COBRA 101

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 experience another qualifying event. You can only get the extension if Social Security certifies that you are "disabled."

To qualify for this extension, during the first 18 months of COBRA, you must:

• Apply to the Social Security Administration for Social Security Disability Income (SSDI)
• Be declared to be disabled by the Social Security Administration
• Have Social Security declare that the Onset Date (Social Security terminology for the date your disability started) of your disability was within sixty days of your losing coverage; and
• Deliver a copy of the SSDI Notice of Award letter to the health plan administrator within sixty days after you receive it and during the 18 month COBRA period.

To get the extension, consider the following steps:

Step 1: Apply for Social Security Disability Insurance (SSDI) right away.

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

Step 2. When you apply for SSDI, keep in mind that the date your disability began must be within 60 days of the loss of your employer-sponsored health insurance 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. 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 your COBRA coverage.

• If you mail the award letter, mail by certified mail. Include a cover letter requesting confirmation that you qualify for the extension.
• SAMPLE COVER LETTER TO CLAIM DISABILITY EXTENSIONYour 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

• If you are 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 from Social Security. Please send written confirmation that I qualify for the COBRA 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. Ask for immediate written confirmation from your employer or plan administrator 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. 
• Also, keep in mind that during the extension period, your premiums can jump up to 150% of the premium. For example: if you were paying $150 per month for COBRA coverage, it could jump to $225 per month for months 19 through 29 of your COBRA coverage.   To figure out what your premium will be, just multiply your COBRA premium by 1.5.

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