09/07/2010 (5:36 pm)
health insurance after disabilty and COBRA expire Best answer on the web
say this will be followed by a 26 week period of long term
disabiltiy payments. Then, she will be eligible for COBRA for 18
months. She will then be 2.5 years short of MEDICARE eligibilty.
What programs exist to provide health insurance coverage for this
gap??
In which state does your sister reside?
Thanks,
hummer
Not to worry, your sister should be able to keep COBRA until Medicare kicks in as long as she meets all of the requirements on time. COBRA consists of:
1) Initial 18 month group coverage
2) 11 month group Disability Extention (premium will be at 150% of initial coverage) 3) Option to convert to individual health coverage for remaining period of time
1) US Department of Health and Human Services
Centers for Medicare and Medicaid Services
Standard Periods of Coverage
"The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) establishes required periods of coverage for continuation health benefits. COBRA beneficiaries generally are eligible for group coverage during a maximum period of 18 months for a qualifying event of employment termination or reduction of employment hours. Other qualifying events may entitle a spouse and dependent children to a total of 36 months of COBRA coverage." Employment termination: 18 months
http://www.cms.hhs.gov/COBRAContinuationofCov/05_StandardPeriodsofCoverage.asp#TopOfPage
2) US Department of Health and Human Services
Centers for Medicare and Medicaid Services
Extended Periods of Coverage
"29-Month Period (Disability Extension): Special rules for disabled individuals and certain family members may entitle them to an 11-month extension of Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) continuation coverage (from 18 to 29 months). Specifically, if a qualified beneficiary is determined under Title II or XVI of the Social Security Act to have been disabled within the first 60 days of COBRA coverage, then that qualified beneficiary and all of the qualified beneficiaries in his or her family may be able to extend COBRA continuation coverage for up to an additional 11 months. (An individual who has been determined under Title II or Title XVI of the Social Security Act to have been disabled before the first day of COBRA continuation coverage, and who has not been determined to be no longer disabled at any time between the date of that disability determination and the first day of COBRA continuation coverage, is considered to be disabled within the first 60 days of COBRA continuation coverage.) However, qualified beneficiaries may lose all rights to the additional 11 months of coverage if notice of the determination is not provided to the plan administrator within 60 days of the date of the determination (when the determination is issued during the initial 18-month period of COBRA coverage) and before the expiration of the 18-month period. The qualified beneficiary who is disabled or any qualified beneficiaries in his or her family may notify the plan administrator of the determination. (Click on ?Notices Required of Qualified Beneficiaries? on the left navigation bar.)" http://www.cms.hhs.gov/COBRAContinuationofCov/06_ExtendedPeriodsofCoverage.asp#TopOfPage
Frequently Asked Questions about COBRA Continuation Health Coverage
Can individuals qualify for longer periods of COBRA continuation coverage?
"Yes, disability can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours. To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must: * Have a ruling from the Social Security Administration that he or she became disabled within the first 60 days of COBRA continuation coverage * Send the plan a copy of the Social Security ruling letter within 60 days of receipt, but prior to expiration of the 18-month period of coverage If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage. Plans can charge 150% of the premium cost for the extended period of coverage." http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html
3) US Department of Health and Human Services
Centers for Medicare and Medicaid Services
Other Coverage Considerations
"Although COBRA specifies certain periods of time that continued health coverage must be offered to qualified beneficiaries, COBRA does not prohibit plans from providing continuation coverage beyond the periods required by COBRA. Also, some plans allow participants and beneficiaries to convert group health coverage to an individual policy. If this option is available from the plan, the COBRA law gives you the right to exercise that option when you reach the end of your COBRA continuation coverage. The plan must offer a qualified beneficiary the option of enrollment in a conversion health plan within 180 days before COBRA coverage ends. The premium for a conversion policy may be more expensive than the COBRA premium, and the conversion policy may provide a lower level of coverage. The conversion option, however, is not available if the qualified beneficiary ends COBRA coverage before reaching the end of the maximum period of coverage. Important Note: One of the conditions that must be met to obtain individual health coverage as a HIPAA-eligible individual is that the individual's most recent period of coverage must be employer-sponsored group health plan coverage. COBRA coverage meets that requirement; a COBRA conversion policy does not. Federal law does not give an individual who takes a COBRA conversion policy a right to switch from the conversion policy to other individual health coverage on a guaranteed available basis." http://www.cms.hhs.gov/COBRAContinuationofCov/13_OtherCoverageConsiderations.asp
What Happens When COBRA Ends?
"Last month?s column described how someone could stay on their employer?s health insurance even after they stop working there. But COBRA only lasts 18 months for terminating employees. What happens after that? There are two federal laws that can be used to continue health insurance once your COBRA Continuation Coverage ends. Both provide access to health insurance without having to prove that you are ?insurable.? 1. If you leave work due to disability??
"COBRA was amended to allow people, who had to stop work due to disability, to extend the time they can keep COBRA Continuation. Under this law, someone who qualifies may stay on their employer?s COBRA Continuation until they become eligible for Medicare, which is normally 29 months after they leave work due to disability. However, to qualify for this extension of COBRA, you must meet several requirements: 1. You must apply for Social Security Disability Insurance (SSDI) benefits.
2. Social Security must approve your benefits during your initial 18 month COBRA period. 3. The Onset Date of your disability, must be within 60 days of the start of your COBRA coverage. 4. Finally, you must provide a copy of your Social Security Notice of Award letter to your COBRA administrator within 60 days of receiving it AND within 18 month COBRA period."
This is a good way to stayed insured since it allows you to stay on your employer?s health insurance plan until you become eligible for Medicare. The primary drawback is that during the months after the first 18 months of COBRA, the employer can (and will) charge you the actual premium PLUS 50%. For example, if you were paying $200 per month on COBRA, the extended months will cost $300 per month." How It Works
"Once your COBRA Continuation coverage ends, the insurance company or administrator is required to send you what is called a ?Certificate of Creditable Coverage? which is usually simply a letter confirming the starting and stopping dates of your coverage with them. Upon presenting that letter to the HIPAA plan or carrier, the plan is required to let you purchase the coverage. Thanks to these two laws, now, if you ever become insured under an employer health plan, you will be permitted to maintain health insurance indefinitely, even after your employment terminates." http://www.hcvadvocate.org/hepatitis/About_Hepatitis_pdf/1.1.1_Living_With_HepatitisC/cobra-2.pdf
It's a bit complicated but I hope I've been able to help you see through the maze. If you have any questions, please post a clarification request and wait for me to respond before closing/rating my answer.
Thank you,
hummer
Google Search Terms Used: cobra extension continuation
I also searched the Centers for Medicare and Medicaid Services website.
If your sister is disabled enough to get long term disability from her employer it's highly likely that she might also qualify for Social Security Disability benefits. If she does qualify for SSA disability she will be covered for Medicare after 24 months.
http://www.ssa.gov/disability/
Benefits For People With Disabilities
http://www.ssa.gov/d&s1.htm
Disability & SSI
http://www.ssa.gov/pubs/10043.html
Before age 65, you are eligible for free Medicare hospital insurance if:
-- You have been entitled to Social Security disability benefits for 24 months; or
http://www.nosscr.org/faqind.html
Social Security Disability
Frequently Asked Questions
Good luck,
~ czh ~
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