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Summary

The law allows an extension of health coverage beyond the initial 18 months if you have a "disability" at the time you stop work or other Qualifying Event.. Note that you can only get the extension if Social Security certifies that you are "disabled."

In order to get Social Security to certify that you are "disabled", you must apply for Social Security Disability Insurance (SSDI), even if you are not eligible for it. It is through the SSDI process that Social Security determines whether you were disabled at the time you left work.

The steps to take, which are described in other sections of this article, are:

Step 1. Apply For Social Security Disability Insurance (SSDI) Right Away.
Step 2. When You Apply For SSDI, Keep In Mind That The Onset Date Of Your Disability Must Be Within 60 Days Of The Loss Of Regular Coverage.
Step 3. You Must Present Your SSDI Notice Of Award Letter To The Plan Administrator Within 60 Days Of Receiving It And During The Initial 18 Months Of COBRA.
Step 4. Obtain Immediate Written Confirmation From Your Employer Or Plan Administrator Of Your Extended Coverage. 

Keep in mind that during the extension period, your premiums can jump up to 150% of the premium co-workers pay. If you were paying $150 per month for COBRA coverage, it could jump to $225 per month for months 19 through 29.   To figure out what your premium will be, just multiply your COBRA premium by 1.5.

NOTE: For related information, see:

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Medicare Social Security Disability Income (SSDI)

Step 1. Apply For Social Security Disability Insurance (SSDI) Right Away -- Even If You're Not Eligible To Receive SSDI Benefits.

Although there is a 5 month waiting period before SSDI payments start, do not wait until the end of the waiting period to apply. Gathering the necessary information and processing a claim takes time. If your claim is denied, you will have time to file at least one appeal, and maybe more.

If Social Security has not made a decision about your disability status before the end of the 18 months of regular COBRA, then there is no way to extend the coverage even if Social Security later approves your claim.

At the time of application, tell Social Security that you have COBRA so they will expedite the claim.

If you are not eligible for SSDI due to not having paid into the Social Security system (for example, many school teachers and government employees), apply anyway. Tell Social Security that you are applying for COBRA extension purposes. Social Security representatives have been instructed to process your claim to determine your disabled status. Some Social Security employees are not familiar with this directive, so you may need to speak to a supervisor.

To learn about applying for SSDI, see: Applying For SSDI.

Step 2. When You Apply For SSDI, Keep In Mind That The Onset Date Of Your Disability Must Be Within 60 Days Of The Loss Of Regular Coverage.

If you are applying for SSDI some months after leaving work, make sure you and your doctor show that your inability to work because of your health condition started back at the date of your qualifying event, or as close to it as you can.

Step 3. Present Your SSDI Notice Of Award Letter To The Plan Administrator Within 60 Days Of Receiving It And During The Initial 18 Months Of COBRA.

  • Get your award letter to the employer/administrator promptly.
  • If you mail the award letter, mail by certified mail.
    • Include a cover letter requesting confirmation that you qualify for the extension. (See Sample Letter below).
    • If you're late getting the Social Security Disability letter to the employer, and the employer agrees to look at it, send the Social Security award letter with a cover letter, but don't be specific about the details. Just say something general, such as: Here's the award form from Social Security. Please send written confirmation that I qualify for the COBRA/OBRA extension.
  • If you deliver Social Security's award letter in person, get a receipt. Ask for written confirmation that you qualify for the extension.
  • Keep a copy of the award letter and cover letter for your files.
  • Whether you request the extension in writing or in person, don't mention how much the employer can charge you.  Some employers aren't aware they can add-on a surcharge. It's not your job to educate them.

Step 4. Obtain Immediate Written Confirmation Of Your Extended Coverage.

If the employer wants to challenge your request at a later date, you have time to argue the matter while you still have insurance. Don't wait until COBRA ends to have this battle if there's going to be one. 

SAMPLE COVER LETTER TO CLAIM DISABILITY EXTENSION

Your address

Date

Name and address of addressed party

Dear XXXX(Administrator/Employer):

Enclosed is a copy of the Notice of Award from the Social Security Administration.  You will see that Social Security declared the onset date of my disability to be XX/XX/XXXX.

This should qualify me for the extension of my health insurance for an additional eleven months.

Please confirm to me in writing that you have received a copy of the Award and that you are extending my COBRA coverage.

Thank you,

Your name