HEALTH INSURANCE AND GOVERNMENT BENEFITS

Spinal cord injury is expensive. Complete quadriplegia costs more than a million dollars the first year, and for C1-4 injuries, lifetime costs can exceed 6 million.

You're going to have to pay for medical bills and possibly long term care, and you're probably dealing with loss of income while you have other bills to pay.

Paperwork is probably the furthest thing from your mind. Worrying about how you are going to pay for this medical care shouldn't be one of your concerns but it has to be.

If you live in the U.S. the government currently (2026) offers assistance through health insurance (Medicaid and Medicare) and monthly checks to live on (Social Security Insurance and Social Security Disability Insurance) to those in need including people with disabilities. Applying for these benefits, and understanding how to use them, may be very important moving forward.

Medical Insurance

If you have private health insurance you'll need to see what they'll cover. You'll need inpatient and outpatient rehab. If you don't have medical insurance then it's time to get it. The medical facility where you're treated should have a social worker you can discuss health insurance options with.

You need a health insurance plan that will cover rehabilitation and long term services and supports.

Long-term services and supports (LTSS) refers to a host of services that aren't covered by private health insurance. This includes Home and Community Based Services like in-home assistance with routine daily activities, like bathing, dressing or getting in and out of bed.

Medicare and Medicaid cover far more health care and support services than any private health plan including Long Term Services and Supports (LTSS) and Home and Community Based Services (HCBS). It's worth it to find out if you qualify.

Apply for your state's Medicaid program right away.

Since you're not working at the moment, you may qualify, depending on spousal income, or parental income if you're under 22, and whether or not you have more income, savings or assets. If you own your primary residence it may be exempt and some states allow individuals with high medical expenses to "spend down" their income to qualify, even if they exceed standard income limits. States set a "budget period" (typically between one and six months) during which you must meet your spend-down amount by paying on medical bills to maintain eligibility.

Medicaid benefits include inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and HCBS like in-home caregivers, among others. They'll also pay for prescription drugs, case management, physical therapy, and occupational therapy.

Typically, staying in a skilled nursing facility, having an in-home personal caregiver, or living in assisted living, all require Medicaid or personal financing.

Income limits for Medicaid vary by state. For example in Montana you can make $21,597 per year without losing insurance while in Georgia the limit is $11.928 per year. (2026 data) Typically people with disabilities can participate in "trial work periods" during which benefits can be retained. These are discussed later in the book.

Then there's Medicare, managed by the federal government rather than your state and it's based on age or disability, not income.

Regardless of your income, you can usually get Medicare after receiving disability checks through SSDI for 24 months. If you're on SSI Medicare won't kick in until you're 65. Medicaid acts as your primary insurance. If you aren't on SSI or SSDI you can pay for Medicare by paying for premiums.

Medicare Part A covers hospital stays, labs and surgeries, short term skilled nursing facility stays, hospice, and home health care (skilled nursing). Part B covers doctor and other health care providers' services as well as outpatient care, durable medical equipment, home health care, and some preventive services. Medicare Advantage Plans (Part C) use private companies that must follow rules set by Medicare. Part D covers prescription drugs.

Apply for Social Security or Disability Insurance (SSI or SSDI)

Don't hesitate to apply for Social Security if you didn't work, or Social Security Disability if you've worked.

SSDI (apply if you have a work history)

You will qualify for Social Security Disability Insurance (SSDI) if you've paid enough taxes within a certain amount of time. The amount you receive will be calculated using your previous income, or the previous income of a deceased parent or spouse. Checks reflect lifetime earnings history, indexed for inflation and averaged over your highest-earning years, with the severity of your disability not affecting the amount, only your work record does.

Like Medicare, SSDI provides payments to disabled people regardless of our financial need (or lack of). Even if you have assets and money in the bank, that SSDI is yours.

There's a waiting period for SSDI: Benefits start in the sixth month after the date on which Social Security determines you become disabled.

Your family members, like a spouse or minor children, may be eligible to receive "auxiliary benefits" (also called Family Benefits) as a percentage of your benefit. Benefits are calculated from your Social Security earnings record, and the total family payout has a maximum limit (around 150%-180% of your benefit).

SSI (apply if you don't have work history)

If you've never worked, you can still receive disability benefits in the form of Supplemental Security Income (SSI) if you have little to no income and less than $2000 in assets. (2026 data)

Instead of being based on your work history like SSDI, SSI is based on your level of need like Medicaid.

For married couples, both spouses' incomes are considered to be part of the applicant's countable income for SSI. However, only part of a spouse's income is considered.

Most states add money to the federal SSI payment; this is called a state supplement. Every state except Arizona, Arkansas, Mississippi, Tennessee, and West Virginia has a state supplement as of 2026. The amount can depend on whether you are single or married and on your living arrangements. Some states pay a supplement only to those living in a skilled nursing facility.

You can earn income while on SSI, but each month doing so reduces your SSI benefits 50 cents for every dollar that you earn over $85. (2026 data)

There's no waiting period with SSI, so you can draw a full SSI benefit while waiting for SSDI to kick in.

Who can help with these applications?

You can ask hospital social workers especially if you're in a spinal institution. Unfortunately dealing with the government can be a difficult and lengthy process.

You can reach out to the peer mentoring network, SPINALpedia. (Spinalpedia.com) Founded by C4 complete quadriplegic Josh Basile in 2007, the resource has helped thousands of people with SCI adapt to life, including navigating tricky government benefits. This incredible nationwide nonprofit seeks to walk newly injured individuals through all the challenges of life with spinal cord injury.