Who Is Responsible for Health Insurance During Long-Term Disability?

Being disabled is difficult in many ways. This is especially true if your disability has caused you to be unable to work. Being unable to work is financially stressful in many ways – especially at a time when you may have increasing healthcare costs because of your disability. If you find yourself in this situation, you may be worried about how you will maintain health insurance while you deal with a long-term disability and who will pay for it. That’s an understandable worry. Let’s take a closer look at potential options together.

Health Insurance and Social Security Disability Benefits

Many disabled individuals choose to apply for disability benefits provided by the Social Security Administration. Two types of disability benefits, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits may be available, depending upon your particular circumstances.

Both SSDI and SSI are federal disability programs administered by the Social Security Administration, and to receive either type of benefit, an individual must have a qualifying medical disability that has rendered them disabled for one continuous calendar year or more. They differ, however, in terms of how people qualify, as well as the amount of benefits they receive and how those benefits are financed. Ultimately, it is essential to consult with an attorney who knows and understands the law and can advise you as to which type of benefit you should pursue.

In most states, those who receive SSI benefits automatically qualify for and receive Medicaid coverage. Typically, those who receive SSDI benefits will qualify for Medicare benefits after receiving disability benefits for at least two years. Some individuals will qualify for both Medicare and Medicaid—this is typically known as being dual-eligible.

Health Insurance Provided Through an Employer

Many employers provide insurance coverage for their employees. Some employees choose to opt into that coverage, while others may choose coverage under a spouse’s insurance policy instead.

Those who are covered through their spouse’s insurance will likely remain covered despite their disability, as their eligibility for the policy does not depend upon their personal employment. As long as the spouse’s employer continues to offer health insurance benefits and as long as the employed spouse continues making premium payments under the policy, coverage should continue despite the disability.

On the other hand, if you are disabled and you receive health insurance coverage through your employer, the situation may be different.

Several factors may come into play to affect whether or not your health insurance benefits continue, including:

• The length of your disability: If your disability is for a shorter term – less than twelve weeks, for example – and your leave is protected under FMLA rules, then typically, your employer must continue your health insurance benefits, even if you are on unpaid leave otherwise. If your disability is longer than a short-term disability, however, there is typically no requirement for an employer to continue to maintain health insurance.
• Your disability is protected under FMLA: As noted above, FMLA (the Family Medical Leave Act) generally requires that covered employers maintain an employee’s health insurance coverage for up to 12 weeks when that employee cannot work due to a medical condition. As a general rule, all private-sector employers with more than 50 employees for at least 20 work weeks in the calendar year are covered by FMLA, as are all public agencies. As an employee, in order to be covered, you must have worked for the covered employer for at least 12 months and have contributed at least 1250 working hours that year.

While these two factors may affect your ongoing entitlement to health insurance, it’s also important to speak to your employer’s human resources department and review your specific insurance policy to determine whether you might be entitled to ongoing coverage in your circumstances.

If you lose health insurance coverage, you may still have various options available, and you shouldn’t panic. Instead, you should contact an attorney who knows and understands the law and can provide the advice and guidance you need during this difficult time. At Keener Law, we’re here to help.

Keener Law – Here For You

When you’re struggling with a long-term disability, it’s not easy. You may find yourself feeling worried and overwhelmed. It’s understandable to worry about things like health insurance. It’s normal to wonder how you’ll care for yourself and those you love when you cannot work. At Keener Law, we understand those concerns. That’s why we specialize in helping our clients seek the disability benefits they need and deserve by pursuing the best legal strategies on their behalf. We know and understand the law and have years of experience helping clients through this process. If you’re ready to get started, give us a call today. We look forward to helping you soon.