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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Reform Affects Disability Care

Other Protections

The Affordable Care Act protects your insurance coverage in several ways:

  • You cannot be dropped from your plan because you have a disability.
  • Your plan must cover your child, even if the child has a disability.
  • You cannot be turned down for coverage if you have a disability.
  • Your children can stay on your plan until they reach age 26.
  • Your plan cannot include a dollar limit on care.  Annual and lifetime limits go away.
  • You cannot be charged more for insurance because you are sick or disabled.
  • Your out-of-pocket costs are capped. There's a limit on how much you will spend each year. After reaching that amount, your plan covers all costs. That includes copays and deductibles.



Getting Coverage

If you use the Marketplace to shop for health insurance, you will be able to see what health care plans are available to you, the cost of the plans, and whether you qualify for help with your costs.

The Marketplace is not for you if you’re already covered by Medicare or Medicaid, or if you have a health plan through your employer.

Eligibility for Medicaid varies greatly from state to state. In states that expanded Medicaid under the Affordable Care Act, you will qualify if you earn $16,243 or less a year ($33,465 for a family of four). If you qualify for Supplemental Security Income because of your disability, you will generally qualify for Medicaid coverage in your state. You should check with your State Medicaid agency to find out the details.

Helping You Live Independently

If you are struggling to live on your own with a disability or care for a relative who is disabled, the Affordable Care Act may help. The law expanded Medicaid programs that provide in-home care and help you avoid moving to a nursing home. The expansion of Medicaid’s Home and Community-Based Service options can help you stay independent or provide care for a loved one. In general, these services are only available to people who qualify for Medicaid.

Savings on Drug Costs for Seniors

The gap in Medicare coverage for prescription drugs – also called the donut hole -- is slowly going away. By 2020, you'll pay only 25% for covered brand-name and generic medications. See "What Medicare Costs, Part D" to get the details, including what discounts are available until the donut hole closes.

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