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Monday, Dec 22, 2014
Healthcare Exchange Q&A

Does my disabled relative need health insurance as they wait for Medicare?

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Q: I have an independent family member living solely on Social Security Disability. They have not been in the program long enough to be on Medicare. Will they have to purchase insurance under the Affordable Care Act? — Dan from Tampa

A: Millions of disabled Americans receive assistance from Social Security. But when it comes to medical coverage, many of those with Social Security Disability Insurance are stuck in a waiting game.

If your relative is not yet 65, he must wait two years to apply for Medicare, the government’s low-cost, primary health insurance program for seniors and the disabled. Right now, most of people the federal government recognizes as disabled have to pay high private insurance premiums, or pay out-of-pocket or rely on charity health clinics when they needed medical help.

If your relative also has applied for Social Security Income, he may qualify for Medicaid, an even lower-cost health insurance plan run jointly by the state and federal agencies.

If Medicaid is not an option, your relative can apply, starting Tuesday, for insurance on the health insurance marketplace, or exchange. Depending on income, he may qualify for subsidies on the commercial plans offered there.

Your relative’s situation is not listed as an exemption from the health law’s mandate that nearly all Americans get insurance. And nothing from Medicare or Social Security indicates that people in this coverage gap can go without insurance.

I encourage you to talk with an insurance expert about your situation. It seems that the already frustrating waiting game for your loved one may complicated some by the new health law.

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