Your Spousal Insurance Rights (Including Cobra) After Divorce


Are you insured through your spouse’s insurance? If the answer is yes, then this is a priority!

What do you do? What are your options? And who do you even talk to in order to find out? You’re going to need a reputable and trustworthy licensed insurance broker in your state (yes, you must do it through someone in your own state) that can help you navigate what’s available and the best direction for you. 

Amongst all the other things to think about in the midst of getting a divorce, health insurance is a big one. It’s really something a lot of people don’t think much about until we need it or lose it. It’s also quite common for women, in particular, to have their health insurance through their husband’s employer, and this means a major change is coming once the divorce is finalized.   If you are insured through your own job, then you’re probably fine and don’t necessarily need to make a change, other than removing your partner from your policy. 

There are some specific details that you’ll want and need to understand as you’re starting to figure out what’s right for you. 

  1. Premium payment – you may have heard the term before but what is it? In a nutshell, it’s the cost of your insurance. It’s the payment you make every month. The reason it’s tricky is because when you do get insurance through your job (or your partner’s job), you may not really know the premium because most of the time the employer is contributing and covering a portion of that cost. But now, in a divorce, you may have to end up paying the whole boat yourself, and it’s a lot more than you think.
  2. If you like the insurance you’ve been getting through your partner’s plan, then you do legally have the option of remaining on that plan for up to 18 months. It’s called COBRA, and it’s really just you paying the employer or a COBRA company directly for your coverage. While you may find aspects of COBRA limiting, you should know that purchasing individual insurance can be even more limiting. The reason for this is because employers can usually customize their plans so they’re not as cookie-cutter as the individual insurance plans. So if you are able to afford to maintain your current insurance through COBRA, it’s often the best option.
  3. One of the main choices you have to make when it comes to choosing any health insurance plan is whether you go for a high deductible or low deductible. It can sometimes be confusing, but basically, a high deductible means your monthly premium payment will be lower. That sounds great, but a lot of the coverage benefits won’t kick in until you’ve paid your deductible. So you may be glad to hear that your plan covers 90% of costs after the deductible, but if you have a very high deductible – say $5000 – and you don’t go to the doctor very often, it’s possible you may not even hit your deductible over the course of the year. Which means that you paid for pretty much all of your medical costs throughout the year because you never spent enough to qualify for that 90% coverage.

On the flip side, if you have a low deductible, your premium payments will generally be more. But this is a great option for someone who does see doctors a lot and maybe has some medical issues, because you will easily hit your deductible and then all the coverage benefits will activate. To put it bluntly, a fair way to determine which is the better option for you – if you frequently see doctors and have medical costs, you will probably be better served with a high-deductible/low premium payment plan. If you mostly go to the doctor only for your annual check ups and generally have low medical costs throughout the year, you will probably be better off with a low-deductible/higher premium payment plan.

  1.  It’s important to note, as you’re trying to find your way through the maze of health insurance options and terminology, that you will come across the phrase “out of pocket maximum”. It’s really just the amount that you will have to spend before your insurance covers 100% of your doctors’ visits and costs. So even if you have a $1000 deductible, that’s the point at which maybe your insurance will cover between 70%-90% of your medical bills. But then, you will still only have to pay up to whatever your “out of pocket maximum” is, and then your insurance would cover everything. Obviously, all of these amounts vary by company, by plan and by state, so you must speak with your insurance broker or existing carrier to make sure you fully understand what your coverage is.
  2. Another point to keep in mind relates to whether or not your plan specifies that doctors be “in network”. This just means that whatever your insurance company pays, it will only be applied to doctors that take your particular insurance. So even if you’ve paid your deductible AND hit your out of pocket maximum, if you choose to see a doctor that is not in your network, you will be responsible for that bill in its entirety.
  3. One last thing to be aware of is that not every plan comes with dental or eye care. If you haven’t been the one responsible for your health insurance coverage up until now, you might now realize these are actually add-ons, and not part of your standard coverage. You definitely want to review these options with your insurance broker, and be sure to only use in-network practitioners, if that’s the type of plan you end up with.

At the end of the day, there’s a lot to know, and while you’re in the middle of dealing with everything else from your divorce, this can seem particularly overwhelming at times. 

There is no charge for using an insurance broker, since they get paid by whichever insurance company you go with, so you can ask questions, have them research which plans your current doctors accept and more.

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