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Winter 2020  Volume 13, Number 4        

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Health Benefit Options for Those Who Are Disabled

Are you disabled and wondering if you qualify for health insurance at a reasonable rate?

You might be surprised to learn that you can get coverage and that there are several government programs designed to help you afford health coverage — even if you don't have a job.

The Affordable Care Act (ACA) requires insurance companies to cover everyone at the same rate — regardless of their health history. This was not the case before the ACA was implemented. Insurers were allowed to decline those who were disabled or had serious pre-existing conditions.

The ACA additionally puts a limit on out-of-pocket health costs and requires health plans to cover 10 essential health benefits, including preventive care, inpatient care, pediatrics and maternity care. Mental health and substance use disorders also are covered by any ACA-compliant health plans. Individual and small group health insurance plans must 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.

To determine which health insurance plan is best for you, consider working with a qualified broker. Health plan benefits and costs can vary drastically, and you’ll need someone to show you a variety of plans that fit your specific needs. For instance, every plan has different coverage levels and your broker can help you figure out if the equipment and medications you’re using are covered.

You also can obtain coverage through your employer. An advantage is that employer-sponsored coverage is subsidized by your employer.

Of course, it always pays to plan ahead for a worst-case scenario. Consider purchasing disability insurance — either on your own or through your employer. Disability insurance will pay part of your income for short or long-term situations.

Government Options

If none of the above options work for you, there are several government programs that might provide the assistance you need.

There are two federal programs designed for people with disabilities — Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

  • Social Security Disability Insurance: SSDI is for those who are fully disabled and who have a history of working and paying payroll taxes. In order to qualify, you must present medical evidence and other supporting documentation when you file a claim.
  • Supplemental Security Income: This program is income-based only and is for those who haven’t worked or who have not earned enough work credits to draw from SSDI. You won’t get as much money, but you will be automatically approved for Medicaid.

Another governmental plan that might be able to provide you with the health care coverage you need is Veterans Administration coverage. Veterans who have the most severe service-related disabilities receive the highest amount of coverage and benefits from the VA. Veterans with moderate disabilities come next and those without a disability receive fewer benefits and coverage.


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In this issue:

This Just In...

Your Life Insurance Options During the COVID-19 Pandemic

Health Benefit Options for Those Who Are Disabled

Tips for Saving for Retirement — Even When Budgets are Tight

Depression — No Excuse Not to See a Doctor


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