Lauren Lewthwaite Last Updated On: June 27, 2023

Find the Best Disability Health Insurance for Individuals. Start Here.

The world is far from perfect for people with disabilities, and ableist conventions can and do prevail, but thanks to The Affordable Care Act (ACA), there’s never been a better time to get affordable health insurance for disabled adults under 65. 

Before, disabled individuals were denied coverage altogether or charged exorbitant rates—rates that made it impossible for many disabled persons to afford the health care they needed. Now, because of ACA regulations, health insurance providers can’t cap your benefits, charge you substantially more for your insurance or deny you coverage. In fact, carriers cannot consider pre-existing conditions at all when assigning or offering rates for health insurance. 

The result is a country where adults and even children are more readily, easily, and affordably insured.

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Table of Contents

Understanding How Health Insurance for Disabled Under 65 Works

There are several places you can look for health insurance for disabled adults under 65 or health insurance for a disabled child. We’re going to take you through the best options here and now so you can make the best decision for you. 



You may already know what you have to be over 65 or under 65 with a qualifying disability to be covered for Medicare. But there’s more to it than that. 

If you’re under 65 and want to be insured by Medicare, you must have received Social Security Disability Insurance (SSDI) for at least two full years or have end-stage renal disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), in which case you do not have to wait the two years. There’s also a five-month waiting period once you’re officially determined to be disabled before you can begin to collect these benefits. 

If you meet the criteria for Social Security Disability Insurance, you’ll be automatically enrolled in Medicare Parts A and B. After two years have elapsed (if you were required to wait the two years) you will be sent a Medicare card in the mail. 

If you wish to enroll in Medicare Advantage (Part C) or Medicare prescription (Part D), you will need to apply during your Initial Enrollment Period, which is within the seven months after you receive your two years of Social Security disability, or, alternatively, after you’ve received disability benefits from the RailRoad Retirement Board for two years.

Health Insurance for Disabled Persons Under 65 Who Don't Qualify for SSDI

If you meet the standards for Medicare, but don’t qualify for Social Security Disability Insurance benefits (usually because you have not worked long enough to earn the credits necessary to qualify), you can apply for Supplemental Security Insurance and receive Medicaid (a state and federal program for people with lower incomes). 

Supplement Security Insurance allows individuals to claim disability if they are medically disabled and/or have never worked. Just keep in mind there is an income and resource limit for the program ($2,000 in resources for an individual and $3,000 for a couple). 

Talk to your Social Security Office if you have questions about your Supplemental Security Insurance eligibility.

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Other Options for Health Insurance for Disabled Workers & Adults Under 65

In most states, you can apply for health insurance for disabled persons during the Marketplace’s open enrollment period (usually between  November 1st and December 15th). If you don’t apply during this period, you have to wait unless you have a life-altering event (like losing a job, and by extension, your employment insurance), in which case you can apply for a special open enrollment period.

Remember, thanks to the ACA, your condition cannot stop you from getting the coverage you need at a reasonable rate.

How Else Does ACA Ensure Your Coverage?

We’ve already mentioned that the ACA prevents you from being dropped, denied, or charged prohibitively expensive rates for your insurance just because you have a disability. Let’s look at some other ways the ACA ensures you get insured fairly in the Marketplace.
  • Out-of-pocket expenses are capped. So, there is a limit on how much you have to pay each year before your policy kicks in and covers costs. And that limit includes deductibles and copays.
  • Your plan can’t include a dollar limit on care.
  • Your plan must cover your child, even if that child has a disability. Also, your child can stay on your plan until s/he/they are 26 years old.
  • Mental health disabilities are included as disabilities—a groundbreaking win for people who are suffering from debilitating mental illness, including addiction.
Social Security data reveals that the approval rates for mental illness range from 73% for neurocognitive disorders and 88% for intellectual disorders. If you need help navigating the Marketplace, just request a free quote here with us. In just a few minutes, you’ll be on your way to getting the most affordable health insurance for disabled adults available.

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Veterans Health Insurance for Disabled Adults

Individuals who have served in the military can apply at Veterans Affairs for VA health benefits. Your VA health insurance will cover you whether your disability is a result of service or not, but those with service-related disabilities receive the most thorough benefits and coverage. 

Learn more: VA Health Insurance for Veterans: Check Your Eligibility.

Employer Insurance Through Your Spouse

If you have a spouse with an employer-provided insurance plan, hop on their policy. This is one of the easiest and most affordable ways to get health insurance for disabled persons under 65. 

More good news: if you qualify for Medicare, you can use this government insurance to help pay for your health care in tandem with your spouse’s group health plan coverage. Medicare will pay first and the group health plan will pay second if your spouse’s employer has less than 20 employees. If the employer has 20 or more employees, the group plan pays first and Medicare pays second.

The Takeaway: Health Insurance for Disabled Persons Under 65

Whatever option you choose, rest assured that even though the system isn’t perfect, the ACA has made life easier for disabled individuals looking for health insurance.

We’re also here to help.

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No, you can apply for Social Security Disability insurance (SSDI) and within two years, you will automatically be enrolled in Medicare after 24 months. If you have ALS or end-stage renal disease, you don’t have to wait the full two years and can receive coverage after a few months. There’s another exception to the two-year rule if you don’t qualify for SSDI, in which case you can apply for Supplemental Security Insurance (SSI) and qualify for Medicaid.

Unless Medicare is not giving you the coverage you need, there is no need to investigate Marketplace carriers for health insurance for disabled persons. In fact, it’s unlawful for health insurance providers to sell an individual market plan to someone with Medicare.

No, thanks to the Affordable Care Act (ACA), you cannot be denied health insurance because of your disability. You also cannot be dropped from your existing plan or charged substantially higher premiums.

Absolutely they do! You can qualify for SSDI or SSI, and by extension, Medicare or Medicaid, because of your mental illness. You are also protected from being charged prohibitive premiums or dropped or denied coverage thanks to the ACA.


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