Divorce and health insurance rank at the top of the list of issues most people would rather avoid. They’re complicated, confusing, and beyond difficult to deal with.
Unfortunately, they often go hand in hand with each other.
If you’re facing a divorce, and you’re currently on your spouse’s health insurance plan, you WILL have to deal with getting your own health insurance once your divorce is final. Unfortunately, health insurance these days can be crazy expensive and a mess to figure out. That’s why you need to get on top of your health insurance situation LONG BEFORE your divorce is over.
Waiting until AFTER your divorce is final can leave you scrambling for coverage at the last minute. Not only is doing that stressful, but it can be expensive.
Health insurance is not cheap! Shopping around for your best option is essential if you don’t want to have a ginormous hole in your post-divorce budget.
What’s more, if you don’t get some form of health insurance within 60 days after your divorce, you may be forced to go without health insurance until the next open enrollment period.
Here’s how to get on top of your divorce and health insurance now, before it’s too late.
A lot of people have heard that you can get insurance through COBRA after your divorce. Unfortunately, not a lot of people truly understand what COBRA is or how it works.
COBRA (otherwise known as the Consolidated Omnibus Budget Reconciliation Act), is a federal law. It allows you to continue to get health insurance after your divorce from your spouse’s employer. This law makes it illegal for an employer to terminate your health insurance coverage just because you and your spouse got divorced.
What’s more, getting COBRA coverage is relatively easy. All you need to do is fill out a few forms from your ex’s employer, pay the first month’s premium, and you’re good to go. You don’t need to compare coverage and premium options. You can continue using exactly the same insurance plan as you had pre-divorce.
That’s the good news.
The bad news is that COBRA doesn’t apply to everyone.
The federal COBRA requirements only apply to employers with 20 or more employees.
If your spouse works for a small employer (one that has less than 20 employees) federal COBRA coverage may not be available to you. If your spouse is self-employed or unemployed, you also may not be able to get federal COBRA coverage.
You may, however qualify for COBRA coverage through your state’s laws.
Many states have enacted “mini COBRA” laws that cover employers with less than 20 employees. So, even if the federal COBRA law doesn’t apply to you, a state COBRA law might.
(To find out whether COBRA coverage is available to you, check with your spouse’s employer, a health insurance broker, or an attorney in your state.)
What Does COBRA Give Me?
If you qualify for health insurance after your divorce under the federal COBRA law, you will be entitled to get 36 months of coverage by paying the group rate that your spouse’s employer pays. (You may also have to pay an administrative charge on top of that.)
If you qualify for health insurance after your divorce under a state COBRA law, you may only be entitled to receive 18 months of coverage. (Again, check with your spouse’s employer or a lawyer in your area to be sure.)
Either way, you must apply for COBRA coverage within 60 days after your divorce. Otherwise, you will not be eligible for COBRA coverage.
But before you do the happy dance thinking that COBRA will solve all of your health insurance problems, you need to check out the price.
Fair warning: You’re probably going to experience major sticker shock!
What Does COBRA Cost?
Getting health insurance through COBRA is usually one of the most expensive ways to get health insurance today.
Even if your spouse only pays a relatively small amount for his/her employer-based medical insurance, that doesn’t mean you will get a similarly good deal. That’s because your spouse only pays a PART of his/her total health insurance premium. Your spouse’s employer is paying the other part.
(NOTE: According to the Kaiser Family Foundation, the average premium for employer-sponsored family healthcare coverage in 2020 was more than $21,000.)
When you opt in to get COBRA coverage you have to pay both the employee and the employer portions of the health insurance premium. You also have to pay administrative costs of up to two percent. So your total post-divorce health insurance premium can be up to 102% of the regular monthly premium.
What that means is that your monthly payments under COBRA will likely be substantially more than what your spouse pays for his/her health insurance. Those payments can also be substantially more than what you would pay for health insurance on your own. (More about that in a moment.)
Why Can’t I Just Stay on My Spouse’s Insurance?
Most employer-sponsored health insurance policies will not allow a divorced spouse to just “stay” on their ex’s health insurance. Once an employee is divorced, his/her spouse MUST get their own health insurance coverage.
(NOTE: This does NOT apply to the employee’s children. The employee CAN continue to maintain their employer-sponsored health insurance benefits for their children after a divorce.)
Because health insurance is such a headache, and such an enormous expense, some amicably divorcing couples are tempted to just “forget” to tell their employer about their divorce. That way they can both keep the coverage they have, right?
First of all, that’s called insurance fraud. It’s a crime. If you think that you have problems now because you’re getting divorced, those problems will pale in comparison to dealing with defending yourself against federal criminal charges.
Second, even if you don’t get prosecuted for fraud, if the insurance company finds out that you were divorced but didn’t tell them, it can deny coverage for you. So, for all practical purposes, your post-divorce health insurance coverage will be worthless.
What’s more, if the insurance company already paid benefits that you were not entitled to receive, it can go after you for reimbursement. It can also require you to pay all the court costs and attorneys fees it incurred in chasing you down for repayment.
