Types of Health Coverage

With a disability, a top priority is to make sure that you have health coverage. Your financial situation and employment status decide what types of coverage you can get. These are the main options:

Private Health Care Coverage

Private health care coverage is the most common type of health coverage.

What it offers

It pays for some of your medical costs when you see a doctor, go to the hospital, get medical exams, or get prescription medicine. You may need to pay copayments, premiums, or deductibles for these services. Depending on your coverage plan, it may pay for almost the entire cost of your medical expenses, or it may pay only a portion of those expenses. If you have low income and get private coverage through Healthcare.gov the government may help pay your premium.

How you get it

The most common way of getting private health coverage is through your job or your spouse’s job. Many, but not all, jobs offer health care benefits. If you are still working and get health coverage through your job, your employer will continue to pay most of the expenses for your health insurance. Your spouse or parent (if you’re under 26) may also have a job that will provide health insurance for you.

You can also buy your insurance directly from a private insurance company, through an insurance broker, or on Healthcare.gov. You can buy private coverage for yourself and for your entire family. Insurance companies cannot reject your application or charge you more because you have a health condition. Healthcare.gov is the only place where people who have lower incomes can get government help paying for their individual coverage plan.

When it’s a good option

Private health coverage is best when you or your spouse (or parent) has a job where the employer will pay for it. Or, if you make less than 400% of the Federal Poverty Guidelines (FPG), $48,560 for an individual in 2018 ($100,400 for a family of four), and can’t get affordable health coverage through your job, the government will help pay for your premium. To get government help paying your premium, you must buy a plan through Healthcare.gov.

It’s important to also note that private health coverage doesn’t always cover everything – you may get private coverage and also be able to get public health coverage to cover whatever the private insurance doesn’t pay for.

To learn more, read the DB101 page about Private Health Care Coverage.

MO HealthNet

Missouri’s public health coverage program is called MO HealthNet.

What it offers

MO HealthNet pays medical expenses for people with disabilities, older adults, children, pregnant women, and people with low income.

If you qualify, MO HealthNet will help pay for your visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. You may need to pay a small copayment for these services.

How you get it

There are various ways of qualifying. The income limit and resource limit depend on your situation. For example, MO HealthNet for Kids is easier to qualify for than MO HealthNet for adults. Likewise, if your disability meets the Social Security definition of disability, it may be easier for you to qualify.

To apply for health care coverage through MO HealthNet:

When it’s a good option

If you, your spouse, and your parents (if you’re under 26) don’t have jobs where the employer will supply you with private health coverage, MO HealthNet is your best bet. If you have very low income and resources, you may qualify for MO HealthNet. If you are under the age of 19, you may qualify for MO HealthNet for Kids. If you have a disability that meets Social Security’s definition of disability, you can have a job and will still likely qualify for MO HealthNet.

MO HealthNet’s Ticket to Work Health Assurance Program
If you have a disability and have a job, you may still be able to get MO HealthNet coverage, even if your income is higher than the usual income limit. That’s because MO HealthNet has special rules for people with disabilities, allowing them to earn some money without losing the health coverage they need. One of these rules is called the Ticket to Work Health Assurance Program (TWHA). If your income is higher than what’s usually allowed for people on MO HealthNet, you can choose to keep your coverage by paying a small monthly premium.

To learn more about how this works and other ways you can get MO HealthNet if you have a job, read the DB101 article on Health Care Coverage Options While Working.

To read more about your health coverage options when you have a job, click here.

Read more about MO HealthNet on the website of the Missouri Department of Social Services (DSS).

Medicare

Medicare is another public health program, but it is run by the federal government, not by the state. While you work, some of the money you earn automatically comes out of your paycheck and goes into a Medicare fund. If you become disabled and start getting Social Security Disability Insurance (SSDI), you will start getting Medicare 2 years after your SSDI benefit begins.

What it offers

Medicare has different “parts” that each help pay for your medical care.

  • 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, like when you go to the doctor.
  • Medicare Part C, also known as Medicare Advantage, is a way to get Part A, B, and sometimes Part D coverage through private companies.
  • Medicare Part D helps pay for prescription drugs.

Each Medicare part has different rules for how you sign up, how much you have to pay in premiums or copayments, which medical costs it helps with, and how much of the costs it will help pay for.

How you get it

People with disabilities get Medicare after being on Social Security Disability Insurance (SSDI) for 24 months. SSDI provides income for people who have worked and earned enough work credits to qualify, but who can no longer work because of a disability. Once you’ve been getting SSDI for 2 years, you automatically qualify to get Medicare and will begin to get coverage without having to fill out an application.

In the two years before you qualify for Medicare, you’ll need to get coverage through one of the other health coverage options introduced in this article.

When it’s a good option

Medicare is always a good option if you qualify. Often it can also be combined with other programs, such as MO HealthNet, so that your share of expenses is lower.

Read more about Medicare on the Medicare website.