Who Pays for Your Health Care When You Can’t Work? A Guide to Long-Term Disability and Health Insurance

If you suffer from a serious injury or illness that prevents you from working for a long time, you may qualify for long-term disability benefits. But who pays for your health care when you can’t work?

These benefits can provide you with a portion of your income while you recover. But what about your health insurance? Who pays for it when you’re on long-term disability?

This is a common question that many people have when they face a long-term disability situation.

The answer depends on several factors, such as the type of health insurance you have, the type of disability benefits you receive, and the laws and policies that apply to your case.

Who Pays for Your Health Care When You Can’t Work | Photo courtesy: Money
The best option for you depends on your personal and financial circumstances, as well as your health care needs | Photo courtesy: Money

In this article, we’ll explain the different scenarios that can affect your health insurance coverage when you’re on long-term disability.

We’ll also give you some tips on how to maintain your health insurance and reduce your costs.

Employer-Provided Health Insurance

If you have health insurance through your employer, you may be able to keep it for a certain period while you’re on long-term disability.

However, this depends on the terms of your employer’s policy and the state laws that govern your case.

According to the Family and Medical Leave Act (FMLA), employers with 20 or more employees must continue to provide health insurance coverage for up to 12 weeks to employees who take medical leave due to a serious health condition.

However, this only applies to employees who are eligible for FMLA, which means they must have worked for the same employer for at least 12 months and at least 1,250 hours in the previous year.

If you’re not eligible for FMLA, or if your FMLA leave expires, your employer may still choose to continue your health insurance coverage for a longer period.

However, they are not legally required to do so, and they may terminate your coverage at any time.

In addition, you may have to pay a higher share of the premium, or even the full amount, depending on your employer’s policy.

COBRA Coverage

If you lose your employer-provided health insurance due to long-term disability, you may be able to extend it for up to 18 months under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

COBRA is a federal law that allows you to continue your group health plan coverage if you experience a qualifying event, such as termination of employment, reduction of hours, or disability.

However, COBRA coverage is not free.

You have to pay the entire premium yourself, plus a 2% administrative fee. This can be very expensive, especially if you’re on a limited income due to disability. Therefore, COBRA coverage may not be the best option for everyone.

COBRA coverage may make sense for you if:

  • You have a pre-existing condition that makes it hard to get a new health insurance plan
  • You need to keep seeing the same doctors and specialists that are in your network
  • You have a high income that disqualifies you from other programs that can lower your costs

Private Health Insurance

If you have private health insurance, such as an individual plan that you bought yourself or a family plan that covers you and your dependents, you can usually keep it regardless of your employment status.

As long as you pay your premiums on time, your coverage will continue.

However, private health insurance can also be costly, especially if you don’t qualify for any subsidies or discounts.

If you’re on a tight budget due to disability, you may want to shop around for a cheaper plan that still meets your needs.

You can compare different plans and prices on the Health Insurance Marketplace, which is a website that helps you find and enroll in health insurance plans that are available in your area.

The Health Insurance Marketplace also lets you know if you’re eligible for any financial assistance, such as:

  • Medicaid, which is a state and federal program that provides free or low-cost health coverage to low-income people
  • Premium tax credits, which are subsidies that lower your monthly premium for a private health insurance plan
  • Cost-sharing reductions, which are discounts that lower your out-of-pocket costs, such as deductibles, copayments, and coinsurance
Factors in disability insurance premiums | Photo courtesy: Investopedia
Factors in disability insurance premiums | Photo courtesy: Investopedia

Your eligibility for these programs depends on your household income, family size, and other factors. You can use the HealthCare.gov website to check your eligibility and apply for these programs.

READ MORE: Disability Insurance for Self-Employed and How to Get It

Government Programs

If you don’t have any health insurance, or if you can’t afford your current plan, you may be able to get health coverage through government programs, such as Medicare or Social Security Disability Insurance (SSDI).

Medicare is a federal health insurance program that covers people who are 65 or older, disabled, or have certain medical conditions. Medicare has four parts:

  • Part A covers hospital services, such as inpatient care, skilled nursing facility care, hospice care, and home health care
  • Part B covers medical services, such as doctor visits, lab tests, preventive care, and durable medical equipment
  • Part C, also known as Medicare Advantage, is an alternative way to get your Medicare benefits through a private health plan that may offer extra benefits, such as vision, dental, and prescription drug coverage
  • Part D covers prescription drugs, either through a standalone plan or as part of a Medicare Advantage plan

If you’re on long-term disability, you may qualify for Medicare after 24 months of receiving SSDI benefits.

SSDI is a federal program that pays monthly benefits to people who have a disability that prevents them from working and who have paid Social Security taxes for a certain number of years.

To apply for SSDI, you need to submit an application to the Social Security Administration (SSA), which will review your medical records and work history to determine your eligibility.

An infographic on navigating health care during long-term disability. Who pays for your health care when you cant work?
An infographic on navigating health care during long-term disability. Who pays for your health care when you can’t work? By Michael Ndenga


Health insurance is a vital part of your financial security when you’re on long-term disability.

However, your health insurance coverage may change depending on your situation.

You may be able to keep your employer-provided health insurance for a limited time, extend it through COBRA, switch to a private health insurance plan, or apply for government programs.

The best option for you depends on your personal and financial circumstances, as well as your health care needs.

Therefore, it’s important to do your research and compare different plans and programs before making a decision.

You can also consult with an insurance agent, a disability lawyer, or a financial planner to get professional advice and guidance.

Remember, health insurance is not something you want to lose or ignore when you’re on long-term disability.

It can help you pay for your medical expenses, protect your savings, and improve your quality of life.

Now you know who pays for your health care when you can’t work. So, don’t wait until it’s too late. Take action today and secure your health insurance coverage for the future.

READ MORE: Why Disability Insurance Matters More Than You Think

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