Is it Right for You?

Almost everyone should be able to get health coverage, so you just need to see which option is right for you and your family. This page helps you see if Health Coverage for Workers with Disabilities (HCWD) might be a good choice for you.

If you don’t qualify for HCWD, you may still qualify for NC Medicaid based on other rules or for other programs, like Medicare and private health insurance.

HCWD Basic Eligibility Requirements

To qualify for HCWD, you must:

• Be age 16 to 64
• Be determined blind or disabled according to Social Security Administration rules
• Be a U.S. citizen or meet specific noncitizen requirements
• Be working and paying Social Security and Medicare taxes
• Have $30,828 or less in resources, and
• Have $1,956 or less in unearned income per month. There's no limit on how much you can earn at work!

Note: If you’re on Supplemental Security Income (SSI) or SSI’s 1619(b) provision, you automatically get NC Medicaid coverage, do not need to apply for HCWD, and do not need to worry about the rules discussed on this page. Read more in DB101’s Disability-Based NC Medicaid article.

Disability Determination

To qualify for HCWD, you must have a disability that meets Social Security’s definition of disability. If you currently get disability benefits, like Social Security Disability Insurance (SSDI), you already meet Social Security’s disability standards. If not, the state will check to see if your disability qualifies for HCWD.

Under these rules, you have a disability if:

• You have a physical or mental impairment or combination of impairments, and
• Your condition has lasted or is expected to last for at least 12 months.

Note: For HCWD, Social Security’s disability rules related to earned income do not apply.

Citizenship and Noncitizen Requirements

You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for HCWD:

• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get, including HCWD.
• Most immigrants who have been lawfully present for less than five years do not qualify for HCWD. However, they may qualify to get private coverage subsidized by the government through HealthCare.gov.
• Undocumented immigrants do not qualify for HCWD, but they may qualify for Emergency NC Medicaid. To learn more about this, contact your local Department of Social Services (DSS) office.

Resources

To qualify for HCWD, you must have $30,828 or less in resources. Money in an ABLE account, the house you live in, and a car are not counted.

Income

To qualify for HCWD, your unearned income must be at or below $1,956 per month for individuals ($2,644 per month for couples). Unearned income includes things like Social Security Disability Insurance (SSDI); short- or long-term disability insurance; VA benefits; workers’ compensation; and income, dividends, or profits from a trust or investment.

There is no limt on how much earned income you can have. No matter how much you make at work, you can still get HCWD coverage if you meet all other program rules!

You may have to pay a small annual fee and a monthly premium that is based on your countable income, which includes earned and unearned income. The higher your income, the more your premium will be. We'll discuss how much you may have to pay later in this article.

HCWD and Employer-Sponsored Health Coverage

You can have HCWD and employer-sponsored private coverage at the same time. There are two main advantages to this:

• Employer-sponsored private insurance may cover some benefits that HCWD doesn’t or vice versa.
• Employer-sponsored private coverage may let you choose from more doctors.

The disadvantage is that you would have to pay premiums for both programs. Private coverage usally has higher copayments than HCWD, so it may not be worth the expense. On the other hand, if your HCWD monthly premium is high, you may choose not to enroll in HCWD and only sign up for employer-sponsored coverage.

If you are eligible for HCWD and have private insurance through your employer or your spouse's or parent's employer, NC Medicaid may help pay your employer-sponsored coverage premiums, if NC Medicaid would save money by doing so. In order to qualify for help paying your employer-sponsored coverage premiums, you must have a high-risk illness, not be able to afford your premiums, and not have Medicare coverage.

HCWD and Medicare

If you are eligible for both HCWD and Medicare, you can have both at the same time. This can help because HCWD will help pay for things that Medicare doesn't pay for.

HCWD will help pay your Part B premium. And, if your income is low enough, you may also qualify for a Medicare Savings Program to help pay other Part B expenses (and your Part A premium, if you have one), and the Part D Low Income Subsidy, to help pay for your prescription drugs.

Contact the Seniors' Health Insurance Information Program (SHIIP) if you have questions about how your NC Medicaid and Medicare benefits work together. To learn more, read DB101’s Medicare article, which has detailed information on Medicare Savings Programs and the Part D Low Income Subsidy.