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Social Security Disability and the Affordable Care Act3 minute read

Travel into the future with me.

For many years Mary worked as a waitress.  One day she slid in a spilled drink and fell, hitting her head, sustaining a brain injury that affects her short term memory and causes her to be fatigued after just an hour or two or trying to do anything.  Mary tried to go back to work – her employer tried very hard to help her succeed – but despite her and her employer’s best efforts, it became clear Mary could not mentally or physically work a full time job.  Mary’s employer reluctantly terminated her on April 1, 2014.  She couldn’t afford her COBRA coverage so, once she was terminated, she had no health insurance.

Mary applied for Social Security Disability (SSD).  She was denied twice and then came to us.  We represented her at her hearing and got her SSD approved in June 2015.  Once she was approved Mary received her back time pay and her monthly benefits began, but her Medicare eligibility did not start until May 2016.*

Before the Affordable Care Act (ACA), also known as “Obamacare”, Mary had no choice but to try and buy a private policy of insurance that most likely would not cover her pre-existing conditions.  Under the Affordable Care Act, she has more options.

Under the ACA, if a person does not have Medicare/Medicaid and does not have insurance through an employer or relative’s employer, she may qualify for coverage through the Exchange.  A person who is out of work and applying for SSD or SSI may find this the only possible way to get coverage since she may qualify for subsidies that cover some of her premiums.  Also, beginning in 2014 insurers must cover pre-existing conditions.

I don’t pretend to be an expert on the ACA, but people who are either applying for SSI/SSD or who have been approved for Social Security Disability but are not yet eligible for Medicare should investigate coverage under the ACA by:

  • going to www.healthcare.gov or
  • calling 1-800-318-2596, 24 hours a day, 7 days a week (TTY: 1-855-889-4325)

To be approved for Social Security Disability (SSD) or Supplemental Security Income (SSI) requires medical documentation of disability.  That can be hard or impossible to prove if a person is uninsured and cannot get in to see a doctor, have tests, or even get prescriptions filled.  Now people who find themselves in this spot may be able to get coverage under the ACA and get the medical care they require and the medical documentation that Social Security requires.  And those who have been approved but are waiting on Medicare to kick in may be able to get coverage to bridge that gap.

If you would like more information about Social Security Disability, we would recommend that you read our blog post about filing for SSDI and whether you should hire an attorney.  Also, if you have questions, you can simply complete the “Need Help” form at the right or call the phone number at the upper right of this page.

*  Medicare eligibility begins 25 months from the onset date determined by the Social Security Administration.  So, for example Mary’s onset date (the date she was determined to be unable to work) was April 1, 2014.  She gets Medicare coverage beginning May 2016.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.

To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

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