If you have a disability, don’t qualify for disability benefits, and need health coverage, you have options in the Health Insurance Marketplace.
APPLYING FOR COVERAGE THROUGH THE MARKETPLACE
When you fill out a Marketplace health coverage application, you’ll find out if you qualify for a private health plan with premium tax credits and other savings based on your income. You’ll also find out if you qualify for Medicaid coverage.
When you fill out your application, you may be asked if you:
Have a physical disability or mental health condition that limits your ability to work, attend school, or take care of your daily needs.
Get help with daily living activities through personal assistance, a medical facility, or nursing home.
If you answer “yes” to any of these questions, the Marketplace may send your application to your state Medicaid office to see if you qualify for Medicaid based on a disability. Your state Medicaid office may contact you for more information about your disability.
Insurers offering coverage through the Marketplace can’t deny coverage or charge you more based on your answers to these disability questions. Private insurance plans in the Marketplace and all Medicaid programs cover all pre-existing health conditions from the first day your coverage takes effect.
IF YOU DO NOT QUALIFY FOR MEDICAID BASED ON YOUR DISABILITY
If you don’t qualify for Medicaid based on your disability, you have 2 more options for health coverage through the Marketplace:
You may qualify for Medicaid based only on your income. Some states have expanded their Medicaid programs to cover all adults who make less than a certain income level. Find out if your state is expanding Medicaid and what this means for you.
You may qualify to enroll in a health plan through the Health Insurance Marketplace with premium tax credits and other savings that make coverage more affordable. This will depend on your household size and income.
THE FEE FOR NOT HAVING COVERAGE
Under the health care law, most people must have health coverage, pay a fee, or get an exemption from the fee. This applies regardless of disability status.
If you don’t have coverage through Medicaid, another public program, a job, the Marketplace, or another source, you may have to pay the fee.
Some people can get an exemption from the fee based on low income, hardship, or other factors.