April 3, 2024

This paid piece is sponsored by Avera Health.

When it comes to health insurance, in many cases a marriage, divorce or death of a spouse is a “qualifying life event” that opens up a special enrollment period for you and your family. That period can vary with some private insurance providers, but it’s typically 60 days.

“The special enrollment period is a window of time you don’t want to miss when you can look into all your options and make sure that you and your loved ones have coverage going forward,” said Tara Stombaugh, director of consumer sales and client services with Avera Health Plans. “Missing this special period can mean missing your chance to set up health insurance until the next time fall open enrollment rolls around.”

These options may include health insurance offered by your employer, your spouse’s employer or the federal marketplace. If you qualify, it also might include government-sponsored programs like Medicaid and Medicare.

Marriage

As a single person, you probably had individual health insurance coverage. The special enrollment period that’s allowed after marriage is a great time to look into moving both you and your spouse to the same plan if that’s a better deal. Here are some possible scenarios:

• If one or both of you are younger than 26 and you are on your parents’ health insurance plan, you can stay on that plan until you turn 26. Then, you’ll qualify for another special enrollment period to set up your own health insurance.
• If both you and your spouse are covered at work, it may be advantageous to get coverage as a couple or family at one employer or the other. Or, it may be better to stay on separate plans. Do the math, and sign up for the best possible coverage at the most affordable cost.
• If neither of you has access to affordable health care coverage through your employer, you can shop at the federal marketplace at HealthCare.gov. If you have what’s considered affordable coverage through your employer, you may not qualify for tax credits that make the premiums more affordable.

Divorce

If you are getting divorced and will lose coverage because your spouse is the policyholder through his or her employer or otherwise, you’ll need to set up your own coverage. The special enrollment period does not begin until your divorce is final and your health insurance coverage is ending.

• Check with your employer to see what plans are available. If you are offered affordable health care coverage at work, that’s likely to be your best option.
• Ensure your children are covered either through your former spouse’s plan or your own plan.
• If affordable employer group coverage is not available to you, you have an open window of time to shop for health insurance at HealthCare.gov. Most people qualify for tax credits that make the premium more affordable.
• Typically in family law, a set of rules, sometimes called automatic temporary restraining orders, prevents either spouse from making changes to things like health insurance. Whether you or your spouse is filing for divorce, neither party can remove the other while the divorce is pending.

Death of a spouse

If you experience the death of a spouse and were covered on a family plan or employer group plan, you’ll need to transition coverage to just yourself and any dependent children. Check with your spouse’s employer to see exactly when your existing coverage will end or transition.

• If you are employed, learn about individual and family plans your employer may offer through group coverage.
• HealthCare.gov is your next best option if you don’t have access to affordable health insurance at work.
• If you are not employed and you and your children need coverage, you may qualify for Medicaid – check into the income guidelines for your family size in your state.
• If you are at or near 65 or older, look into Medicare for your ongoing coverage.

Other qualifying life events include adding a baby to your family or a job change.

If your health insurance coverage is ending for whatever reason, another option is coverage through the Consolidated Omnibus Budget Reconciliation Act, or COBRA. This is typically the most expensive option, and you may have special circumstances for going through COBRA on a short-term basis – for example, if you are currently in treatment for an injury or illness.

When making health insurance transitions, you may need a letter from your health insurance company showing the termination or upcoming termination of coverage. If you are widowed, you may need a copy of the death certificate to ensure completion of these steps.

If your situation is complex, be sure to get advice from experts. Speak with your human resources team or the HR provider of your spouse as soon as possible. If needed, do this through your lawyer. Licensed health insurance agents also can answer questions.

“A licensed agent can look at all the facts and offer approaches that fit your life,” Stombaugh said. “Having that help can provide peace of mind.”

Learn more about Avera Health Plans coverage options.