understand health coverage
The health care costs associated with living with a spinal cord injury can be significant, even overwhelming. The good news is that there are many options for getting health care coverage, even if you are uninsured or underinsured.
To begin the process, meet with a social worker at your hospital to help you gather the relevant paperwork and begin applying for Medicare, Medicaid, and Social Security. social workers or caseworkers are there to help you manage your care or that of your family member.
Hospitals that accept federal money must provide a certain amount of free or reduced-price care. check with the hospital’s financial aid department to see if you qualify for reduced or charity care.
health insurance market
The Affordable Care Act (ACA), passed in 2010, requires that all American citizens have the opportunity to shop online (or over the phone) for the best available insurance coverage that fits their individual needs and budget.
The health insurance marketplace, sometimes called the “exchange” or simply “the marketplace,” was established as part of the ACA. is a service that helps people shop for and enroll in health insurance. The Marketplace can help you if you don’t have coverage, or if you do but want to explore other options.
With a Marketplace app, you can compare your coverage options side-by-side and enroll. Depending on a person’s income, coverage options provided through the Marketplaces may be a better option than what is currently offered through a person’s employer, but not necessarily. the market also offers the uninsured options they may not have been aware of in the past.
healthcare.gov will direct you to your state’s marketplace seamlessly. It is certainly the best place to start. The site will ask you basic questions about your income, family size, where you live, and give you an overview of the insurance options (both public and private) you qualify for. then you can make decisions based on your own needs, the needs of your family, and your budget.
Medicare is a federal insurance program available to those:
- 65 years or older (regardless of your income)
- under age 65 with a disability who have received social security disability insurance (ssdi) for at least 24 months
- individuals of all ages who have end-stage renal disease (permanent kidney failure requiring dialysis or a transplant)
Medicare enrollees pay part of the costs through hospital deductibles and other costs. small monthly premiums are required for non-hospital coverage.
medicare is not part of the health insurance marketplace, and the marketplace does not offer medicare supplemental insurance (medigap) or part d prescription drug plans.
the medicare open enrollment period is from October 15 to December 7. During this time, everyone with Medicare can make changes to their health plans and prescription drug coverage.
For more information, including resources to help you compare coverage options and costs, verify current enrollment, or enroll in coverage, visit medicare.gov or call 1-800-medicare
Medicaid is a state assistance program that serves low-income people. (The program has guidelines for qualifying income.) patients generally pay nothing for covered medical expenses, although a small copay may be required.
Each state sets its own guidelines regarding eligibility and services, so please contact your local medicaid office directly for help scheduling necessary appointments or interviews to expedite the process.
Be aware of any deadlines or important documentation you may need to provide, and keep accurate records of everyone you come into contact with. If you are unsure of your eligibility, it is best to complete the application and have your application reviewed by a caseworker or legal aid office before submitting.
the aca gave all states the option to expand their medicaid programs. as of 2022, 39 states have expanded their programs. For information about the Medicaid program in your state, you can call the Centers for Medicare and Medicaid Services (CMS) at 1-877-267-2323 or visit Medicaid.gov
children’s health insurance program (chip)
Individuals under the age of 18 may qualify for coverage under their state’s children’s health insurance (CHIP) program. chip provides health coverage to nearly eight million children in families with incomes too high to qualify for medicaid but too low to afford private coverage.
Eligibility is determined by each state and is based on income and disability. each state’s chip program may have a different name. It’s important to note that your child may qualify for chip coverage even if he or she is denied Medicaid.
Children may also be eligible for some Supplemental Security Income disability benefits.
Also, under the Affordable Care Act, young adults can stay on their parent’s health insurance plan until age 26.
If you are looking for more information about health insurance or have a specific question, our information specialists are available Monday through Friday from 9 am to 8 pm at 800-539-7309
in addition, the reeve foundation maintains fact sheets on social security, as well as medicare and medicaid. Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.
We recommend that you contact the following organizations for more information:
center for medicare advocacy
The Center for Medicare Advocacy is a national nonprofit legal organization that works to promote access to comprehensive Medicare coverage for seniors and people with disabilities. His work includes legal assistance, advocacy, education, and litigation important to Medicare beneficiaries.
centers for medicare and medicaid services (cms)
cms is a federal agency that administers the medicare program and works with state governments to administer medicaid.
social security administration: benefits for people with disabilities
ssa provides benefits to people living with disabilities.