Am I Covered? Divorce and Health Insurance

AvatarHeather Collier, Principal

‘Tis the season for many employers open enrollment period for health insurance coverage and other employment-related benefits. Choices abound. But what if you and your spouse are divorcing and you are on their health insurance? The plot thickens.

  • How long after divorce will you be covered? Do you have any options to continue coverage through your spouse’s plan? Who will provide health insurance for your children? And who pays? Is your ability to continue coverage linked to any other decision you make or rights you derive from the divorce?  Here are the basics: * If you are covered on your spouse’s health insurance at the time of separation, your spouse can continue to cover you until the entry of a judgment of absolute divorce.
  • Divorce is a terminating event for health insurance coverage. If you were on your spouses’ coverage, in most cases, you can elect to continue coverage for a specific period through the same health insurance plan. There is typically a 60-day grace period for you to decide to elect continuation coverage (if available), seek coverage on the health insurance Marketplace, or seek coverage through your employer’s plan if you are employed and they offer benefits.
  • There are differences in the continuation coverage benefits offered based on the employer and whether the employer falls under federal or state laws. With exceptions, private sector companies with 20 or more employees fall under federal COBRA, while companies with less than 20 employees fall under state based continuation coverage laws. The Federal government provides continuation coverage through the Federal Employee Health Benefits program (FEHB).
  • COBRA allows continuation coverage for 36 months post-divorce. State law based continuation coverage periods vary.
  • FEHB also allows temporary continuation coverage (TCC) for 36 months post-divorce. However, former spouses of federal employees insured under FEHB during the marriage may also be eligible for extended continuation coverage beyond 36 months, called Spouse Equity Coverage. This is available if the former spouse receives a share of the federal employees FERS or CSRS pension benefit and/or is designated as a survivor beneficiary of the federal employees FERS or CSRS plan based on the division of property in the divorce.
  • If you elect continuation coverage under the applicable laws, you will pay 100% of the premium cost (without subsidy) and a percentage of the premium as an administrative fee. Therefore, it may not be the most cost effective option, particularly if you are eligible for insurance through your own employer.  If you are seeking spousal support and need continuation coverage, you will need to factor the cost into your expenses and ultimately your support request.  If you are eligible for insurance through you own employer, the divorce will qualify you to enroll in your employer’s plan even if it is outside the normal open enrollment period.
  • Even though your former spouse cannot continue carrying you on their health insurance policy post-divorce, they can continue to cover your children. The cost of the premium for the children’s health insurance coverage is factored into the calculation of child support. If your former spouse has other health related benefits like dental or vision insurance, they can also cover your children on those policies. If you or your former spouse have access to other health related benefits, e.g. a Flex Spending Account (FSA) or a Health Savings Account (HSA), confirm before the divorce what policies and rules apply to using those funds so you can determine whether that impacts who provides insurance coverage for the children, who claims them as dependents on tax returns, etc. and negotiate accordingly.

If health insurance coverage is a concern for you post-divorce, it is imperative you obtain information, informally or formally, from your spouse and/or their employer about the availability of continuation coverage, the cost, and the period of time continuation coverage will be available to you because of the divorce.  Do not wait – this information may influence the resolution of other parts of your divorce case such as spousal support and, if you have minor children, child support, and income tax related benefits.