Where can I sign up for health coverage?

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How you sign up depends on the type of coverage you get:
  • For Medicare, you automatically get coverage if you’ve been getting SSDI for two years. Otherwise, you may need to sign up.
  • For employer-sponsored coverage, talk to your employer’s Human Resources department.
  • For individual coverage, apply at Healthcare.gov. Healthcare.gov will first check whether you qualify for Medicaid and, if not, will let you compare individual plans and see whether the government will help with tax credits.

For Medicaid or the Working Disabled Medicaid Buy-In, you can apply:

If you use the combined application for services, you can also apply for other benefits at the same time, such as APA, Food Stamps, and Alaska Temporary Assistance Program (ATAP). If you apply for Medicaid online, you will have to apply for other benefits separately.

If my job offers me health coverage, can I still qualify for Medicaid or get subsidies for an individual plan on Healthcare.gov?

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You can qualify for Medicaid if your family’s income qualifies, even if your job offers insurance.

You cannot get subsidies for purchasing an individual health plan through Healthcare.gov if your job offers you affordable insurance.

Does it matter how I qualify for Medicaid?

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In most cases, no. The actual medical coverage you get from Medicaid will be the same, no matter how you qualified. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and if you have a disability and start working, you can earn a lot more while still getting Medicaid coverage through the Working Disabled Medicaid Buy-In.

Note: If you qualify for APA-related Medicaid, you may also get a monthly payment from the APA program. Learn more in DB101's SSI and APA article.

What is the most money I can make and still get Medicaid?

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For income-based Medicaid, the main income rules are:
  1. If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($21,528 per year for an individual; $44,422 for a family of four), you may qualify.
  2. If you are 18 or younger and your family’s income is at or under 208% of FPG ($66,955 per year for a family of four), you may qualify.
  3. If you are pregnant and your family’s income is at or under 205% of FPG ($65,990 per year for a family of four), you may qualify. The unborn baby is counted as a family member.

Income-based Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.

If you have a disability, you may be able to get Medicaid coverage if your income is a lot higher than this, thanks to the Working Disabled Medicaid Buy-In program. With the Working Disabled Medicaid Buy-In, the exact income limit depends on your living situation. If you live alone and don't have any unearned income, you could make as much as $6,585 per month and still qualify. (That's as much as $79,020 per year!) Learn more about the Working Disabled Medicaid Buy-In program.

Health Coverage Income Limits for Your Family

I’m an immigrant. Can I get Medicaid?

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  • Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
  • Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, if their income is at or below 400% of the Federal Poverty Guidelines (FPG), they can get private coverage subsidized by the government.
  • Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for all of the same programs that U.S. citizens can get.

Note: You can get Medicaid coverage if you are a Native American born in Canada or Mexico who has rights to cross the border.

What will happen to my Medicaid coverage if I go back to work?

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There are different health coverage options as your income goes up:
  • Depending on how much your income goes up, your Medicaid may continue, unchanged.
  • If you got Supplemental Security Income (SSI) before you started earning more, you can usually keep Medicaid thanks to SSI’s 1619(b) rule.
  • If you have a disability and work, you can also consider the Working Disabled Medicaid Buy-In. With the Working Disabled Medicaid Buy-In, if you live alone, you can work, earn up to $6,585 per month, and pay a monthly premium to get Medicaid coverage. The income limit is higher if you live with others. Note: The amount of earned income you can have for the Working Disabled Medicaid Buy-In depends on how much unearned income you have.
  • If your employer offers it, you may be able to get employer-sponsored coverage.
  • If your employer does not offer coverage, you should consider private individual coverage. If your income is at or below 400% of the Federal Poverty Guidelines (FPG) ($60,720 per year if you’re single), you may get government help to pay for an individual plan on Healthcare.gov.

The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage.

Who is eligible for the Working Disabled Medicaid Buy-In program?

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To qualify for the Working Disabled Medicaid Buy-In, you must:
  • Be a U.S. citizen or a qualified immigrant
  • Be working
  • Have a disability that meets Social Security’s medical standards.
    • Note: For the Working Disabled Medicaid Buy-In, SSA’s disability rules related to income do not apply.
  • Have unearned income at or below the APA need standard ($1,432 per month). Only your unearned matters for this requirement.
  • Have household countable income at or below 250% of the Federal Poverty Guidelines (FPG), including other members of your family you live with. That’s $3,250 per month if you live alone.
    • Not all of your earned income is counted. If you live alone and have no unearned income, you could actually earn up to $6,585 per month and still qualify for the Working Disabled Medicaid Buy-In. (That's as much as $79,020 per year!)
  • Have less than $10,000 in resources ($15,000 for couples). The house you live in and one car are not counted.

If you get Working Disabled Medicaid Buy-In coverage, you may need to pay a monthly premium. The amount you pay is based on your income and your family’s income. To learn how much your premium might be, try DB101's Benefits and Work Estimator.

How many programs does Medicare offer?

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Medicare has three main parts:
  • Medicare Part A helps pay for medical care you get while you’re in a hospital.
  • Medicare Part B helps pay for medical care you get outside of a hospital.
  • Medicare Part D helps pay for prescription drugs.

How do I become eligible for Medicare?

