Understanding Health Coverage

The healthcare costs involved in living with a spinal cord injury can be significant, even overwhelming. The good news is there are many options for getting healthcare coverage, even if you are uninsured or underinsured.

To start the process, meet with a caseworker at your hospital to help you gather relevant paperwork and begin applying for Medicare, Medicaid, and Social Security. Caseworkers or social workers are there to assist you in managing your or your family member's care.

Hospitals that accept federal money must provide a certain amount of free or reduced fee care. Check with the hospital's financial aid department to see if you qualify for reduced or charity care.

Health Insurance Marketplace

The Affordable Care Act (ACA), passed in 2010, requires that all American citizens have the opportunity to shop online (or by phone) for the best available insurance coverage to fit their individual needs and budget.

The Health Insurance Marketplace, sometimes called the “exchange,” or just “the marketplace,” was established as part of the ACA. It is a service that helps people shop for and enroll in health insurance. The Marketplace can help if you don't have coverage or if you have it but want to look at other options.

With one Marketplace application, you can compare your coverage options side-by-side and enroll. Depending on a person's income, the coverage options provided through the Marketplaces may be a better choice than what is currently offered through an individual's employer, but not necessarily. The Marketplace also offers the uninsured choices that they may not have been privy to in the past.

Healthcare.gov will direct you to the Marketplace in your state, pretty seamlessly. It's certainly the best place to get started. The site will ask you basic questions about your income, your family size, where you live, and will provide an overview of the insurance options (both private and public) for which you qualify. You can then make decisions based on your own needs, the needs of your family, and your budget.


Medicare is a federal insurance program available to those:

  • 65 years and older (whatever their income)
  • Younger than 65 years with a disability who have received Social Security Disability Insurance (SSDI) for at least 24 months
  • Individuals of all ages who have end-stage renal disease (permanent kidney failure in need of dialysis or a transplant)

Medicare enrollees pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage.

Medicare isn't part of the Health Insurance Marketplace, andthe Marketplace does not offer Medicare supplement (Medigap) insurance or Part D prescription drug plans.

Medicare's open enrollment period is October 15 – December 7. During this time, all people who have Medicare can make changes to their health plans and prescription drug coverage.

For more information, including resources to help you compare coverage options and costs, check current enrollment, or enroll in coverage, go to medicare.gov or call 1-800-MEDICARE


Medicaid is a state-based assistance program serving people with a low income. (The program has guidelines for incomes that qualify.) Patients usually pay nothing for covered medical expenses, although a small copayment may be required.

Each state sets its own guidelines regarding eligibility and services, so contact your local Medicaid office directly for help setting up appointments or interviews needed to expedite the process.

Be aware of any deadlines or important documentation that you may need to provide and keep accurate records of everyone you are in contact with. If you are unsure of your eligibility, it is best to fill out the application and have a caseworker or legal aid office review your application before you submit it.

The ACA provided all states with the option to expand their Medicaid programs. As of 2022, 39 states have expanded their programs. For information regarding the Medicaid program in your state, you can call the Centers for Medicare and Medicaid Services (CMS) at 1-877-267-2323 or visit Medicaid.gov

Children's Health Insurance Program (CHIP)

People under 18 years of age may qualify for coverage under their state's Children's Health Insurance Program (CHIP). CHIP provides health coverage to nearly eight million children in families with incomes too high to qualify for Medicaid but too low to afford private coverage.

Eligibility is determined by each state and is based on income and disability. Each state's CHIP program may have a different name. It is important to note that your child may qualify for CHIP coverage even if denied Medicaid.

Children may also be eligible for some disability benefits from Supplemental Security Income.

Additionally, under the Affordable Care Act, young adults are able to remain on their parents' health insurance plan until age 26.

Additional Resources

If you are looking for more information on health insurance or have a specific question, our Information Specialists are available Monday through Friday from 9 am to 8 pm ET at 800-539-7309

Additionally, the Reeve Foundation maintains fact sheets on Social Security as well as Medicare and Medicaid. Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.

We encourage you to reach out to the following organizations for more information:

Center for Medicare Advocacy


The Center for Medicare Advocacy is a national nonprofit law organization that works to advance access to comprehensive Medicare coverage for older people and people with disabilities. Their work includes legal assistance, advocacy, education, and litigation of importance to Medicare beneficiaries.

Centers for Medicare and Medicaid Services (CMS)


CMS is a federal agency that administers the Medicare program and works with state governments to administer Medicaid.

Social Security Administration: Benefits for People with Disabilities


SSA provides benefits to people living with disabilities.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.