By Eric A. Shore, Founding Attorney “How am I going to pay for my doctors?”
As a DISINJURY Lawyer, I hear this question all the time. Some people were fired. Others got hurt at work or had to stop working because of a disability. They still need treatment.
Now they’re worried about losing their health insurance too.
You have options. COBRA may let you keep your current insurance. An ACA Marketplace plan may cost less. Medicaid, a spouse’s work plan, or VA health care may also be available.
When someone calls me about losing health insurance, I also ask why they stopped working. If their health forced them to leave, we should be looking at disability benefits too.
What should I do first?
Ask your employer when your health coverage ends. Your last day of work and your last day of insurance may be different. Get the date in writing.
If you are still employed, ask about FMLA before you quit or agree to leave. Eligible employees can receive up to 12 weeks of job-protected leave. During qualifying leave, health insurance generally continues on the same terms.
Then compare your options. Look at the monthly premium and deductible. Check whether your doctors and prescriptions are covered. A cheaper premium does not always mean cheaper medical care.
Can I keep my insurance through COBRA?
COBRA may let you keep the health plan you had through work. That can help if you’re in the middle of treatment and want to stay with your doctors.
The cost can be a shock. You usually pay your share of the premium plus what your employer was paying. There may also be an administrative fee.
Ask HR or your benefits administrator about eligibility and enrollment. You generally have at least 60 days to elect COBRA. That period starts from the later of when your coverage ends or when your election notice is provided.
Compare your options before choosing. Dropping COBRA voluntarily generally does not create a new opportunity to enroll in a Marketplace plan outside open enrollment.
Can COBRA last longer if I am disabled?
Some people qualify for an extension from 18 months to 29 months. Social Security must find that you were disabled during the required period. The plan can charge more during the extension.
Contact your benefits administrator as soon as you receive your Social Security disability determination. Follow the plan’s notice instructions and deadlines. This extension may help you maintain coverage while waiting for Medicare.
Is Obamacare only for people with low incomes?
No. The ACA Marketplace, often called Obamacare, offers private health insurance. You do not have to have a low income to buy a plan.
Your estimated household income for the year helps determine whether you qualify for financial assistance. Some people receive help paying their premiums. Others pay full price. Income earned before losing your job counts toward that estimate too.
You generally have 60 days after losing job coverage to enroll in a Marketplace plan. You can also apply before your coverage ends. Start at HealthCare.gov to compare plans and find your state’s Marketplace.
Could I qualify for Medicaid?
Possibly. Medicaid eligibility depends on your income and your state’s rules. Having no income does not automatically qualify everyone.
Medicaid is separate from Marketplace insurance. But a Marketplace application can help identify whether you may qualify. You can apply for Medicaid throughout the year.
Many states also have special Medicaid programs for people with high medical bills or people with disabilities. Ask your state Medicaid office what is available.
Can I join my spouse’s insurance?
Losing your coverage may allow you to join your spouse’s employer plan without waiting for its annual enrollment period.
Ask your spouse’s HR department right away. You generally must request enrollment within 30 days after losing your other coverage.
Does my state offer other help?
It might. A few states pay part of your wages when you can’t work because of an illness or injury. These include California, New Jersey, New York, Rhode Island, and Hawaii. Several other states now have paid medical leave programs. This money does not replace insurance, but it can help you pay your premiums.
Many states also let workers at smaller companies keep their plan when federal COBRA does not apply. Some states add their own help on top of Marketplace savings. Your state’s Marketplace can tell you what is available where you live.
I’m a veteran. Can I get VA health care?
Possibly, and it’s worth checking right away. Many veterans who served on active duty and were not dishonorably discharged can apply for VA health care. If you have a
service-connected disability, you may get care at little or no cost.
Some veterans never apply because they assume they won’t qualify. Losing your job and your income can also change what you are eligible for. Apply at VA.gov, by phone, or at your local VA medical center.
If you have a condition caused or worsened by military service, you may also qualify for VA disability compensation. That is separate from VA health care.
Can an independent insurance agent help?
Yes. An independent insurance agent who handles Marketplace plans can help you compare costs and coverage. Their help is generally free to you because the insurance company pays them.
Ask which insurers they represent. Make sure the plans you’re comparing cover the treatment you need.
What if I was injured at work?
A workplace injury may involve workers’ compensation. That coverage may pay for treatment of the work injury and replace part of your lost wages. The rules depend on your state.
It does not replace health insurance for unrelated medical care or your family. Report the injury promptly and tell your doctors that it happened at work.
Do I have disability insurance through work?
Many people do and never know it. Ask HR whether you have short-term disability or
long-term disability insurance. These benefits can replace part of your paycheck while you can’t work. That money can help you pay for COBRA or a Marketplace plan.
If your claim is denied, you may have the right to appeal. Check the denial letter for the deadline.
What if my health keeps me from working?
The Law Offices of Eric A. Shore handles short-term disability, long-term disability, Social Security disability, and VA disability claims nationwide. Depending on your circumstances, you may qualify for more than one type of benefit.
For Social Security disability, your condition must meet Social Security’s rules and have lasted or be expected to last at least 12 months or result in death. SSDI also requires sufficient work credits. You do not have to wait a year to apply.
Being unable to return to your old job does not automatically qualify you. Social Security also considers whether you can adjust to other work.
Can Social Security disability help me get Medicare?
Yes. Winning an SSDI claim can lead to Medicare before age 65.
Medicare generally begins after 24 months of entitlement to SSDI benefits. Some of that time may have passed while your claim was pending. Approval does not always mean another two years of waiting.
People with limited income and resources may qualify for Supplemental Security Income, or SSI, instead. In most states, SSI eligibility also provides access to Medicaid.
Check your health insurance options while your disability claim is pending. You still need coverage for the care you need now.
Could losing my job raise other legal issues?
It might. Being fired after missing work because of a medical condition can raise questions about medical leave or disability discrimination. What happened before the termination matters.
That is why I ask about more than insurance. Someone who calls about losing coverage may also need help protecting their income or understanding their rights at work.
Your health insurance checklist
- Get the date your health coverage ends in writing.
- If you are still employed, ask about FMLA leave before you quit.
- Ask HR for your COBRA notice and the monthly cost.
- Compare Marketplace plans and enroll within 60 days after your job coverage ends.
- Check whether you qualify for Medicaid or other state programs.
- If you are married, ask your spouse’s HR about joining their plan within 30 days.
- If you are a veteran, apply for VA health care.
- If you were hurt at work, report it in writing and ask about workers’ compensation.
- Ask HR if you have short-term or long-term disability insurance.
- If you can’t work, talk to a disability lawyer about your options.
How can I get help?
Call the Law Offices of Eric A. Shore at 1-800-CANT-WORK. We can discuss your situation and whether you may have a disability claim.
Eric A. Shore is the founding attorney of the Law Offices of Eric A. Shore and a DISINJURY Lawyer with more than 30 years of experience. His firm handles disability claims nationwide.
