Who Pays Health Insurance While on Long-Term Disability?

A long-term disability changes your life. In addition to coping with your medical condition, you may worry about how you will pay your bills and support yourself and your family. One of the most pressing concerns is often health insurance. How will you maintain coverage while you are unable to work?

The answer depends on several factors, including the source of your long-term disability (LTD) benefits, your health insurance policy terms, and federal and state laws. An experienced LTD lawyer can explain what you need to know.

Employer-Sponsored Health Insurance

If you have health insurance through your job, the first step is to review your benefits handbook or summary plan description. Look for information on how your coverage works if you take a leave of absence due to disability.

Under the Family and Medical Leave Act (FMLA), eligible employees can take up to 12 weeks of unpaid, job-protected leave per year for a serious health condition. During this time, your employer must maintain your group health insurance coverage as if you were still working. You will need to continue paying your average share of the premium.

However, FMLA leave is limited and may not cover the duration of your disability. Once you exhaust your FMLA leave, your employer can terminate your health insurance unless another law or company policy provides additional protection.

COBRA Continuation Coverage

If you lose your employer-sponsored health insurance due to a disability, you may be eligible to maintain coverage through COBRA. COBRA is a federal law enabling employees and their families to extend group health benefits temporarily following a qualifying event, such as job loss or reduced work hours.

Under COBRA, you can maintain your health insurance for up to 18 months if you become disabled. If you already receive Social Security Disability Insurance (SSDI) benefits when you elect COBRA, you may be able to extend coverage for an additional 11 months, for 29 months.

The catch with COBRA is that you must pay the full premium, including the portion your employer previously covered, plus a 2% administrative fee. This can make COBRA coverage very expensive, especially when you’re living on a reduced income. However, maintaining access to your doctors and avoiding a coverage gap may be worth the cost.

Private Health Insurance

If you have an individual health insurance policy you purchased independently, your coverage should continue as long as you pay your premiums. However, you may face challenges if your disability prevents you from working and earning an income.

Review your policy carefully to see if it includes any provisions for waiving premiums or suspending coverage during a disability. Some policies may allow you to pause your payments temporarily or reduce your benefits to lower costs. You may also have the option to switch to a different plan with a higher deductible or fewer benefits to make premiums more affordable.

If you’re seeking a new individual health insurance policy while on disability, you cannot be refused coverage or charged higher premiums due to a pre-existing condition, thanks to the Affordable Care Act (ACA). However, factors like your age, location, and chosen plan may still result in increased costs.

Medicaid

If your income and assets are limited, you may be eligible for Medicaid, a program jointly funded by the federal and state governments that offers health coverage to low-income individuals and families. Medicaid eligibility requirements vary by state, but generally, it includes people with disabilities who meet certain financial criteria.

Protecting Your Health and Finances

Keeping your health insurance premiums paid while you’re on long-term disability can feel overwhelming, especially when you are already dealing with the physical and emotional challenges of your condition. However, maintaining coverage is essential to protecting your health and financial well-being.

If you struggle to afford your premiums or encounter problems with your insurer, feel free to seek help. Many organizations, including local disability rights groups, legal aid clinics, and social service agencies, offer assistance and advocacy for people with disabilities.

You may also want to consult with an experienced disability attorney who can review your insurance policies, explain your rights, and help you explore your options for coverage. A knowledgeable lawyer can also assist you with filing claims, appealing denials, and negotiating with insurers to get the benefits you deserve.

Get the Support You Need

At Capitan Law, we understand the stress and uncertainty of managing a long-term disability. Our compassionate attorneys are here to help you obtain your disability benefits. We can review your policies, advise you on your rights, and advocate for your interests with insurers and government agencies.

If you have questions about maintaining health coverage while on long-term disability, do not hesitate to reach out. Call (267) 419-7888 today or contact us online to schedule a consultation and learn more about how we can help you.