Filling the need for trusted information on national health issues…

I am 54 and living with a permanent disability, and for the past 12 months I have been receiving Social Security disability insurance (SSDI) payments. But I do not have health insurance. I am required to wait another 12 months before I can go on Medicare due to the two-year waiting period for people receiving SSDI payments. Am I eligible to purchase health insurance coverage from a marketplace plan under the ACA? Am I eligible for a premium tax credit? And what about Medicaid?

Yes, you are eligible to purchase coverage through the Marketplace, and if your income is between 100% and 400% of poverty ($12,060 to $48,240 for an individual in 2018) you will qualify for premium tax credits to help make Marketplace coverage more affordable.  If you live in a state that has expanded its Medicaid program to cover adults under age 65 with incomes up to 138% of poverty (about $16,640 for an individual in 2017), you might also be eligible for this coverage, depending on your income.

If you apply for and receive Marketplace coverage and subsidies, keep in mind that your eligibility for Marketplace subsidies will end when your Medicare Part A and Part B coverage automatically begins after the two-year waiting period.  At that point, you will have to pay the full price for your Marketplace coverage, but you could instead drop your Marketplace coverage and enroll in Medicare Part A, Part B and Part D.  If you keep both Medicare and Marketplace coverage, Medicare will be the primary payer.

Once your Medicare coverage begins, depending on your income, you may qualify for Medicaid in addition to Medicare or for extra help with premiums and cost sharing for your Part D prescription drug benefits.  A good place to turn for information about these programs and whether you might qualify is your local Social Security Administration office or the State Health Insurance Assistance Program in your state.  Medicare provides links and phone numbers for these and other organizations at the following website: http://www.medicare.gov/contacts/.

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.