Question: I have been unemployed for a year. I could not afford to continue my health insurance benefits through COBRA. I recently was hospitalized and as a result have been declared Permanently Disabled. I have applied for Medical Assistance and Disability. If I am rejected for Medical Assistance, what options do I have to obtain medical insurance? I have some savings, but those are diminishing quickly and as I have now exhausted all my Unemployment Compensation with no employment options, I have no current income. My health issues will all be considered pre-existing even if I were financially able to purchase health insurance.

- Joseph

If you live in a state that expands its Medicaid program as part of health reform, you will be eligible for coverage regardless of whether you qualify as disabled. Medicaid will extend to everyone with an income below 133% of the federal poverty level. With no current income, that would include you. New Jersey will expand its program; however Pennsylvania will not.

If you live in Pennsylvania, you can instead purchase an insurance policy on an exchange. The health reform law requires insurance companies to accept all applicants regardless of preexisting conditions with no additional premiums. The exchanges will begin accepting applications on October 1, and coverage will become effective on January 1. However, because of a quirk in the law, you would not be eligible for a subsidy to help with the cost, if your income falls below the federal poverty level.

A final possibility for coverage may be Medicare. If your disability is total, you could qualify for benefits under that program. It would begin two years after you become eligible for disability benefits under Social Security.


Robert I. Field, Ph.D., J.D., M.P.H. is a professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He also writes for The Field Clinic blog. Ask Rob your questions about the new healthcare laws.