Health Care Reform For People With Disabilities

Starting January, under the Affordable Care Act ("ACA"), Medicaid will be expanded to cover almost all low-income Americans, even those under 65, and even those without children or disabilities.[1] The maximum income levels to qualify for Medicaid will vary depending on the year, the size of the family, and other factors, but for 2014, single people making under about $15,280 may qualify for Medicaid, and a family of three making under around $25,975 also may qualify.[2]

Another major change starting in 2014: Health insurers can no longer deny coverage to people due to their disabilities or other "pre-existing conditions." Thus, people with
disabilities will be able to buy health insurance, even if they make too much money or otherwise fail to qualify for SSI and Medicaid, and even if their employer doesn't provide health benefits. J. Owen, The Affordable Care Act and People with Disabilities (Forbes, 7/18/12)

The “trade-off” for eliminating pre-existing exclusions is that now everyone is required to have health insurance.[3] If your employer does not provide health insurance, you will have to buy a policy from your state's "insurance exchange," and there will be a penalty for not having insurance. For 2014, the penalty will be fairly small ($95 per adult and $47.50 per child), but the penalty will increase significantly in later years.[4] However, there are a number of cases where the penalty will not apply, including if the cost of the insurance is more than 8% of your income.

To make it easier to avoid penalties, the ACA will provide subsidies to help cover the cost of buying health insurance if you don’t qualify for Medicare or have an employer-provided health plan. For 2014, individuals making up to $46,000, and four-person families making up to $94,200 will be eligible for subsidies, and in some cases, the subsidy amounts will be substantial.[5]

New insurance plans start January 1, but you will be able to start enrolling on October 1 of this year, and you can preview the plans and coverage options at California's "insurance exchange," Covered California. The website also has a calculator that estimates your health insurance cost and subsidies. The first open enrollment will last until March 31, 2014, but you should start your planning and enrollment as soon as possible: it may be more costly, and more difficult, to buy health insurance outside of the open enrollment periods.[6]

There are a number of other changes under the ACA.[7] These changes apply to all health plans, whether provided through employment or bought on the exchanges, including: (i) ability to keep children on the parents' plans until age 26, (ii) required minimum benefits, (iii) preventive care without co-pays, (iv) no lifetime or annual limits on essential coverage, and (v) limits on "demographic rating" practices (insurers will not be allowed to charge higher premiums based on gender or health status, and will be limited in the additional amounts they can charge based on age). There are also limits on insurance companies’ rate-setting policies, which may help to lower insurance premiums.  Am. Public Health Association

For more specific information on what the new laws mean to you and your family, and to get help enrolling and filling out forms (including even to get live, in-person help!), this website will direct you to phone numbers, websites, and health centers local to your neighborhood. (California only.)

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This article is written for California residents. Your state’s benefits and programs may differ. Consult your local health agency for more details. Last update 9/6/13.
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[1]  Currently, Medicaid is only available to people with disabilities and some low-income children and parents. Also, the new Medicaid eligibility only applies in states, such as California, that have chosen to allow this benefit. Am. Public Health Association.
[2]  The exact language is 133% of the federal poverty level ("FPL"). The $15,282 and $25,975 amounts are based on 2013 numbers, which may change for 2014, but should be good for an estimate. Families USA (citing data from the U.S. Department of Health and Human Services).
[3]  When everyone is insured, the pool is large enough to spread the risk of covering people with pre-existing conditions. If there were no requirement for healthy people to buy insurance, but insurance companies were required to sell policies to sick people, then healthy people could just wait until they get sick to buy insurance.
[4]  U.S.News & World Report (There are also maximum limits on penalties, based on family income.)
[5]  California HealthLine.
[6]  Get Ready For Open Enrollment (Market Wired, 8/21/13). Also, later enrollment periods will be shorter than this first, six-month period.
[7] Or later, as in the case of some provisions which are being delayed to allow more time to implement.