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How to survive until my Social Security benefits are approved: A Multi-Part Series – Pt 1 Medical Care

Almost every single client will at some point ask me how am I expected to get by until my benefits are approved? There is no easy answer, but there are resources that could help you prior to approval. over the course of the next few weeks I will touch on some things that could be helpful during that wait for benefits. I start this series off with one of the most important aspects of your Social Security case, medical care.  Medical care is the cornerstone of proving your disability and it’s important to continue to have access to it. So what can you do when you’ve lost your job and lost your medical insurance.


1) Does your spouse or co-habiting partner have employer sponsored health insurance? If so, your loss of employment is considered a life changing event allowing them to immediately enroll you on their plan, even outside of open enrollment. Please note, not all states have laws that allow co-habiting partners to enroll on health insurance plans. If your under the age of 26, you may also be able to be enrolled on your parents’ health insurance plan.


2) If you can afford it, you are eligible for COBRA coverage for up to 24 months after leaving your employment. While this option is very expensive, it continue continue your existing health insurance coverage for up to 2 years.


3)  Talk to doctors about self pay options.  Some will charge lower rates to patients who are self pay and some will set up affordable payment plans so that you can continue to receive medical care.


4) Look for  low-cost or free health care clinics in your area.  These may be run by religious organizations, volunteer organizations, or associated with major medical groups.  Some will offer sliding scale costs, based on your ability to pay.  Other’s will offer free health care.  Generally, the services provided cover both regular medical care, dentistry, and mental health care.  The downside to these clinics is the difficulty in getting appointments and how often you can get an appointment.  It is also sometimes difficult to get medical source statements from free clinics and you may not always see the same provider.


5)  Even if you’re getting low-cost or free medical care or have insurance, your prescriptions may still be too expensive for you.  Many drug companies now have prescription assistance programs which can help in covering the costs of your prescriptions each month.  You should contact the manufacturer of your prescriptions for information about these programs.


6)   Ask your doctor about switching to a generic drug prescription.  Generics are less expensive than name brand drugs and many time have the same effect.  Also, many pharmacies now offer programs for low-cost of free generic drugs.  Walmart runs a $4 and $9 generic drug program.  Many grocery stores also run similar programs as Walmart.   Walgreen’s and CVS also have prescription savings clubs which may have a fee to join, but can cut your medical costs especially for generics.


7) Ask your doctor for free samples of your name brand drugs and for any coupons they may have for them.  These coupons may cover several months of co-pays for your prescription or offer further help if you have no insurance.


8) Finally, if you are unable to get medical care or cannot obtain care on a regular basis, your attorney can ask for Social Security to do a Consultative Exam.  This is an exam that Social Security will arrange and pay for.  Social Security can also request that you attend one.  While they are not the best option for care, they can provide evidence of your disability.  With a CE, it is important that you take notes on the exam and even a good idea to take someone along with you to observe the exam.


It is important to attempt these options to help explain to an ALJ why you may have few medical records to support your case or why you cannot get needed medications.  From the ALJ’s point of view, if you’re not seeking out medical care, then you’re not hurting, your symptoms don’t bother you, and you should be able to work.  By trying each of the above options, you have proved to the judge that you are seeking out care because you are hurting and your symptoms are bothering you.  Plus, your building the medical evidence needed to win your case.