The Affordable Care Act did not change your SSDI monthly payment amount

When the Affordable Care Act (also called Obamacare or the ACA) became law in 2010, it did not alter the formula Social Security uses to calculate your SSDI benefit. Your payment is still based on your work history and the age you were when you became disabled — the same calculation that existed before the ACA passed.

What the ACA did change was what you could do with your SSDI income once you received it. It expanded health coverage options for people on SSDI and created new rules about how much you could earn while keeping your benefits. Those changes affected your real financial situation even though the dollar amount of your check stayed the same.

Key Takeaways

  • The ACA did not change how much SSDI pays you each month — your benefit amount is still based on your work history.
  • The ACA expanded Medicaid in many states, which gave SSDI recipients a new way to get health coverage without losing benefits.
  • The ACA created new rules allowing you to earn more money from work while keeping your full SSDI payment, through programs like Medicaid Buy-In.
  • Some SSDI recipients became able to afford health insurance through the ACA marketplace, which reduced their reliance on Medicaid.
  • The effect of the ACA on your benefits depends on which state you live in and whether that state expanded Medicaid.

How the ACA expanded health coverage for SSDI recipients

Before the ACA, many people on SSDI had only one realistic way to get health insurance: Medicaid, which is run by your state. If you earned too much money, you lost Medicaid coverage. This created a trap — you could not work enough to support yourself without losing the health coverage you needed.

The ACA created two new paths. First, it allowed states to expand Medicaid to cover more working-age adults, including people on SSDI who earned a little more money. Second, it created the health insurance marketplace, where you could buy coverage directly from private insurers, sometimes with federal tax credits that made it affordable.

For SSDI recipients, this meant you were no longer forced to choose between earning money and having health insurance. You could potentially earn more, buy marketplace insurance, and keep your SSDI check — something that was much harder before 2014.

Medicaid Buy-In programs and how they work with SSDI

Many states created or expanded Medicaid Buy-In programs after the ACA passed. These programs let you keep Medicaid coverage even if you earn money from work, as long as you pay a small premium (usually between $20 and $75 per month) and your income stays below a certain threshold.

Before the ACA, these programs existed in only a handful of states. After 2010, more states added them because the ACA made federal funding available. If you live in a state with a Buy-In program, you can now work part-time or full-time, earn income above the normal Medicaid limit, and still keep your Medicaid coverage by paying the premium.

This directly affects what you can do with your SSDI check. Instead of your SSDI payment being your only income source, you can add work earnings without losing health coverage — which means your total monthly income can be higher.

Which states expanded Medicaid and what that means for you

The ACA allowed states to expand Medicaid, but did not require them to. As of 2024, about 40 states have expanded Medicaid, while about 10 have not. If you live in an expansion state, you may have been able to get Medicaid coverage even if your income from SSDI and work combined would have disqualified you before.

If you live in a non-expansion state, the ACA's effect on your SSDI situation is smaller. You still have access to the marketplace for health insurance, but you may not have the Medicaid Buy-In option, which means your choices for affordable coverage are more limited.

Your state's Medicaid office or your local Social Security office can tell you whether your state expanded Medicaid and what that means for your specific situation. This is worth checking because it directly affects how much you can earn while keeping your benefits intact.

The relationship between SSDI, Medicaid, and marketplace insurance

The ACA created a three-option system for SSDI recipients seeking health coverage. You can stay on Medicaid (if you may have access to), buy insurance through the marketplace (sometimes with subsidies), or use a Medicaid Buy-In program (if your state offers one). Your SSDI payment itself does not change, but which option makes sense for you depends on your income and your state.

Some SSDI recipients found that marketplace insurance with a federal tax credit became cheaper than Medicaid, especially if they earned enough money to trigger the credit. Others found that a Medicaid Buy-In program was the best fit because it let them work without losing coverage. The ACA gave you options that did not exist before, even though your SSDI check amount stayed the same.

How work incentives changed after the ACA

Social Security has long had work incentive programs that let you earn money without losing all your benefits. The ACA did not create these programs, but it made them more useful by expanding health coverage options alongside them.

For example, the Plan to Achieve Self-Support (PASS) program lets you set aside income and resources for a work goal without affecting your benefits. Before the ACA, using PASS meant you might still lose Medicaid if you earned too much. After the ACA, you could use PASS, earn more money, and keep health coverage through a Buy-In program or the marketplace — making the work incentive actually workable.

The same applies to the Impairment Related Work Expenses (IRWE) program, which lets you deduct disability-related costs from your earnings. The ACA made these programs more valuable by removing the health coverage penalty that came with earning more.

What did not change: your SSDI payment formula

It is important to be clear about what the ACA did not do. It did not increase SSDI payments. It did not change the formula that calculates how much you receive based on your work history. It did not create a new category of SSDI recipients or change who qualifies.

The ACA changed the environment around SSDI — what you could do with your benefits, what health coverage options existed, and how much you could earn without losing everything. But the actual monthly check you receive is calculated the same way it was in 2009.

If your SSDI payment amount changed after 2010, it was because of a cost-of-living adjustment (which happens every year), not because of the ACA. Your payment is still based on your Primary Insurance Amount, which comes from your Social Security work record.

Frequently Asked Questions

Did the ACA increase SSDI payments?

No. The ACA did not change how much SSDI pays. Your monthly payment is still calculated from your work history. The ACA changed what you could do with your benefits and what health coverage options were available, but not the payment amount itself.

Can I work more now because of the ACA?

Possibly, depending on your state. If your state expanded Medicaid and offers a Buy-In program, you can earn more money from work while keeping Medicaid coverage by paying a small premium. This makes it more realistic to work without losing health insurance. If your state did not expand Medicaid, your work options are more limited.

What if I live in a state that did not expand Medicaid?

You can still buy health insurance through the ACA marketplace, sometimes with federal tax credits that make it affordable. You will not have access to a Medicaid Buy-In program, but you are not without options. Contact your state's health insurance marketplace or call 1-800-318-2596 to learn what coverage is available to you.

Does buying marketplace insurance affect my SSDI benefits?

No. Buying health insurance through the marketplace does not change your SSDI payment or count as income that reduces your benefits. Your SSDI check stays the same whether you have marketplace insurance, Medicaid, or no insurance at all.

How do I know if my state has a Medicaid Buy-In program?

Contact your state's Medicaid office or call your local Social Security office. They can tell you whether your state offers a Buy-In program and whether you would may have access to based on your income and work status. This is worth checking because it can significantly change what you can earn while keeping your benefits.