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One of the many scary things about being disabled is the crushing debt that can occur and add stress to your life.

Most disabled people end up relatively poor, sometimes below the poverty level, due to the combination of expenses and lack of income.

We often find ourselves struggling to do more with less and to try to make our checks(if we’re lucky enough to have them) stretch enough to cover our necessary expenses.

Why am I talking about this?

Well, bills are a major source of stress, especially if you simply don’t have the funds to manage them.

Our bodies don’t really differentiate between physical and emotional stress, so any stress you can get rid of gives you more time and opportunities to heal or at least leaves you more energy to manage the next crisis.

Debt and it’s accompanying stresses are not going to help you feel any better about your life!

So, today, I want to talk to you about some of the heavier expenses we may have and ways to manage or reduce those bills.

Medical bills – the price for diagnosis and treatment

While doctor’s bills are often unavoidable, you can minimize future ones by carefully selecting the best insurance provider for you.

Which health insurance provider you use, especially combined with staying in-network and purchasing covered medications can really reduce what you pay for each appointment, test, and treatment.

That said, ideally, you are selecting your coverage based on the doctors you trust(so they are in-network) and the medications you take(so they are covered well).

No matter what insurance you have, do your best to look at your total cost rather than just those premiums.

However, the biggest and scariest bills usually come directly from hospitals, and there’s a specific solution for that.


Charity Care is available at hospitals

I recently wrote Navigating the Charity Care Labyrinth focused on lessons learned when I most recently used charity care.

Whether it’s a trip to the emergency room, a multi-day stay, or an outpatient procedure, the expense of going to the hospital tends to be a lot more than individual doctor’s visits or medications.

The good news is that there is some recognition of how expensive hospitals are. Most hospitals have a charity care program for low-income individuals, as mandated by state law(the link is to New Jersey’s program as an example).

Don’t worry, even if you get charity care help, your surgeon will still get paid.

Even if you have insurance, you can still apply for charity care for your residual bills. There are some bills you will still have to pay because the hospital itself doesn’t make the charges.

For example, if you had surgery, your anesthesiologist and surgeon can bill you separately and that’s not covered by charity care. It doesn’t cover test interpretations or any tests they need to outsource.

Charity care applications can be a bit of a pain, but it’s often worth looking into. While most hospitals have it in some form, some hospitals have the process well-managed and share the details regularly, while others are much more quiet about it.

If you have been hospitalized or had an expensive emergency room visit, look over your bill for the payment contact number if the charity care program isn’t mentioned, and ask them about applying for charity care.

Like most government programs they will need a lot of identifying information(like a birth certificate and state ID), proof of income, insurance information(if you have any), and possibly a few additional requests.

If you may be Medicaid-eligible, they also will help you apply for Medicaid, since it covers your previous 3 months of medical bills and the hospital does get some money from that program.


Student loans are another major expense

If you already had some college experience and have debts from that, or if you are looking ahead at potential debts, there are some programs that give you temporary relief. There now is also a plan that will completely forgive your student loan if you are “disabled enough”, without any major downsides.

Once you have your loan and have finished school, you typically get a six-month grace period before your loans are due.  

There are few feelings better than succeeding in a big goal like completing college or grad school – but the cost is getting pretty terrifying!

Before the grace period ends, you want to have your paperwork completed and turned in.

You may choose to use an income-based repayment plan(IBR)  or if your situation qualifies you can also apply for a deferment or forbearance.  

Deferments and forbearances can only be used for a certain length of time(I believe about 3 years), so while you can use them, they are only good a few times. You may want to check into IBR plans first as those are always an option.

IBRs and related programs are something you can participate in annually for any length of time.  If you spend 25 years in one of these programs, the debt may be forgiven.

I never got very far in paying down my college or graduate school debt.  

Some years I have used forbearance, and most years I have had my IBR calculated.  Some years, my IBR has been about $30/month, other years they tell me $0/month.  

IBR does not count disability income in its calculations(which is why it’s often been $0 for me).

The focus seems to be on the IRS’s judgment, so if your income isn’t taxable it doesn’t count.

That does mean that if you work while on disability, not only will that income be counted, but a small part of your check may be included in the calculation if any of it becomes taxable.

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Disability-based Loan Forgiveness

I learned about the Total and Permanent Disability discharge mid-2018. It allows anybody who is “totally and permanently disabled”(which in this case translates to “disabled and not earning our definition of substantial income for at least 8 years”) to have their student loan debt forgiven.

If your disability prevents your working, a small silver lining: you may be able to have your student loan forgiven!

The more precise wording is that you need to have particular VA disability-related paperwork, proof that SSDI checks on you only every 5-7 years, or paperwork from your doctor explaining your condition and certifying that you have been disabled for at least 60 months(5 years) or cannot be expected to recover significantly for at least that length of time. So basically, there needs to be a consensus that you aren’t getting better any time soon, or have been debilitated for at least 5 years already.

Once accepted to the program, there’s a 3-year monitoring period, where if your income(not counting disability payments) goes over their magic number, they consider you “not disabled enough”.

The good news on that front is if that happens, your loans just continue, but no interest or other expenses are added in(like there often is if you get a deferment).

