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Country: United States; State: TX Tax Info: Filing separately Spouse: Employed (client-based business); Me: Self-Employed and work for a corporation.

My spouse recently had a medical issue that will disable him from working, possibly permanently. We recently combined health insurance and I switched jobs, so from what I gather, we are within the time frame of Cobra (which I'll be signing up for one month until I receive the next health insurance from the new company, which I estimate will take a 30-60 days). My spouse had a co-pay plan for January, but got off in February because he joined mine in February. I am almost sure that he can't keep it or pay on it for this catastrophe (we've been in the ICU for 2 days and there's talk of it being at least 5 more days).

From what I understand, with Cobra, my plan will cover this under the guidelines of what we had with my former employer. Note: if this is the wrong assumption, I'd love to be warned.

My question involves the future of health insurance for us and disability. Because he has this heart attack (he's only 22), I would almost bet that insurance in the future will do everything possible to make it heck on us in terms of costs (understandable). Likewise, the loss of his income will significantly hurt us. After looking at some information on disability, is it possible that we could have different health insurance - me with my employer and him through benefits for people with disabilities (they have diagnosed him with a genetic issue on this heart ordeal, so I'm sure it will qualify). Since our incomes are separate and we file separately, I wondered if this is possible? Also, if he has different insurance than I do and with a government benefits program, would this help reduce his costs, as it would be tied to his disabled income?

Some more specific details about the situation regarding disability income.

Since he was sixteen, he's worked every year (except one) and made at least $5000 a year, which from what I understand is part of the contingency in the credit system regarding disability income (see this link: http://www.ssa.gov/disability/). From what I gather, a worker earns 4 credits a year if they make over $5000 a year, so my spouse would have had 6 years (24 credits). The only problem is that some of the years, he was considered a dependent, so I'm not sure if these years count for this, or what we would need to determine that? On top of that, does a spouse who's earning money disqualify the other spouse who's disabled?

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  • Big problem--at age 22 it's highly unlikely he qualifies for government disability insurance.
    – Loren Pechtel
    Commented Mar 4, 2013 at 4:59
  • @LorenPechtel Thanks; would my spouse at least be eligible for disability income while he's recovering, which may take six months to a full year?
    – QuestionC3PO
    Commented Mar 7, 2013 at 15:42
  • The problem is that SSDI requires you to have worked 40 quarters to qualify. I would think he would be eligible for SSI but it's means tested.
    – Loren Pechtel
    Commented Mar 7, 2013 at 18:12

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Sorry to hear about your spouse's health issues. May he have a speedy and, as far as possible, full recovery.

The Patient Protectection and Affordable Care Act (PPACA, aka Obamacare) is now the law of the land. Among its many provisions are that insurers may no longer deny coverage for pre-existing conditions, they may not put lifetime caps on benefits, and they may not charge different premiums based on any criteria except age cohort and geographic area (i.e. rates may be higher for 50 year olds than 30 year olds, but sick and healthy 50 year olds living in the same area pay the same).

If he gets government health coverage because he's on disability, this may not matter. On the other hand, you might find it better to put him on your employer's policy, because you like the coverage better, the employer covers part of the dependent premium, or some other reason. In any case, they can't discriminate against him or you based on his condition.

ETA: Rates may vary by geography as well as age.

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    I think that pre-existing conditions part kicks in only in 2014.
    – Dmitry Shevchenko
    Commented Mar 4, 2013 at 2:05
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    @DmitryShevchenko - Partially true. If you're eligible for insurance (as through an employer), they haven't been able to exclude coverage on pre-existing conditions since Sept 2010. I think you're right that they aren't required to take you as an individual until the exchanges kick in next year. In the meantime, there are high-risk pools set up to cover the otherwise uninsurable.
    – Rick Goldstein
    Commented Mar 4, 2013 at 3:11
  • @DmitryShevchenko: I'm going to second Rick Goldstein here--while the must-take-you doesn't apply yet there are either high risk pools or the PCIP. They work NOW.
    – Loren Pechtel
    Commented Mar 5, 2013 at 21:37
  • Does anyone know at what age would government disability insurance be allowed? Is it based on credits, like earning a certain amount for a number of years?
    – QuestionC3PO
    Commented Mar 7, 2013 at 15:45

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