A Bridge to Medicare

A disability beneficiary is eligible for Medicare coverage, but there is a 24 month waiting period. When that is added to the 5-month SSDI waiting period, a beneficiary is not eligible for Medicare until 29 months after onset of disability.

COBRA (the Consolidated Omnibus Budget Reconciliation Act), provides a bridge until Medicare is available. Under COBRA, workers who leave employment (for other than misconduct), can continue health insurance coverage under the employer’s group health plan for an initial period of 18 months after the “qualifying event,” e.g. leaving employment. However, the beneficiary must pay the health insurance premium.

Assuming that the beneficiary has the financial means to pay the premium, can the 18-month initial COBRA period be extended to bridge the entire 29-month Medicare waiting period? The answer: Yes, there can be a COBRA extension of 11 months if the beneficiary is found disabled for Social Security disability benefits before the expiration of the initial 18-month period and requirements are met including:

1. The Social Security decision must be dated before the 18-month period lapses.
2. The Social Security decision must find that the individual became disabled within 60 days of the COBRA “qualifying event,” i.e. the date the individual stopped working.
3. The favorable Social Security decision must be received by the insurer/plan administrator within 60 days of the decision date.

Randy Zeldin, Esq. is a Social Security Disability Attorney and Lawyer practicing in Boca Raton, with offices in Ft. Lauderdale, Boynton Beach and West Palm Beach.

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