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The Politics of Health Care

Having Insurance Doesn't Rule Out Social Security Disability Eligibility

Published July 12, 2012 2:30 PM by Adrianne OBrien
Editor's note: This blog was written by Karen Hercules-Doerr, a healthcare executive and director of Community-Based Representatives at Allsup. Contact: k.hercules-doerr@allsupinc.com. 

It seems reasonable to assume that patients with health insurance are ineligible for Social Security Disability Insurance (SSDI), a program that provides benefits to Americans unable to work because of a disability.

After all, more than 55 percent of Americans aged 26-64 participate in employer-based healthcare coverage, and if they have employer-based insurance, they're able to work, right?

Although working typically disqualifies a patient from SSDI, simply having health insurance does not. Even if patients have health coverage when they are initially treated, that may not be the case in just six months, or later on. When patients have progressive chronic illnesses, they experience increasing difficulty in maintaining work schedules and can lose access to steady income and health insurance. Patients who could be receiving SSDI benefits, but aren't, can become a higher cost patient for the provider.

A 2010 study found that the average SSDI beneficiary visited the doctor seven times per year. That escalated to an average of 22 times per year over the course of three years. As their condition worsens and patients visit healthcare providers more often, they also become increasingly likely to lose employer-based insurance to help pay for care.

Patients with worsening health and rising costs may not be able to pay for their care if they don't file for SSDI in the interim.

However, there is good news for patients: after 24 months on SSDI, patients are eligible for Medicare. The 2-year waiting period underscores the critical importance of identifying at-risk patients and helping them apply for SSDI benefits as early as possible. That's why it's important to look for warning signs with patients who may become SSDI-eligible, so they can begin the process of applying for benefits as soon as they're eligible.

Healthcare professionals find that when their insured patients fully understand the benefits of filing for SSDI with a representative such as Allsup, they are less likely to become uninsured or underinsured later.

It is critically important that hospitals, physician practices and healthcare providers understand that it's never too early to inform their patients that SSDI benefits may be available if they are deemed disabled and cannot work in any capacity for at least 12 months.

Giving patients options regarding their future and offering them help from expert representatives can minimize the tremendous losses they face when they can no longer work because of a disabling condition. This step also can expedite access to benefits that patients have paid into and deserve, and helps minimize providers' exposure to the significant cost demands of treating patients who don't have a steady source of income or insurance.


1. Ensuring Patients with Disabilities Can Maintain Care and Coverage." Allsup, 2012.


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