Extended Medical Benefits (COBRA) for Disabled Texans

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers who lose their job and who had medical benefits through a group health plan provided in that job the right to choose to continue those group health benefits( (including medical beneftis for dependents such as a spouse or child) for limited period of time under these circumstances:

• Retirement
• Layoff or Reduction-In-Force (“RIF”)
• Voluntary or involuntary job loss (this includes being fired as long as not for “gross misconduct”)
• A reduction in hours that eliminates medical insurance eligibility

Employers Required to Office COBRA

The employer must have employed at least 20 employees on more than 50% of its typical business days during the preceding calendar year. Full-time employees count as one while part-time employees are count proportionately.

Texas COBRA Benefits Related Rights

Texas is not a state known for its generous social programs. So it is both surprising and hopeful that Texas law does provide some additional months of coverage beyond that available through the federal COBRA laws.

Texas continuation is not an alternative 18-month COBRA program. It generally does one of two things:

1. Provides nine months when federal COBRA is unavailable; or
2. Adds six months after federal COBRA has been exhausted.

These Texas protections apply only when the policy is subject to Texas insurance law—normally a fully For a Texas employer with fewer than 20 employees, Texas state continuation may still apply if the group plan is fully insured and governed by Texas insurance law, generally providing up to nine months of continuation. Thus, “fewer than 20 employees” does not necessarily mean the employee has no continuation rights. Here is a summary of these unique benefits available to Texas residents:

Time Period to Elect COBRA benefits

You can’t just decide anytime within the 18 month period of extension to of elect COBRA extended benefits . You have only 50 days. The 60-day period begins on the later of:

1. The date your employer-sponsored coverage ends; or
2. The date the COBRA election notice is provided to you—often the date it is mailed.

Time period of extended coverage

As noted above, eligibility for COBRA is for a limited number of months. The months of eligibility start with the co-called “qualifying event”, hiwch is in most cases the day you quite, were let go or fired for other than “gross misconduct. Here are the eligibility periods:

• 18 months: if you lost coverage because your employment ended, whether voluntarily or involuntarily, or because your work hours were reduced.
• 29 months: if a covered person qualifies for COBRA’s Social Security disability extension. This adds 11 months to the normal 18-month period.

The extension of eligibility for COBRA benefits from 18 months to 29 months for a Social Security disability recipient Is extremely important To the Social Security Disability Insurance claimant. The “take home” is this:

Electing COBRA Extended medical benefits is pricey for disabled not unemployed Texan, and often summarily discarded as unaffordable . But ongoing medical treatment often can be the difference between winning and losing your Social Security disability case. My advice from 30 plus years of handling only Social Security disability cases in North Texas: Don’t just throw the COBRA extension letter offer in the trash saying “this is way too expensive”. It’s true it will be expensive but you need to consider carefully the damage going without ongoing uninsured can have for your Social Security disability case.

Take a very hard look at your financial situation. Disabled Texans are often understandably reluctant to cut family expenses particularly those impact their spouse and their children.

In my view If radical reductions in your spending mean you could afford COBRA coverage and you’re pursuing a Social Security disability case You should make those cuts. It’s tragic decision for one 2 discard COBRA benefits as “too expensive” while maintaining expensive cable packages, Or expensive car payments.

If you’re unsure about whether you can afford the COBRA premiums go ahead and elect and pay the premium for at least one or two months. You always get then reassess whether you truly are able to make the cuts in your family budget that are needed to maintain this vital insurance coverage.