One of the first things the Social Security Administration (SSA) looks at when you apply for disability benefits is your medical history. The agency wants to see that you've been regularly visiting a doctor to get treatment for your disabling conditions.
But many people with disabilities who've been out of work for a while don't have the resources—such as health insurance—to pay for medical care. And because being able to enroll in Medicare or Medicaid is a big reason why people apply for benefits, they can find themselves stuck in a situation where they need disability benefits to get insurance, but can't prove that they're disabled without insurance.
Social Security is aware that medications, tests, and hospital visits can be prohibitively expensive for uninsured and underinsured applicants, and won't hold it against you if you're unable to get medical care due to a lack of adequate health insurance. But the agency can't award you benefits if you don't have enough medical documentation for a disabling condition.
Unfortunately, no easy answers exist for disability applicants ("claimants") who can't afford to pay for their necessary medical treatment. Disability attorneys who represent uninsured claimants often recommend that they find a free or low-cost medical clinic in their area in order to establish a health baseline.
But even these options can pose a barrier for claimants in rural or underserved areas. If you can't see a doctor because you can't physically get to the office, Social Security can send you to a consultative examination on the agency's dime. The SSA can also arrange transportation for you if you let them know you need help getting to the exam.
For more information, see our article on how to get medical evidence for disability if you haven't seen a doctor.
Even if you've seen a doctor regularly or have been hospitalized several times, you might not have the funds to cover expensive medications that your doctors recommend. People with diabetes, for example, often can't afford the insulin they need to manage their symptoms. Because the SSA wants to see that you're following "doctor's orders," the agency can confuse not being able to afford medication with failing to follow prescribed treatment, which can keep you from getting benefits.
If you need assistance paying for your prescriptions, you may want to visit the Partnership for Prescription Assistance website. Funded by pharmaceutical research companies, the site will ask you a few questions about your medications and your income and then help you apply for some of the hundreds of public and private prescription assistance programs in the U.S.
You might also qualify for subsidized health insurance under the Affordable Care Act (ACA). The federal government has a website—https://www.healthcare.gov/—that can help you determine if you meet eligibility requirements for Medicaid or the Children's Health Insurance Program (CHIP). The ACA is a federal law, but the health insurance plans are administered by the states.
Learn more about available financial assistance in our public benefits section.
Updated September 12, 2022