Health Insurance Market and Divorce: What You Need to Do to Stay Covered

Dealing with a life transition such as a divorce is hard. Dealing with health insurance is hard.

Dealing with a life transition is hard. Dealing with health insurance is hard.

Trying to figure out the health insurance market after a divorce is even harder.

Are you feeling a little overwhelmed by life’s events and underwhelmed by the health insurance search?

A Fiorella Insurance Agent can help you choose insurance that’s right for you.

Read this blog for some guidance on how to stay covered in the health insurance market after a divorce.

Health Insurance Marketplace Overview

There are a few things you should know about the health insurance marketplace before you apply for health insurance coverage. The ACA health insurance marketplace offers four levels of health insurance coverage plus catastrophe insurance (for certain qualified individuals.) Those plan levels are:

  • Bronze
  • Silver
  • Gold
  • Platinum

These health insurance options do not affect your quality of care. Rather, they indicate levels of health coverage – the higher the plan level, the higher your premiums, but the lower your deductible and copays.

This means that the lower health insurance plan levels that are less expensive, like Bronze and Silver, have higher deductibles and copays than the Gold and Platinum plans.

Evaluate the Health Insurance Plans Carefully

Compare these different health insurance plan levels carefully – if you go to the doctor a lot for a serious pre existing medical conditions, or you have several prescriptions you take each month, for example, it may cost you less out of pocket to pay for a more expensive plan.

And pay attention to your out-of-pocket maximums – you may end up paying a significantly lower amount if you have a relatively low out-of-pocket maximum.

5 Things to Consider About Health Insurance When Getting A Divorce

Getting divorced takes enough time as it is. Having to figure out your health insurance options through the government run healthcare marketplace after a divorce shouldn’t take up even more time. We’ve compiled a few questions you need to ask to figure out which direction you should go.

Here are some things you need to consider about health insurance when getting a divorce:

1. How Long Can You Stay on Your Current Insurance?

Everyone’s situation will vary, so there is no general answer to this question. If you have insurance through your own employer and are not at risk of losing coverage, you won’t qualify to sign up for health insurance plan during the Special Enrollment Period.

If you are covered by your ex-spouse’s insurance and you are losing health insurance coverage, you should qualify for a Special Enrollment Period so you can purchase health care coverage through the marketplace.

2. Have You Applied to the Marketplace?

If you are eligible for marketplace insurance after your divorce, the first thing you need to do is fill out an application. You may need to submit documents proving you previously had insurance and that you are getting a divorce, but once you submit those, you’ll be able to choose a plan.

If you aren’t losing coverage and aren’t eligible to sign up for a marketplace plan yet, don’t worry. The Open Enrollment Period for 2023 is from November 1, 2022, to December 15, 2022.

3. What is Your Monthly Budget for Premiums?

An important consideration in choosing a health insurance plan after divorce is your monthly budget for your health insurance premiums. Depending on whether your financial situation changes or not, you may not need to worry about this.

The good news for those who fall in a lower income bracket after divorce: if you qualify for Medicaid or CHIPS, you can get coverage at any time.

4. Do You Qualify for Medicaid or Medicare?

If you qualify for Medicaid or Medicare, you should be able to apply for coverage at any time after your divorce. There is no Special Enrollment Period for these programs, so don’t be dissuaded from taking advantage of these programs after your divorce.

Keep in mind that some states did not expand Medicaid coverage. Income limits or eligibility may vary in some places.

5. Are you eligible for COBRA?

In some cases, you may be eligible to elect COBRA coverage and stay on your former spouse’s insurance if you were previously covered. This means you don’t need to worry about health insurance through the federal government run health insurance marketplace after your divorce.

To qualify for COBRA insurance coverage on the employer’s health insurance plan of your spouse, a spouse’s company must employ at least 20 people, and insurance must already be offered as a benefit through the employer.

If your spouse works at an employer with less than 20 employees, a mini-COBRA plan may be available.

The primary drawback is that COBRA premiums can be expensive, and it may be wise to look elsewhere for coverage.

Health insurance companies have stringent rules about when and how they must be notified following a couple’s divorce.  Be sure to notify them or you might find yourself out of compliance with the rules.

One thing you do need to keep in mind is your premiums. They may or may not change after you stay on that health insurance policy, so compare your options and talk to an agency for more advice.

Bottom Line – You have many options when it comes to health insurance.

Here are a few of the more common:

  • Employer-sponsored plans
  • Private/individual health insurance
  • Affordable Care Act (Obamacare)
  • Continued coverage under COBRA  (or state mini-COBRA)
  • Medicare
  • Medicaid
  • Tricare (military program)

What the Affordable Care Act Says about Divorce and Health Insurance

Whether your divorce qualifies you for a Special Enrollment Period or not depends on your situation. The Affordable Care Act only considers you eligible for a Special Enrollment Period if you lose coverage under your divorce agreement.

If you don’t lose coverage under your divorce arrangements, you don’t qualify for the Special Enrollment Period and you won’t be eligible for marketplace insurance until the next Open Enrollment Period.

Medicaid Eligibility

If your divorce makes you eligible for Medicaid or CHIPS, you should be able to apply and be qualified at any point after your divorce. There is no Special Enrollment Period for applying to these programs.

If you have to move because of your divorce, you may qualify for a Special Enrollment Period.

There may be other qualifiers, but it’s important to contact Healthcare.gov or an insurance agency to see if you are qualified or if you need to go a different route.

How to Stay Covered After A Divorce

It basically comes down to a couple of things:

  • Are you losing coverage after your divorce?
  • Is your financial situation changing after your divorce?
  • Are you having to move after a divorce?
  • Do you qualify for COBRA?

If you’re losing coverage, you may want to contact an insurance agent to see if you qualify for health insurance through the market place.

If you’ve had changes in your income or financial situation, you may need to contact Healthcare.gov.

What About Keeping Your Current Doctor? 

If you are committed to your doctor or a particular facility where you like to receive care, make sure they are in the health insurance company network of the plan you are most interested in. The customer service number of the health insurance company can let you know if your doctor is in their provider network.

Health Insurance After Divorce

There are many possible scenarios, but the bottom line is that you do have certain rights that you can exercise. If you’re heading for divorce, you should take time to understand these rights and make them an integral part of the divorce process.

That’s it – staying covered after a divorce isn’t that hard. It does take a bit of time to do some research on the best plans for you and your family, but that’s what we’re here for.

Fiorella Insurance Agency can connect you with the best healthcare  marketplace plans after a divorce. Contact us today at Fiorella Insurance to see how we can make your transition easier.

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