When you’re disabled, getting the right medical care is vital. Unfortunately, in many cases when a disabled individual stops working, they lose the health insurance they had through their employment. Or if they have the option for extended coverage through COBRA, it’s too pricey. Oftentimes during the wait for the Social Security Administration (SSA) to decide a claim, individuals find themselves totally uninsured. All approved SSD claimants automatically qualify for Medicare coverage, but it doesn’t begin when payments do. Known as a “Medicare gap,” this is a required two-year waiting period before Medicare medical insurance officially kicks in.
Why is there this Medicare gap? Well, Congress originally approved Medicare only for individuals over 65. Then the program expanded to include persons with disabilities, but that was a very expensive proposition. Basically, the two-year waiting period is a governmental cost-saving measure.
So, what do you do in the meantime? Well, the first thing is not to panic. You have options. The next thing to do is learn more about the Affordable Care Act.
How the Affordable Care Act Closes the Medicare Gap
Many people think they can’t afford health insurance in the United States. And for a long time, that was true. But with the passage of the Affordable Care Act (ACA) in 2010 came the creation of the healthcare Marketplace. The Marketplace made it possible for the first time for citizens without employer-sponsored insurance to have access to quality coverage.
As a result of expansion programs, people under 138% of the Federal Poverty Level (FPL) may now qualify for Medicaid. And a health insurance company cannot deny any citizen coverage owing to a pre-existing condition. This is especially important for individuals facing disability whether from illness or injury.
What’s more, the ACA offers financial subsidies that reduce health coverage premiums for millions of Americans. The Biden-Harris administration’s “American Rescue Plan” (ARP) — passed during the pandemic — further increased consumer tax credits making health insurance affordable.
In fact, during the Open Enrollment Period (OEP) for 2022, a record 14.5 million Americans signed up for Marketplace coverage. This was a 22% increase from previous years. The ARP subsidies mitigated the financial burden of healthcare on Americans during the worst public health crisis in a generation. Nearly 6 million formerly uninsured people now have healthcare thanks to changes made in the first year of Biden’s presidency.
All this to say, there is no reason for you to go without healthcare coverage while waiting for disability approval. There are currently more options than ever before for people to find assistance.
Can I Qualify for Medicaid?
Medicaid programs have expanded exponentially with the advent of the ACA and more recently the additional ARP. However, these programs vary from state to state, with some states offering more expanded benefits than others.
Many people assume if they qualify for disability, they’ll automatically qualify for Medicaid, but that’s not always the case. It truly depends on where you live.
Currently, there are 34 states and the District of Columbia that confer automatic Medicaid enrollment to Supplemental Security Income (SSI) disability recipients. There are other states that use the same financial qualifications as SSI, but you must submit separate paperwork for coverage. And there are nine states with more restrictive application parameters than SSI.
Basically, if you qualify for SSI benefits, you stand a good chance of also qualifying for Medicaid. And it is especially helpful in bridging the Medicare gap for disabled individuals. That being said, Medicaid is also a great option for people with limited income even if they’re not on disability.
To see the Medicaid rules in your state and learn how to apply, visit Medicaid.gov or call toll-free: 877-267-2323.
What If I’m Still Stuck in the Medicare Gap?
Don’t despair if you discover you’re in a state that has yet to expand Medicaid (currently there are 12)! This is where the ACA Marketplace comes back into play.
By taking a quick assessment at the Healthcare.gov site, you can learn what health insurance options are available to you. Keep in mind that there are generous subsidies and tax credits offered through the ARP. As a result, you may still be able to get coverage as low as $10/month, or even free! You just have to be willing to fill out the paperwork.
Fortunately, the ACA has streamlined the process immensely. Here are the steps:
- Create an account on the Healthcare.gov site.
- Log in to complete the application. Keep in mind you’ll have to answer questions about your income. If you’ve not yet qualified for disability, do not include any payments you think you’ll receive. Only include your current income (which may be $0 if you’re not working).
- If you’re waiting for a disability determination, check “yes” on the Marketplace form when asked if you’re disabled. That will automatically get your application forwarded to your state Medicaid agency who will check your eligibility. If you qualify, they’ll help you enroll.
- If you don’t qualify for Medicaid, you may still qualify for premium tax credits and other savings. You can use these to finance your participation in a private health plan through the Marketplace.
The ACA Marketplace will help close the Medicare gap while you wait for other health insurance coverage to start.
The Final Word
Health insurance is important. While awaiting a decision on your disability claim, you still need to get your meds and see your doctor. Why is this particularly vital? Because treatment from a doctor is often required medical evidence for disability claims.
In other words, don’t think you have to skip health insurance until you can afford it. The reality is thanks to the ACA and ARP, you can probably afford it now. In fact, you can’t afford not to.
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 healthcare needs!
Kimberly Dawn Neumann
Kimberly Dawn Neumann is a multi-published NYC-based magazine and book writer whose work has appeared in a wide variety of publications ranging from Forbes to Cosmopolitan. She graduated summa cum laude from the University of Maryland, College of Journalism. For more, visit: www.KDNeumann.com, Instagram @dancerscribe, and Twitter/X @KimberlyNeumann.