If you are determined “not disabled enough”, however long the TPD program was in effect was effectively a forbearance. It’s a no harm, no foul type situation.

There was a law change in 2018 that makes a student loan discharge(loan forgiveness) no longer counted as income by the IRS(at least between 2018 and 2025), because prior to this, people on SSI who had student loan debt forgiven risked losing their SSI for the year their debt was forgiven.

Social Security usually bases its decisions on the IRS’s rules, but with SSI being state-influenced, you may want to look into this further before applying for TPD if you are otherwise eligible.

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Housing and living expenses

The rule of thumb for managing expenses is to have your housing cost about 30% of your income. Most people find themselves spending a larger percentage nowadays. If your income drops suddenly, your housing expenses that previously seemed reasonable suddenly become unaffordable. If you have recently become disabled, you may eventually need to rethink your living situation, but that’s a big decision that shouldn’t be made while under severe stress.

If you are rethinking where you live, there are sites and groups that can help with that, the one I’m most familiar with is a Facebook group, but basically, you want to look into Section 8 and low-income housing.

I’ve repeatedly been told, though, that your ideal solution is more likely to be found by finding a good deal on the market, or to be creative in your housing solutions – for example, if you own a home, you may be able to rent out a room, use space through air BnB or otherwise make additional money from your property, rather than sell or lose it.

In the meantime, there are a few federal programs designed to help you with your survival and housing-related expenses. The biggest is the Low-Income Heat and Energy Assistance Program(LIHEAP), whose application usually covers multiple utility assistance programs.

You basically can apply to your county or city’s program and share your financial information, and they determine what supports you are eligible for.

This can help offset your heat, electricity, or even internet expenses.

These expenses are calculated per household, rather than per individual, so I can’t give you a dollar amount, but if you’re worried about being able to pay, it’s worth exploring.

Finally, you may be financially eligible for Supplemental Nutrition Assistance Program(SNAP) benefits(aka Food Stamps).

Again, this is calculated per household, so the number of mouths to be fed influences your eligibility, as does the state you live in.

Food is an important part of your budget and expenses, so determining if you can get this help can really help you better manage all your expenses and create a realistic budget for yourself.

Travel and Transportation Expenses

Becoming disabled also may have a huge impact on your travel plans, including those day-to-day transportation needs. If you can’t work anymore, you may not have a daily commute, but you’re still going to need to get to hospitals, doctors’ appointments, and find solutions to shopping and related needs.

I have a post specifically focused on saving money(and spoons) when traveling, which should be helpful.

Depending on the nature and severity of your condition, you may also need to explore new ways to travel or need to work with disability-related transportation networks.

Your insurance may help you with some transportation expenses too, as some programs(both private insurance and Medicaid) may offer travel assistance to and from doctor’s appointments and/or hospitals.

It’s worth exploring the fine print in your policy if you are facing this sort of challenge.

There are also some forms of travel that may not be worth it for you. For example, many disabled people predominantly shop online, including their grocery shopping, to avoid germs(especially relevant with the Covid-19 pandemic still occurring) and to save energy and reduce stress.

Think about how and where you normally travel, and take some time to evaluate if those plans still make sense for you.

A quick note on disability, poverty, and shame

All of these programs are going to be really looking at your financial history. Most of them will require copies of bank statements as well as other sensitive financial information.

It’s likely to feel embarrassing to share this information, and you may feel like people are judging you.

In some cases, just reading the names of these programs can bring up feelings and images that you’d rather not experience. I understand this.

I’m afraid it’s something you’re going to need to get yourself through anyway.

Classism and ableism are both deeply instilled in our society, and that’s why these feelings of shame exist.

There are steps you can take to reframe your use of social welfare programs, and I hope that you find these suggestions helpful.

Recognizing that your disability is impacting your life isn’t an easy step, so I applaud you for recognizing it and doing what you can to regain control of your life while managing your condition.

You can get the big-bill monkey off your back!

Use this information to reduce your bills, and your stress!

Going to the hospital is often a stressful experience, and unfortunately, hospital bills are another round of stress when we really don’t need it.

You can reduce your medical stresses by planning ahead and selecting the insurance plan that gives you the lowest overall expenses, by minimizing the number of visits you need to make(finding more helpful doctors and following your treatment plan), and by applying for charity care before or immediately after your hospital visit.

I actually have had charity care people meet with me when I’ve gone into the hospital(I called in advance) and handled my application then and there. That’s a lot less stressful than seeing the bill and worrying about how to pay it.

With student loans, most people are under a lot of stress, even those who are abled and working full time. With the income cuts that often go with becoming disabled, wouldn’t it be nice to just not need to worry about that student loan debt?

Immediately after income loss(or as soon as you are up for it), you can apply for a forbearance or an income-based repayment plan, which will dramatically reduce(or completely cut out) your monthly payments for your student loans.

If you do turn out to be long-term disabled with minimal or no employment, you may eventually be able to get your student loans completely forgiven.

These bills are big stressors and its often hard to step back and find a way to make them more manageable. I hope this post helps you reduce your bills and your stress, so that you can focus on your healing process!


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