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No Insurance, can I get SSDI?

If you are disabled and do not have the ability to work you may be wondering what you need to do to qualify for disability benefits. Recently on our disability forum we had a user ask, “I am unemployed. Do I need insurance to get Social Security Disability Insurance (SSDI)?” This question is a bit confusing and it’s tough to know if this applicant is asking if they need medical insurance to get SSDI or if they are asking if they have to be insured for SSDI. This blog will address both questions

SSDI and Medical Insurance

The first thing the Social Security Administration (SSA) will do, assuming you meet the nonmedical requirements for SSDI benefits, is review your medical records. If your medical records clearly indicate that you have a severe health condition, the condition is expected to last 12 continuous months and you cannot work, if you have sufficient work credits, you will be approved for SSDI benefits.

But what if you don’t have medical insurance? Unfortunately, many applicants who do not have medical insurance are not able to get the type of medical care they need. As a result, they may either not go to the doctor or not go as often as needed to adequately treat their health condition.

When the SSA reviews the medical records for a claimant who has not gone to the doctor and does not have evidence to prove they are disabled they will request they go to a consultative examiner for a health consultation. The examiner will provide additional evidence about the claimant’s condition.

The bad news is the consultative examination is generally not helpful to a claimant’s condition, and the claimant is often denied SSDI benefits if they do not have medical insurance and they have not seen a doctor.

SSDI and work credits for SSDI

Now, if the applicant was asking about whether or not they have to be insured and have earned work credits to get SSDI, the answer is yes. SSDI is only given to applicants who worked, paid taxes and earned work credits. If you have not worked and paid taxes or if your work has not been done recently enough you will not be “insured” for SSDI and you will be denied.

Can you buy credits or borrow them from a spouse? No, unfortunately, you cannot buy work credits or borrow them from your spouse. Work credits must be earned from your own work effort. If you do not have enough work credits your options are to go back to work and earn more or apply for Supplemental Security Income (SSI) benefits.

Bottom line

If a disability applicant does not have medical insurance it will be tough to get adequate medical records to win SSDI benefits, and if you have not worked and paid employment taxes you will not be considered insured for SSDI benefits and you will denied benefits regardless of the severity of your health condition.
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