Scenarios that illustrate the interaction between impairment or condition, activity limitation, and health insurance coverage needs
People with disabilities may experience more than one form of impairment or condition and thus possibly more than one activity limitation. They may also have specific and sometimes unique healthcare coverage needs that need to be considered when they choose health insurance. The following questions can be used as a guide to aid the consumer to identify their basic insurance needs:
- Do you or members of your family for whom you are purchasing insurance have health issues that require a higher level of health services than people might require who do not have those health issues?
- Which healthcare services that you or your family use currently are the most costly (e.g., prescription drugs, therapies, medical equipment), or are likely to be costly in the future?
- Among the plans you are considering, which one provides the best coverage for those costs, taking into account premiums, deductibles, co-payments and potential subsidies?
- Do you or your family members currently have healthcare providers or suppliers who you want to make sure are a part of your potential coverage network?
- Is it more important to you to limit how much you pay for monthly premiums or to limit how much you pay when you need health care services?
TIPS:
- Not everyone with a disability will automatically be eligible for Medicaid
- Some people with disabilities will wish to purchase healthcare insurance through the Marketplace
- Some people with disabilities may not be aware of government healthcare insurance programs for which they are eligible
- The lowest cost health insurance premium may not automatically be the best fit for everyone with a disability
- Some people with disabilities, such as a dependent adult child, could qualify for more than one kind of insurance, such as Medicaid and a parent’s private insurance
The following scenarios illustrate the relationship between impairments or conditions, possible related activity limitations, and healthcare coverage needs.