Disability Benefits and Health Insurance Options | Heart Disease and Stroke

Updated:Apr 11,2014

If you are a heart disease or stroke survivor, you may need to know if you’re eligible for disability benefits and what health insurance options are available. The information below will help you get started.

Health Insurance Marketplaces Now Open: New Health Insurance Marketplaces that provide one-stop shopping for health insurance for individuals and families who need coverage are open in every state. Financial assistance is available to help make the premiums affordable. Insurance companies are not allowed to deny coverage to individuals with pre-existing medical conditions or charge higher premiums because of health status. To find the Health Insurance Marketplace for your state, visit www.healthcare.gov or call toll-free at 1-800-318-2596.

Eligibility: Individuals who need coverage who are legally residing in the U.S. and who are not incarcerated are eligible to purchase coverage through their state’s Marketplace. Small employers with fewer than 50 full-time employers can also purchase coverage through the Marketplace. Insurance companies will not be allowed to deny coverage to individuals with pre-existing medical conditions nor will they be allowed to charge higher premiums to people because of their health status.

Financial Assistance Available: Most uninsured individuals qualify for financial assistance called a Health Insurance Premium Tax Credit to help make their insurance premiums affordable. The amount of financial assistance depends on your income and family size. Individuals with low incomes may qualify for free or very low premiums. To find out how much financial assistance you may qualify for, check out the Kaiser Family Foundation’s subsidy calculator

Types of Coverage: All of the health plans sold through the Marketplace are offered by private insurance companies and are required to meet minimum requirements. All of the plans are required to cover a comprehensive set of benefits that includes hospital care, doctors’ visits, emergency care, prescription drugs, lab services, preventive care, and rehabilitative services. Before choosing a plan, individuals will be able to see whether their healthcare practitioner participates in the plan’s network (if choosing a network plan). Individuals will be able to choose the plan that best meets their needs and budget. Individuals with low-incomes may instead qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program

How to Enroll: Individuals who need coverage can fill out a single application to find out what financial assistance they are eligible for and to apply for coverage. To find your state’s Marketplace and to apply online go to www.healthcare.gov. Individuals can also call toll-free 1-800-318-2596 to apply. Those needing assistance with filling out the application can get help from trained, certified counselors; to find in-person assistance near you, contact your state’s Marketplace or visit www.healthcare.gov.

The next open enrollment period will begin on November 15th, 2014 and end on February 15th, 2015. However, if you have lost your job and therefore your health insurance because you became disabled, you may qualify for a special enrollment period to buy coverage outside of the regular open enrollment period. Check with your state’s Marketplace to see if you qualify for a special enrollment period. Additionally, you may now be eligible for Medicaid as a result of becoming disabled and you can sign up for Medicaid at any point during the year.

Social Security Disability Benefits and Medicare

If you have a medical condition that is expected to prevent you from working for at least one year or result in death you may be eligible for Social Security disability benefits. Individuals who qualify will receive a monthly financial benefit. In addition, individuals who qualify for disability benefits can enroll in Medicare at any age (you do not have to be 65), as long as you have received disability benefits for at least 24 months.

To learn more about Social Security disability benefits or to find out if you’re eligible to enroll in Medicare now, contact your local Social Security Office or apply online or call (800) 772-1213. 

Individuals with very severe disabilities, including several heart conditions, may qualify for Social Security’s Compassionate Allowances program. It provides a faster path to disability benefits for patients with certain life-threatening conditions.

Medicaid: Depending on your income and the state in which you live, Medicaid provides free or very low-cost coverage to the disabled. Medicaid is a partnership between state and federal governments that provides coverage for medical services to certain individuals and families who have low incomes. Find your state’s Medicaid program. Individuals can find out whether they are eligible for Medicaid by submitting a short application through their state’s Health Insurance Marketplace.

High-risk Pools: About 35 states have high-risk pools that provide coverage to people with medical conditions who are not able to get other coverage. Find out if your state has a high-risk pool option. Many states may be phasing out their high-risk pools starting January 1, 2014 when insurance companies will be prohibited from denying coverage or charging higher premiums to people with medical conditions. Many people currently being covered through a high-risk pool will qualify for the Health Insurance Premium Tax Credit to help make coverage more affordable for them through their state’s Health Insurance Marketplace.  

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