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No. 2 – Long-term disability benefits and my healthcare coverage through COBRA
At The Law Office of Nancy L. Cavey, it’s not uncommon for long-term disability applicants to come to our office with a letter from their employer about continuing their healthcare coverage through COBRA.
Federal law requires employers with 20 or more employees to provide COBRA health care continuation coverage, and there are specific time limits for choosing this coverage.
Unfortunately, many long-term disability applicants are also applying for Social Security Disability benefits and are in need of medical treatment. They have not become Medicare eligible and are facing a gap in their health insurance coverage.
While there is no one-size-fits-all answer, there are considerations that each long-term disability applicant should consider in making the difficult decision about continued COBRA coverage or alternative coverage:
1. Are you eligible for COBRA?
2. Do you have any dependents who have medical problems which require ongoing medical treatment?
3. Do you have coverage available to you under a spouse’s employer?
4. Where are you with the Social Security Disability process? COBRA generally allows you and your dependents to keep group health coverage for 18 months after your employment ends.
There is an additional 11-month extension available when qualified beneficiaries are determined by the Social Security Administration to be disabled. This would provide 29 months of healthcare coverage.
You become eligible for Medicare 24 months from the SSA determined date of award.
5. Have you been awarded SSDI, and do you have dependents? If all of the qualified beneficiaries in your family are disabled and meet the SSDI eligibility requirements, all the qualified beneficiaries in the family are entitled to an 11-month extension of the general 18-month COBRA coverage. This will provide 29 months of COBRA coverage.
6. What will your COBRA coverage cost? You will have to talk to your Human Resources Department to determine how much COBRA coverage will cost.
Generally, the first 18 months of coverage can cost as much as 102 percent of the cost of the plan of those who are still employed.
7. What do you anticipate your medical needs to be in the next 18 months?
At The Law Office of Nancy L. Cavey, we suggest that you estimate what medical treatment you are going to require in the next 18 months and what it would cost without insurance? Look at your deductibles and estimate the cost of medication, diagnostic testing, and hospitalization.
If you are facing significant medical treatment, it may be wiser to pay the higher COBRA premium so that you can get the medical treatment you need.
8. What would be the cost of any COBRA premium increases? If you get the 11-month disability extension, the premium for those 11 months may go up to 150 percent of the plan’s total cost.
9. Have you priced any individual health plans?
You have 60 days to make the COBRA election.
At our law office, we provide our long-term disability/ERISA clients with advice as to their COBRA and insurance options. We will help you determine your insurance costs under COBRA, the medical benefits you might require in the future and alternative medical care sources.
We can also refer you to lower cost health care options such as Drug Company and state pharmaceutical assistance programs, various government programs such as Medicaid, Veterans’ Assistance, and State and Local Health Services.
The decision that you make regarding your medical care is not only financial but one that will impact your health as you are trying to deal with your disabling condition and recover.
Nancy Cavey can provide you with assistance.
Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-477-3263.