Maintaining or obtaining health insurance coverage is a common problem for those applying for disability benefits. Many Americans receive health insurance coverage through their employer. When a disability forces the employee to stop working, they are at risk of losing their health insurance coverage unless they timely pay the hefty premiums pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA). Unfortunately, not having health insurance can be very problematic for those applying for disability benefits.
If the disabled individual is able to afford the premiums for continued health insurance coverage under COBRA, then it is probably in her best interest to pay the monthly premiums and maintain her current health insurance coverage. However, many individuals are unable to afford the monthly premiums without the regular income from a job. When a disabled person cannot make these required payments, they will be forced to find new health insurance coverage or forego health insurance at all.
First of all, applying for disability benefits without health insurance coverage is challenging. Without health insurance coverage, the individual is usually unable to afford the out-of-pocket expenses required for regular medical treatment. The individual may miss out on important testing, medications, and regular examinations. Of course, if the patient is not seeing their doctor, there will be a lack of current medical records to document the patient’s disability. For both long term disability claims and Social Security disability claims, a lack of ongoing medical treatment can make it much more likely that their disability claim will be denied.
Second, the claimant should do everything in his power to obtain health insurance. This includes looking for private health insurance via the federal health insurance marketplace: https://www.healthcare.gov/ If the individual cannot afford private health insurance options, they should investigate whether they are eligible for their state’s Medicaid program. For Indiana residents, information about applying for Medicaid can be found at the following website: http://member.indianamedicaid.com/apply-for-medicaid.aspx. Even if an Indiana resident is not eligible for Medicaid, they may still be eligible for another state program, such as Care Select, Healthy Indiana Plan, or Hoosier Healthwise. If the individual already receives Social Security disability benefits, then they should eventually be eligible for Medicare, although there is a two year wait to qualify for Medicare.
If private health insurance, Medicaid, other state programs, or Medicare are not available, then the individual should check with their local hospitals and doctors’ offices for special programs that may be offered. In Indianapolis, Eskenazi Health offers the “Health Advantage” program to low-income and uninsured residents of Indianapolis. An uninsured or underinsured person should contact their local hospitals and treating providers to see if special programs are available to them.
Third, if the person applying for disability benefits absolutely cannot find any health insurance options, they should make it clear to their long term disability insurer and the Social Security Administration that their lack of health insurance has affected the amount of medical treatment they receive. This can be done by having a doctor provide a statement explaining what tests or treatments would be done if the individual had health insurance. Although it can be a major disadvantage to apply for disability benefits without health insurance, the claimant should at least make it clear why their medical treatment has been limited.
If you have applied for disability benefits and your claim has been denied, contact O’Ryan Law Firm immediately for a free consultation. We represent individuals who have been denied short term, long term, or Social Security disability benefits. You may call us toll-free at 1-855-778-5055 or submit information online so that we may contact you.