The Marketplace application and disabilities
When you fill out an application for Marketplace coverage, you’ll be asked several questions about disabilities. Information to help you answer the questions is below.
If you have a disability, mental health condition, or personal assistance needs, you may be eligible for Medicaid or for help paying for coverage.
Conditions that are considered disabilities
If you have one or more of these conditions, you’re considered disabled:
- You’re blind, deaf, or hard of hearing.
- You get Social Security Disability Insurance (SSDI) or Supplemental Security Insurance (SSI).
- You have a physical, cognitive, intellectual, or mental health condition, which causes one or more of these:
- Difficulty doing errands like visiting a doctor’s office or shopping.
- Serious difficulty concentrating, remembering, or making decisions.
- Difficulty walking or climbing stairs.
Disabilities and children
For a child, these conditions are considered disabilities:
- They have limited ability to do the things most children of the same age can do.
- They need or use more health care than is usual for most children of the same age.
- They get special education services or services under a Section 504 plan.
What happens if you indicate you’re disabled
If you indicate you have a disability on your Marketplace application, we’ll send it to your state Medical Assistance (Medicaid) office to see if you qualify for Medicaid based on your disability. If we send your application to your state Medicaid office, they may contact you for more information on your disability. If you don’t qualify for Medicaid based on your disability, you may still be eligible based on your income or you may qualify for a tax credit.
You should still indicate that you’re disabled even if you’re not sure if your state will consider you eligible for Medicaid based on your disability. This will help make sure you get the most help available. Your state will determine if you qualify for Medicaid.
If you say you’re disabled, but your state determines you either don’t qualify for Medicaid based on your income or determines that you don’t have a qualifying disability, you can still buy health coverage through the Marketplace. Plans can’t deny you coverage or charge you more because of your disability.
If you don’t indicate you’re disabled, we won’t send your application to your state Medicaid office because of a disability, but we may send it later in the process if we think you’ll qualify based on your income.
If you need help with activities of daily living
Activities of daily living include seeing, hearing, walking, eating, sleeping, standing, lifting, bending, breathing, learning, reading, communicating, thinking, and working.
If you have a cognitive or mental health condition, you may need help with these activities of daily living through coaching or instruction.
If a person only needs help because he or she is too young to be able to do these activities without help, don’t indicate that they need help with daily activities on your application.