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Posted on Wednesday, June 15th, 2022 at 2:43 pm    

If you become disabled and need to file for long term disability benefits, you might discover that you need additional help covering your medical expenses while you wait for a determination. You’ll need supplemental insurance for the expenses not covered by your primary insurance. Your next question might be whether you can apply for supplemental insurance after you’ve become disabled.

The answer to that question is yes, but it depends on what you need and what your current insurance already covers.

discussing insurance

Job-Based Insurance and What it Covers

Your job-based insurance coverage can be classified in one of two ways. Which classification you have will dictate when and how you can enroll for Medicare, which will be available to most people with disabling conditions.

  • Your job-based insurance is considered primary if it is offered by employers with more than 100 employees. Medicare will be your secondary insurance. You can delay enrollment in Medicare Part B so that you don’t have to pay the associated premium. Your primary insurance should cover all your bills.
  • Your job-based insurance is considered secondary insurance if it’s offered by employers with fewer than 100 employees. Medicare will be the primary insurance, and you will need Medicare Part B. Secondary insurance may provide very little coverage.
  • If you are covered by a spouse’s or family member’s insurance and are eligible for Medicare, you will need to check the date of your Part B Special Enrollment Period (SEP) to see how much time you have to ensure that you have continuous insurance coverage.

The important differences between primary and secondary insurances have to do with what is paid.

Primary insurance pays out first for your medical bills. Secondary insurance pays after the primary insurance, but it doesn’t always pay whatever is left. Secondary insurance may pay deductibles, copays, and incidental costs, but if the primary insurance denies coverage for a particular bill, the secondary insurance may or may not pick up that bill.

For instance, suppose your primary insurance pays 80 percent of your bill after a $100 copay. Your bill is $100,000. After your copay, the bill is $99,900. Your primary insurance will pay $79,920, and your secondary will pay the $100 copay. Your secondary insurance may not pick up the remaining $19,980 of the bill. If you have pressing questions about your own case, don’t hesitate to reach out to our firm today.

Medicare Coverage

If your doctor believes you are going to be disabled for an extended time or that you will no longer be able to work, you can qualify for Medicare even if you’re under 65. If you have received SSDI payments for 24 months, have an end-stage renal disease (ESRD) and need dialysis or a kidney transplant, or have been diagnosed with ALS (Lou Gehrig’s Disease), you automatically qualify for Medicare. This is one reason many long-term disability insurers want claimants to apply for SSDI when filing a claim.

More than half the states require at least one Medicare Supplement Insurance Plan (Medigap) policy to be made available to other qualifying individuals under 65. The remaining states may have Medigap-type insurance available through private carriers at a higher cost. Your Capitan Law attorney can help you determine whether you live in one of the states that require the offer of a Medigap policy. Contact us today.

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Getting Help

Navigating the labyrinth of disability insurance and supplemental insurance is challenging for nearly everyone. You should have the assistance of an attorney who knows what your insurance policy provides and what it doesn’t and what you’ll need from supplemental insurance.

If you contact the long term disability lawyers of Capitan Law, we’ll review your existing insurance policy with you. Our attorneys will go over your options for supplemental insurance and determine whether you will need to file for SSDI and what that may mean for any supplemental coverage.

If Medigap coverage is offered in your state, we will go over the plans that are available for you and determine what your best alternatives will be for coverage. If you do not qualify for under-65 Medicare coverage, we can help you find alternative insurance options to fill gaps in your coverage.

Contact Us

At Capitan Law, we want you to take the burden off your shoulders. Let us fill out the forms and track down the right insurance companies. Our legal team will do the paperwork and make the phone calls, so you don’t need to worry while your disability claims are being processed. We have proven results. Call Capitan Law at (267) 419-7888, or reach out to us online for a review of your insurance status and policy today. Let us help you today.

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