The Affordable Care Act, also called Obamacare, is going to be in full effect beginning January 1, 2014. This means that individuals, including those with pre-existing conditions, are now able to obtain insurance coverage by shopping at a federal or state health insurance exchange. It also means that the Affordable Care Act individual mandate is in place, requiring everyone to have insurance or pay a penalty of $95 unless they fall within a limited exception.
The Affordable Care Act has opened the door to universal healthcare in the United States, but many people, especially those with lower incomes who live in states that have not expanded Medicaid, are concerned about how they will obtain insurance coverage or whether they will become responsible for paying a penalty. For those who are disabled, however, one way to meet the insurance requirements is to qualify for supplemental security income (SSI). Our Boston social security disability lawyers know that supplemental security income recipients are also generally eligible to receive Medicaid benefits, which satisfy the insurance requirements under the ACA.
SSI, Medicaid and the Affordable Care Act
The Affordable Care Act provides many benefits to the disabled by preventing insurance companies from discriminating against applicants on the basis of pre-existing conditions. Under the rules set forth by the ACA, an applicant for insurance cannot be denied coverage because of a medical condition that exists at the time of the application.
There are also controls in place preventing the disabled and sick from being charged exorbitant and prohibitively expensive insurance rates just on the basis of the fact that they are sick. Instead, community ratings mandate that prices are set based on the area where the insurance is being sold, and that older people cannot be charged more than three times the cost of what a younger person’s premiums will be.
Because of these provisions, the disabled who may have been priced out of the insurance market due to their condition may now be eligible to purchase a policy for the first time in a long time or even the first time ever. However, those who are so disabled that they cannot work may still have a difficult time affording payments for insurance coverage.
The Affordable Care Act also included provisions expanding Medicaid to cover individuals who were previously not covered under the income rules. The ACA mandated that it would now be possible for individuals making up to 133 percent of the poverty line to become eligible for benefits. Unfortunately, however, when the ACA was challenged in court and the Supreme Court ruled on the constitutionality of the law, the court ruled that the federal government could not compel the states to accept the money and expand their Medicaid programs. Many states chose not to do so, thus creating a Medicaid coverage gap where individuals who should have qualified for Medicaid were unable to do so yet also made too little to qualify for subsidies to buy insurance on the federal or state exchanges.
For those receiving SSI income, however, Medicaid eligibility typically comes along with eligibility for SSI benefits. This means that no matter what state you live in, you can receive Medicaid benefits and have your insurance coverage needs met in order to avoid being subject to the Affordable Care Act penalty. Individuals who are disabled and who cannot work should speak with an attorney about applying for SSI benefits in order to both get monthly income from the SSA and to ensure they qualify for Medicaid under SSI so they fulfill their obligations under the new insurance mandate.
If you are considering filing for SSD benefits in Boston, call for a free and confidential appointment at (617) 777-7777.
More Blog Entries:
Disabled Workers Struggle to Find Jobs and are Paid Less, Nov. 5, 2013, Boston Social Security Disability Lawyer Blog