Social Security Disability: Medical Treatment

You’ve worked all your life. Maybe you have been relatively healthy, and spent little time worrying about the medical insurance provided by your employer. Then the big change comes your way. Disability. You are unable to do any work of any kind.

Suddenly you are living in a world of worries: “how will I provide for me and my family?” ”And now that I have lost my job, how will I continue to get the medical care I now desperately need?”

You are undoubtedly on this page because you already know that social security disability is the answer. Social security disability provides a month check (as if you had reached full retirement age) and Medicare after 24 months of entitlement to social security disability benefits (more on that later).

But when it comes to medical coverage, inability to work and social security disability, you will now fully understand just what a “Catch -22” is. This often used and often misunderstood comes from the Joseph Heller novel, “Catch-22”. The novel, set in World War II, centers on an American bomber base running dangerous and constant missions. Airmen mentally unfit to fly did not have to do so. The base psychiatrist, however, would never deem an airman who requested a finding of mental unfitness to actually be unfit to fly. Why? Because, the psychiatrist reasoned, anyone who was in fact insane would not have the mental capacity to request a finding of mental unfitness!

So here is the Catch-22 in social security disability and medical treatment:

  • Proving disability requires ongoing and regular medical treatment
  • Most disabled Americans lose their medical insurance coverage because that coverage is tied to the job.
  • Medicare eligibility – intended to replaced the employer-based medical insurance – is only available if you are deemed disability under the Social Security Act, eligibility for which as noted above requires ongoing and regular medical care.

As Dana Carvey’s “Church Lady” character says, “Well, isn’t that special..”

Medical Treatment for the Disabled in North Texas

So how do we solve this Catch-22? In my 25 years of handling only social security disability in North Texas I’ve done it, but I have found most social security disability applicants are not prepared for the radical change in their life that is required to solve this problems. Let’s first look at the options you have:

COBRA extended medical insurance coverage

Your employer (if there are more than 20 employees) must offer you the right to continue the medical insurance benefits under COBRA. The premium for COBRA coverage equals the full cost of your group health coverage – including the employer and employee share – plus up to 2% more for administrative costs. In my opinion, electing to continue existing medical coverage under COBRA is a must for the Texas disabled worker without other medical insurance available.

By the time most social security disability applicants seek my advice, they have already declined COBRA extended benefits because they simply could not afford the premiums. I can hardly blame them: they just lost their job, and the monthly premiums for COBRA are often astronomical.

Yet it is clear to me that at the time they declined COBRA they did not understand the social security disability Catch-22, or how vital medical insurance is to winning a social security disability. There can simply be no higher priority in the household than medical insurance for the disabled worker seeking social security disability benefits. A few examples of the radical change in priority:

  • Cable TV? Time to cut the cord and return to free Over the Air TV.
  • Car Payment? Sell the car and buy a “beater” or move to one car.
  • Mobile Phone Plan? Downgrade immediately.
  • Too much house? This one is painful, but a “downsize” might free up the cash to pay for COBRA medical insurance.
  • Sell stuff on Craigslist.
  • Could other family member take another job or additional part-time work?
  • Eating out or take out? Cut to the minimum.

These are radical, and painful steps to take, I know. In my experience many disabled Texas workers are slightly ashamed of their disability and inability to work despite the reality that it is not their fault. That shame often leads the disabled to try and shield others in the family from the consequences of their disability. So, for example, they are reluctant to cut the cable or downgrade the mobile phon plans because the kids will be disappointed.

Other Sources of Medical Treatment for the Disabled in North Texas

So what if the COBRA train has left the station: you failed to exercise your COBRA medical insurance right. Here are you options:

Affordable Care Act. It is still the law, and it is still available in Texas.

County Medical Assistance. Parkland Memorial Hospital is available to Dallas County residents. If you are accustomed to private medical care, it can be a jarring experience. Parkland is associated with the University of Texas Southwestern Medical Center, and it does offer high quality medical care.

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