When you have to take an extended time away from work for a disability, you may have many questions. Regardless of whether you receive long-term disability benefits through an employer or a private insurer, you may wonder what happens to your health insurance while you’re away from work and receiving those benefits. Will you keep your health insurance – and who will pay for it? These are important and understandable questions to ask.
As with so many legal matters, the answer is – it depends. The good news is that you will likely be able to either retain your existing health insurance or explore other viable options. However, various factors must be considered, including the type of benefits you are receiving, the length of your time away from work, and whether your leave is covered under the Family Medical Leave Act (FMLA), among others. Let’s take a closer look at how long-term disability might affect health insurance together.
What Factors Will Affect Health Insurance Eligibility While Disabled?
Various factors will affect your eligibility for health insurance while disabled. The good news is that if you receive long-term disability benefits from the Social Security Administration, you will likely also have access to some form of health insurance. Those who receive SSDI benefits may be eligible for Medicare, while those who receive SSI benefits may qualify for Medicaid.
If you receive long-term disability benefits in another way, however, whether through privately obtained coverage or an employer, your health insurance options may change. Certainly, if you receive healthcare coverage independently of your employer – whether through a spouse or the Healthcare Marketplace, Affordable Care Act, Medicare, or Medicaid, the disability will not affect that coverage. When coverage is provided through an employer, however, it may be a different story.
Typically, FMLA mandates that covered employees maintain health insurance coverage for their employees for up to 12 weeks of disability. Finding out whether your employer is covered by FMLA will be essential to ensure that you receive these legal protections if available. Even if FMLA does not cover your employer, you will still want to speak with your employer’s HR department and review the employer policies regarding health insurance coverage while on disability leave.
What Options Are Available for Those Who Lose Health Insurance While on Disability?
In some cases, for any number of reasons, you may unfortunately lose your private health insurance while receiving long-term disability benefits. If this is the case, although it is unfortunate, you shouldn’t panic. There are still several options available to obtain health insurance, including:
- COBRA: The Consolidated Omnibus Budget Reconciliation Act, also known as COBRA, is an option usually available for employees who lose employer-sponsored group health coverage to extend their plan for 18 months. In cases where the loss of insurance coverage is related to a disability, it may even be possible to extend coverage for up to 29 months. Often, however, the cost of the insurance will go up significantly as the employer no longer subsidizes it.
- Spousal Insurance: If your spouse already has or is eligible for health insurance through his or her employer, you may be able to be added to that plan if your loss of coverage is considered a “qualifying event.” If this is possible, it may be the most cost-effective and simple option for quickly obtaining the insurance you need.
- The Healthcare Marketplace: For those who do not want the expense of COBRA and cannot obtain insurance through a spouse or other more cost-effective means, seeking insurance on the Healthcare Marketplace may be an option. Typically, those needing insurance can only sign up for coverage through a state exchange during the yearly open enrollment period—although losing employer-sponsored coverage may qualify you to choose a new plan during a special enrollment period. Usually, several plans are available at various price points.
- Medicare Coverage: After a 24-month qualifying period, those who qualify for and receive SSDI benefits may also qualify for Medicare coverage.
Clearly, there are a variety of options available, and the best choice will depend upon your unique circumstances. If you believe you may qualify, you’ll want to consult with a knowledgeable and experienced attorney who can provide the advice and guidance you need. At Liner Legal, we’re here for you.
Liner Legal – Your Disability Benefits Attorneys
Struggling with a disability is difficult. There’s no question about it. In addition to dealing with the challenges of the disability itself, it can be stressful to have unanswered legal questions and financial worries. At Liner Legal, we’re here to provide the answers and support you need. We understand every aspect of the law pertaining to disability benefits, and we would be honored to help you fight for the benefits you need and deserve. If you’re ready to get started, give us a call today. We look forward to talking to you soon.