All and all, trying to keep coverage that you are not entitled to keep is a hugely bad idea.
What If We Just Get Legally Separated?
Back in the day, if you and your spouse got legally separated, instead of divorced, you could stay on your spouse’s health insurance policy. That was one of the main reasons that couples used to get legally separated rather than divorced. The legal separation allowed both spouses to maintain affordable health insurance.
But, no more.
Most insurance companies today will exclude coverage for anyone who is legally separated. That means that it makes no difference if you are legally separated or divorced. Either way, you won’t be allowed to continue to get health insurance on your spouse’s policy.
(NOTE: There is a big difference between a LEGAL separation, and just being “separated” from your spouse. A legal separation is a formal change in status with your spouse. You can only get a legal separation from a judge. Just living separately from your spouse doesn’t change your legal status. So if you and your spouse are just living in different places, but you’re not legally separated or divorced, you can probably still stay on his/her health insurance policy.)
Employer Insurance, Individual Insurance, and ACA Insurance
If COBRA coverage isn’t an option for you after your divorce, what can you do?
You basically have three options:
- You can get insurance through your own employer.
- You can get insurance on the insurance exchange under the Affordable Care Act (ACA).
- You can get your own individual health insurance policy.
As with everything else in life, there are pros and cons to each of these options.
Employer Sponsored Health Insurance
Getting health insurance through your own employer will probably be the least expensive way to get health insurance. But, of course, you can only get insurance through your employer if: a) you are employed; and b) your employer offers health insurance.
If either of those things are not true, then you will have to find health insurance in some other way.
What’s more, even if your employer does offer health insurance, it may not be the best insurance plan. It may not cover the doctors or hospitals you prefer to go to. Or you may still have to pay more than you would like for your premium. Or you may have a big deductible.
The bottom line is that, while employer-sponsored health insurance may be a great option, it still may not be the best option for you when you’re considering how to deal with health insurance and divorce.
If you can’t get insurance through your employer (or if you don’t want to get insurance through your employer), you may get health insurance under the Affordable Care Act (ACA). To do that, you must apply for ACA health insurance through the marketplace within 60 days after your divorce.
Health insurance under the ACA is generally much more affordable than under COBRA. Depending on your income level, you may even qualify for cost assistance. However, the extent of your insurance coverage, and the providers who are included in your coverage, may be very different than what you’re currently used to.
(NOTE: ACA health insurance policies must cover 10 essential health benefits. They also can not deny you coverage based upon pre-existing conditions. However, the exact services that these policies cover depend on the policy itself. Coverage also varies state-by-state.)
Individual Health Insurance
Another way to deal with divorce and health insurance is to get your own individual health insurance policy. Doing that expands your choices of available health care policies. Again, however, getting individual health insurance is not cheap.
The cost of an individual health insurance policy will vary depending on the amount of coverage you’re getting, as well as the deductible you choose. The higher the deductible, the lower the premium you’ll pay.
What’s more, as with any other kind of health insurance, the network of doctors and hospitals that are covered varies from policy to policy. The bigger the health care network you want, the more expensive your health insurance policy is likely to be.
The Most Important Things to Know About Divorce and Health Insurance
Understanding divorce and health insurance isn’t easy. If you’re not employed and eligible for health insurance through your own employer, finding affordable insurance can be beyond frustrating.
Keeping two things in mind will help you enormously.
- DO NOT WAIT until after your divorce to try to figure out what you’re going to do for health insurance. No matter what coverage you get, it’s probably going to be more expensive than you think. That cost WILL affect your post-divorce budget. You need to keep that cost in mind when you’re negotiating spousal support. Otherwise, you may find that you don’t have enough money to live on month-to-month after your divorce.
- GET HELP. Navigating health insurance options is extremely complicated. There are nuances and subtleties involved in getting the best coverage at the best price. This is NOT a field for amateurs! If you can’t get your own employer-sponsored health insurance after your divorce, then start working with a health insurance broker BEFORE your divorce. S/he can help you find the best, most affordable coverage possible.
The Bottom Line About Divorce and Health Insurance
Trying to figure out whether you should get health insurance through COBRA, your own employer, ACA insurance, or an individual policy can be complicated. It requires you to compare different policies, different premiums and different coverages. It also requires a strong stomach and a good set of nerves.
Looking at health insurance prices can be terrifying. That makes it tempting to put off making any decision until after your divorce.
Yet, putting off the issue of health insurance and divorce isn’t wise.
No matter which insurance option you choose, you have no more than 60 days to act. If you blow the 60-day deadline you may have to live without health insurance until the next open enrollment period.
Obviously, that’s not ideal – especially if you have any kind of medical condition that requires ongoing care.
So even though figuring out your health insurance and divorce options can be a headache, biting the bullet and doing it sooner rather than later can be the best thing you can do for yourself and your future.
This blog was originally posted in October, 2016 and updated in November, 2020.