A long-term disability can hit your life unexpectedly.
When you are not able to continue working due to a disability, worries cloud your mind. How will you pay your bills, and who will help your family while you are not working?
Luckily for those cases, long-term disability insurance (LTD) can help you cover a portion of your salary while you cannot work because of a restricting medical condition.
Unfortunately, there’s still a question left to answer: who pays health insurance while on long-term disability?
At Pinyerd Law, we understand that this is a typical concern for employees on long-term disability.
For that reason, in this post, we explain what happens and who pays for your health insurance when you are not earning money.
Health Insurance and Disability Insurance: The Difference
There might be confusion around the terms “health insurance” and “disability insurance“.
Both of these plans aim at helping you if you suffer from an illness or have an accident, but they are helpful in different ways.
On one hand, health insurance covers a portion of your health costs, such as medical consultations, medications, certain procedures, and even vaccines.
On the other hand, disability insurance covers a percentage of your income if you have a disability that prevents you from working to make sure you have money while you’re on leave.
There are different types.
- SSDI: The Social Security Disability Insurance (SSDI) is a government program that applies to people who are not able to perform almost any kind of work due to a medical condition for an extended period of time.
- LTD: Employees eligible for Long Term Disability Insurance (LTD) cannot work due to a medical condition that extends for more than 6 months.
- STD: Short-term disability insurance (STD) applies when employees have short-term conditions, in cases like pregnancy, surgery recovery, accidents, and others.
Now that you know the difference, we will focus on who pays for your health insurance when you are on long-term disability.
Who Pays Health Insurance While on Long-Term Disability?
The situation of your medical insurance varies depending on different factors. First of all, let’s see how you are receiving health insurance.
Health Insurance Through Your Employer
This is one of the most common cases. When you are under an employer-provided medical insurance, being on long-term disability is difficult.
When you are on short-term disability and move to long-term disability, employers frequently consider that you are not actively working and dismiss you.
It is not always the case, but when this happens, your medical insurance benefits end.
To understand your employer’s responsibilities here, it is important to consult with Human Resources and understand the company policies.
In some cases, if you meet the requirements, the Family and Medical Leave Act may apply.
Under the Family and Medical Leave Act (FMLA), employees are entitled to 12 months of leave, and the employer has to pay for health coverage as if the worker were still doing the job.
FMLA also requires that your employer give you back your position, but it does not require paid leave.
You can consult and clear up doubts about your situation with a long-term disability lawyer.
Health Coverage from Your Spouse
If you receive health coverage through your spouse’s job, then there shouldn’t be any problem.
As long as your partner is still working, and you continue being eligible, your situation will not change if you are on long-term disability.
Self-paid Coverage
It might be the case that you pay for your medical insurance on your own.
In that case, as long as you pay, you have the benefits. The problem comes when you are no longer working, so you are not generating money to pay.
Other Possibilities of Medical Insurance Coverage
In the event that you lose your employer-sponsored healthcare coverage during long-term disability, it is important to consider the alternative options you have:
1) Consolidated Omnibus Budget Reconciliation
The Consolidated Omnibus Budget Reconciliation, also known as COBRA, is a law that allows employees to continue their health coverage under certain circumstances for a limited period of time.
Especially when you are disabled, COBRA allows you to extend your healthcare insurance between 18 and 36 months.
However, choosing COBRA comes with a drawback: you have to pay for the full premium. When you are not working, this option can be expensive.
2) Affordable Care Act Marketplace
Another option for you is through the Affordable Care Act (ACA) marketplace.
Varying across states, the ACA marketplace offers you medical coverage plans according to your income. You give information to understand if you are also eligible for Medicaid or other benefits.
The enrollment window for this plan usually takes place at the end of the year, in November and December.
3) Medicare Through SSDI
Although it is much more difficult to get Social Security Disability Insurance (SSDI), those individuals who are eligible for this benefit have access to Medicare.
It is worth noticing that you have to wait 24 months first.
Our lawyers are always ready to help you fill in your claim and collect the evidence you need to get the SSDI benefits.
4) Your Spouse’s Healthcare Plan
If you are married and your partner has health coverage, you can join your spouse’s medical coverage plan as an alternative when losing your healthcare insurance.
Joining your partner’s medical plan is possible, but you have to wait until the specific time of enrollment begins to sign up, and it might not be affordable.
Frequently Asked Questions (FAQs) on Long-Term Disability and Medical Insurance
1. What are the disadvantages of long-term disability insurance?
Some disadvantages of long-term disability insurance include limitations on pre-existing conditions, costs that can be expensive, long waiting periods, and when claiming for the insurance, the risk of rejection and appeal, disagreements, especially with mental health conditions, and lack of evidence are common problems.
2. How long do long-term disability benefits last?
On average, most long-term disability insurance plans last around 2 years and a half years, but other plans might last longer, even up to retirement age. Longer plans are not necessarily better. The time has to adjust to your disability, as you might recover sooner or later.
3. What is the difference between disability insurance and health insurance?
Both disability and health insurance plans are designed to help you in the event you suffer from a medical condition or you have an accident . The main difference is that disability insurance benefits supplement a part of your income, while health insurance covers medical costs, such as medications and medical checks, among others.
Looking for a Long-Term Disability Insurance Lawyer?
If you are struggling with your long-term disability benefits and health insurance, looking for experts in the matter is out of the question.
When you have a disability, experiencing problems with your benefits and your medical insurance adds more stress to the situation.
At Pinyerd Law, we understand that clarifying the situation and understanding your rights and obligations is extremely important.
- Our long-term disability insurance attorneys are ready to guide you and bring you clarity when everything seems to be sheer chaos.
- We analyze your situation and your insurance policy, and we explain it to you with clear communication and simple language.
- Our lawyers also help you present your claim to get long-term disability benefits, gathering solid evidence of your case and representing you if there’s an appeal process.
If you’re looking for a long-term disability insurance attorney to assist you with your case, contact Pinyerd Law today.
