paid Social Security taxes on your earnings.
If you get a negative disability decision — meaning your claim is denied — you can still fill out a Marketplace application to apply for coverage. You may learn at this time you qualify for free Medicaid. As an individual, your income cannot by higher than $13,590/year to qualify for free coverage. For two people, the income limit is $18,310; for a family of three, the number is $23,030/year. Even if find out you don’t qualify for Medicaid because your annual household income is above the threshold, you may qualify for an ACA health plan at a reduced monthly cost.
IMPORTANT: There’s a two-year wait after your approval date for SSD benefits until Medicare coverage kicks in.
A Better Option for Free or Reduced Cost Health Insurance
The Affordable Care Act plans may be a good option for you and your family regardless of the status of your application for disability benefits. These plans can cost as little as $10/month because the Biden administration used the American Rescue Plan to extend subsidies for the 12 states that did not expand Medicaid. Those states that did expand the program made Medicaid accessible for people under 138% of the Federal Poverty Level (FPL).
ACA plans are a great way to get health insurance. In some cases, these plans are even available to you and your family for free. Call this number for a free health insurance evaluation to see if you qualify: 1-888-292-6667.
If you prefer to look online to see income thresholds yourself, here are the poverty guidelines for 2022.
You May Qualify for Legal Assistance
Applying for disability benefits and trying to find health insurance coverage at the same time can feel overwhelming. If you need help, talk to an experienced Social Security attorney for free over the phone. Having a disability lawyer file your paperwork makes the process much easier.
Disability lawyers in every state work on contingency, so you’ll pay nothing for claim help now. Click here to sign up for a free, no-obligation phone call with a local attorney near you.
Want free professional help figuring out which ACA plan can help you bridge the Medicare gap? Call 1-888-292-6667 today and our agents will help you find an affordable plan that fits your needs!
Laura Schaefer is the author of The Teashop Girls, The Secret Ingredient, and Littler Women: A Modern Retelling. She is also an active co-author or ghostwriter of several nonfiction books on personal and business development. Laura currently lives in Windermere, Florida with her husband and daughter and works with clients all over the world. Visit her online at lauraschaeferwriter.com and linkedin.com.