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If you or your spouse worked enough time while paying Medicare taxes, you will qualify for Medicare Parts A and B:
  • When you turn 65
  • When you’ve been getting Social Security Disability Insurance (SSDI) benefits for two years, or
  • If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or end-stage kidney disease (ESRD).

Note: If you have had a disability since before you were 22 years old, you will start getting Medicare if you get Childhood Disability Benefits (CDB) benefits for two years based on a parent’s work record.

Will Medicare pay for all of my medical expenses?

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No. Medicare will only help pay for care that it considers reasonable and necessary. If you need a service that Medicare doesn’t cover, you’ll have to pay for it yourself, unless you have other coverage, such as Medicaid or employer-sponsored coverage.

For certain services, you’ll pay a deductible, copayment, or co-insurance before Medicare will begin to help pay for that service. For Medicare Part B and Part D, you may have to pay a monthly premium.

You may qualify to get help paying for your Medicare premiums, copayments, and deductibles if you have low income. Medicare Savings Programs help pay for Part B coverage and the Low Income Subsidy (LIS) helps pay for Part D coverage.

Learn more about MSPs and the LIS.

Can I be on Medicare and another form of health coverage at the same time?

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Yes. Other types of coverage that you can have with Medicare include:

Learn more about how Medicare interacts with other types of coverage.

How much will employer-sponsored health coverage cost and who pays for it?

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You may be responsible for no cost, a percentage of the cost, or the amount of the cost of the coverage that is above what the employer agrees to pay.

Employers are supposed to offer plans that cost the employee, for the employee’s policy alone, less than 9.5% of the employee’s family income for the monthly premium. Also, that coverage must meet bronze-level standards for copayment, co-insurance, and deductible expenses.

If your employer offers a plan that does not meet these standards, you may qualify for government help through tax subsidies to reduce the premium on an individual plan.

Note: The coverage your employer offers must meet affordability standards for the employee, but not for the family. It may be very expensive for family members to join an employer-sponsored health plan. Even so, anybody who could get employer-sponsored coverage, even if it is not affordable for the family member, will not qualify for tax subsidies to buy an individual plan on Healthcare.gov.

Can I get coverage through my parent’s employer-sponsored insurance?

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Yes, if you are under 26 and cannot get health coverage through your own employer. Employers who offer coverage to their employees must also offer it to their children under the age of 26.

Employers do not have to offer coverage to the spouses of employees, but many do.

Note: While employers must offer this coverage to children, the employee may be required to pay for all of it.

I have a disability. Will I really be able to get insurance that covers my medical problems?

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Yes. Plans cannot deny people coverage. When you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.

Additionally, all plans must cover the Essential Health Benefits (EHBs), which means that they offer comprehensive coverage, including chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, just to name a few.

How does the government help people pay for individual coverage?

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Depending on your situation, you may qualify to have the government help pay for your individual health plan through tax credits. Here's how it works:
  1. When you sign up at Healthcare.gov, you give details about your family's situation. Healthcare.gov reviews that information instantly. If your family qualifies for government help to pay for individual coverage, Healthcare.gov tells you and lists insurance options for you.
  2. Your insurance options list the full cost of the monthly premium, how much of that premium the government will pay each month, and how much you will pay each month. The way the government helps pay for the premium is by giving you a tax credit every month, so you don't have to think about it during the year. All you have to do is make sure you keep paying your part of the premium.
  3. In January or February, the government will send you a form listing how much your total health coverage tax credits were for the previous year. You will need this form at tax time, because it is possible the government paid more or less than it should have for your health coverage. If so, this will be sorted out when you file your taxes.

Do I have to get a silver-level plan on Healthcare.gov if I want government help paying for my insurance?

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No, but depending on your income, you may get more help from the government if you get a silver-level plan:
  • If your family makes 400% of the Federal Poverty Guidelines (FPG) or less, the government helps pay for your premium through tax credits. That means you pay less each month. You can get this help no matter what metal your plan is.
  • If you make 250% of FPG or less and get a silver plan, the government also pays to reduce your copayments, co-insurance, deductible, and out-of-pocket maximum. That means you’ll pay less each time you need medical services. If you get this help, your silver plan might actually be as good or better than many platinum or gold plans. If you do not get a silver plan, the government will not help you with these expenses.

When Healthcare.gov looks at your income, they will count most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

Health Coverage Income Limits for Your Family

What happens if I sign up for an individual plan and then my income changes and I can no longer afford it?

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Usually, when you sign up for a plan through Healthcare.gov, you need to stay on the plan for the entire calendar year. So, if you are signed up for 2019, then you can’t leave that plan until 2020.

However, there are certain situations when you may be able to change plans mid-year:

  • If your income changes and you gain or lose eligibility for government help paying for your coverage
  • If your health provider is not meeting its obligations
  • If you move, or
  • In other life-changing circumstances, such as having a child or getting married.

The first one is the key. If your income goes down and you can’t afford your plan anymore, report your change in income to Healthcare.gov. You may qualify to get Medicaid or to have the government increase how much it pays for your current insurance (meaning that you have to pay less).

Note: American Indians and Alaska Natives do not have these restrictions and can change up to once a month.