Healthcare costs pose a barrier to healthcare for many people, especially for those who have a disability. Disabled individuals need more medication, inpatient, and outpatient appointments. Their average health related expenditures are 5 to 6 times higher, with prescription expenditures 7 times higher, including those with intellectual and developmental disability (1). Having access to affordable and comprehensive health insurance is a vital priority for this population.

Medicare vs Medicaid
Disabled individuals have access to two types of public health insurance: Medicare or Medicaid. ​​​
Medicare
  • Sponsored by Social Security tax and federally run​
  • Eligible to receive Medicare as early as 65 years of age or when individual becomes disabled
  • No income limits to qualify
  • If not yet 65 and are disabled, can begin receiving Medicare benefits 24 months after receiving Social Security Disability Insurance benefits
Medicaid
  • ​Sponsored by federal, state, and local taxes intended to serve low-income individuals
  • Run at the state level with federal guidelines, meaning specific rules vary greatly state to state
  • No age requirement to qualify
  • Can be approved to receive Medicaid benefits right after being approved for Supplemental Security Income (SSI)​ in most states
DatA on disability Insurance Coverage 
Following full implementation of the Affordable Care Act in 2014, public insurance rates have increased greatly in disability groups.
  • Medicaid participation jumping from 22.9% to 28.5% in 2016 (even higher for Medicare) while the uninsured rate has fallen (2)
  • Public programs and policy advocacy are vital as almost 70% of disability related health expenditures are paid by public insurers
  • In 2019, 46.0% of people with disabilities had private health insurance coverage, compared to 75.8% of people without disabilities—for a gap of 29.7%. Because of low rates of employment in the work force, most are illegible for employer based (private) coverage
  • Even though insurance accessibility has improved, disabled individuals still have greater difficulty paying bills, accessing affordable care, and delaying care due to cost concerns​
Failing to Provide for Disabled adults
In many states some degree of insurance coverage is mandated by law for children with any condition listed in the DSM. However, adults (cutoffs around 18 or 21) are merely eligible for healthcare; there is no security. Eligibility, unlike entitlements, does not guarantee access or enrollments into services or programs. ​
Sources
(1) ​Kennedy, J., Wood, E. G., & Frieden, L. (2017). Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 54, 0046958017734031. https://doi.org/10.1177/0046958017734031
(2) ​Houtenville, A., & Rafal, M. (2020). Annual Report on People with Disabilities in America: 2020. University of New Hampshire, Institute on Disability.