You don't need health insurance to qualify for Social Security disability benefits, but you do need medical evidence. Here's how to build a strong record even if you can't afford treatment.
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People with disabilities who’ve been out of work for a while often don’t have the resources—such as health insurance—to pay for medical care. But one of the first things the Social Security Administration (SSA) looks at when you apply for disability benefits is your recent medical history. The agency wants to see that you’ve been regularly visiting a doctor to get treatment for your disabling conditions.
At the same time, not having insurance is often one of the main reasons people apply for disability benefits in the first place. Once you're approved for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) benefits, you can usually qualify for Medicare or Medicaid and get the medical treatment you need.
Unfortunately, many people find themselves in a tough spot: They need Social Security disability benefits to get health care coverage, but they can’t get the medical evidence they need to prove they’re disabled because they can’t afford treatment without insurance. It can be difficult to get disability benefits without health insurance, but it's not impossible. Understanding how you might be able to build a medical history when you have no health care coverage and how Social Security uses your medical history to decide your disability claim can help.
Can You Get Disability Without Health Insurance?
You can sometimes get disability benefits when you don’t have health insurance. But it’s much harder to prove your case.
The SSA knows that medications, tests, and hospital visits can be prohibitively expensive for uninsured and underinsured disability applicants. So, Social Security 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 to prove your disabling condition.
Unfortunately, there’s no simple solution for disability applicants who can’t afford the medical care they need.
Disability attorneys often suggest that uninsured clients visit free or low-cost clinics to document their conditions and start building medical histories. But finding these clinics can be difficult in rural or underserved areas, where the nearest clinic or specialist might be hundreds of miles away.
How Does Social Security Evaluate Applicants Without Medical Records?
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 at the agency’s expense. The exam costs you nothing. The SSA can also arrange free transportation if you let them know you need help getting there.
Social Security routinely sends disability applicants for consultative exams when the agency doesn't have enough recent medical information to decide a claim. A consultative exam isn’t a full course of treatment, but it gives Social Security basic medical evidence to evaluate your condition.
For more information, see our article on how to get medical evidence for disability if you haven’t seen a doctor.
How Can I Find Free or Low-Cost Medical Help?
The federal Health Resources and Services Administration (HRSA) within the Department of Health and Human Services has a directory of sliding-scale health centers that will provide care even if you’re uninsured and can’t pay. You can find the health centers nearest you using the search tool provided at the HRSA website.
If your income is low enough, you might qualify for Medicaid, depending on your state Medicaid agency's requirements. You might even qualify before you’re approved for disability benefits. (If you're approved for SSI benefits, most state Medicaid agencies will automatically sign you up for Medicaid.)
You might also qualify for low-cost, subsidized health insurance under the Affordable Care Act (ACA). Visit Healthcare.gov for information about ACA insurance plans and determine if you meet eligibility requirements for Medicaid or the Children’s Health Insurance Program (CHIP).
Some states run their own ACA health insurance exchanges, while others rely on the federal marketplace. Check the state marketplace finder to locate the insurance exchange where you live.
Document Your Attempts to Find Care
If you haven't been able to get medical treatment and thus can't provide extensive medical records, document your efforts to find medical care. Keep a personal record of every attempt to seek care, including:
- calls to clinics
- applications to sliding-scale or free clinics
- visits to urgent care or emergency rooms
- visits to community health fairs, or
- any requests to charities for help.
Having these records will show Social Security that you're not neglecting treatment and you're doing your best to get medical help. Otherwise, the agency might interpret your lack of medical attention to mean that your condition doesn't bother you much.
If you're applying for disability benefits based on a mental health condition, but don't have a psychiatrist or therapist, Social Security will consider all of the following as evidence of your claim:
- hospitalizations or psychiatric holds
- law enforcement encounters
- crisis interventions, and
- calls to emergency services.
How to Get Medication Without Health Insurance
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 Social Security 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.
However, Social Security's own rules recognize an inability to afford prescribed medication as good cause for not taking it, as long as free or low-cost options aren't reasonably available in your area. (SSR 18-3p.)
If you need assistance paying for your prescriptions, you might 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 United States.
Learn more about other possible financial assistance in our public benefits section.
