SSDI & COBRA: Know Your Options

If you become unable to work due to an illness or injury, then applying for Social Security Disability Insurance (SSDI) could benefit you in a variety of ways. SSDI recipients can become eligible for Medicare faster than if they had to wait until they turned 65, the typical Medicare start age. SSDI recipients are eligible to enroll in Medicare 24 months after their entitlement date to cash benefits, or 29 months after their date of disability onset. Aside from cases of Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD), claimants will have a mandatory 5-month wait period for benefits from their date of disability. If a claimant is awarded with a disability onset of 9/5/2024, entitlement to benefits would begin 3/2026 and Medicare eligibility beings 3/2028. 

While this is certainly exciting news for individuals and families who have been paying medical bills and expenses with what is often insufficient, or no, insurance, this waiting period between receiving an SSDI award and Medicare eligibility can pose significant hardship as it may cause a lapse in health care coverage.

Fortunately, when a claimant is awarded SSDI, he/she may also be eligible for an extension on existing COBRA coverage, but many SSDI applicants are unaware that this option may be available to them.

The United States Department of Labor implemented regulations in July 2004 to allow individuals who are receiving group health plan coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to qualify for an 11-month health care coverage extension while waiting for their Medicare entitlement. This coverage, which normally ends after 18 months, can be extended for a total period of 29 months once a claimant is awarded Social Security Disability Insurance.

• In order to be eligible for the extension, the claimant must provide a copy of their Notice of Award or Notice of Decision from the Social Security Administration to their COBRA provider within sixty (60) days of receiving said notice.

• This notice must confirm that the claimant was disabled during the first 60 days of their original COBRA coverage and has remained disabled throughout the full 18-month COBRA period.

• The notice must also be provided to the COBRA administrator before the original 18-months of coverage has lapsed.
• Please note that the extended period of coverage will end if there is a final determination that the claimant is no longer deemed disabled by the SSA. 

• Find more information about extending your coverage here!

We encourage all claimants to reach out to their health plan administrator or human resources department at their former employer for any specific questions related to their unique health care coverage and COBRA extension options. Contact the Advocator Advantage team today—our licensed agents are ready to provide personalized Medicare assistance and help you secure the ideal plan.

Nothing in this post is intended as advice or a suggestion to elect or not elect to claim benefits of any kind, including Social Security benefits, nor is it intended as financial advice in any way.  The decision to claim benefits is a personal one that is contingent upon each individual’s unique circumstances.