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Learn » Obamacare » Health Insurance After the Death of a Spouse, Parent or Other Plan Member

Health Insurance After the Death of a Spouse, Parent or Other Plan Member

This Qualifying Life Event may make it important to move to a smaller plan.

May 30, 2019 - By Cate Misczuk - read

When a loved one passes away, the last thing you tend to think about is your health insurance plan. Nevertheless, this major life change will affect your health insurance coverage and make you eligible for a Special Enrollment Period.

Ultimately, there isn’t a lot of information out there about what to do when your insurance-dependent spouse or insurance-carrying family member has passed on. And understanding what to do about health insurance during a time of loss is difficult and frustrating. So, we’re here to outline all you need to know to keep your health insurance coverage active, without paying for coverage you no longer use.

Your Loss Begins a Special Enrollment Period

A Special Enrollment Period (SEP) is a 60-day window which allows people to change or sign up for new health insurance coverage outside of the limited yearly Open Enrollment Period.

To qualify for a Special Enrollment Period, you need to have experienced a Qualifying Life Event.

Loss of a Spouse or Dependent is a Qualifying Life Event (QLE)

Before we sort out the details of a death Qualifying Life Event, it’s important to understand what a Qualifying Life Event is.

There are many types of QLEs, all of which can begin a Special Enrollment Period. In the insurance world, a QLE is triggered by major changes that could affect your health plan — everything from getting married to having a child, being laid off, and more. Suffering the passing of a spouse also counts as a QLE.

How Can a Sole Surviving Spouse or Child Stay Insured?

While health insurance may be the last thing you’re thinking about during these hectic times, it’s actually quite important to check that your coverage is continuing as normal. Having secure, affordable health insurance after the loss of your spouse or dependent is one more way to give yourself much-needed support.

Think of healthcare as a preventative measure from any stresses that may arise, and consider the increased financial and emotional help that a health plan can provide during these times.

1. Enter a Special Enrollment Period Due to a Deceased Spouse:

The loss of a spouse is a Qualifying Life Event that triggers a Special Enrollment Period where you can join an ACA health insurance plan or change your existing coverage.

You qualify for this SEP if…

  1. Your spouse or parent has passed away in the last 60 days,
  2. Your spouse or parent was your health insurance dependent, and
  3. The health insurance coverage is in your name.

You also qualify for this SEP if…

  1. Your spouse or parent has passed away in the last 60 days,
  2. You were dependent on your spouse or parent’s health insurance coverage, and
  3. The health insurance was in your spouse or parent’s name but you were named on the plan.

If your current monthly income is substantially lessened following the death of a loved one, you may qualify for increased payment help or Medicaid.

But, it is important to note that Special Enrollment Periods are only available in a short window. If you experience a QLE like your spouse passing, you only have a 60 day window from their death to enroll or change your ACA health insurance coverage. If you miss this Special Enrollment Period, you then have to wait for the annual Open Enrollment Period to start a new plan.

2. Continue Your Deceased Spouse or Parent’s Employer Insurance Using COBRA Rules:

If your spouse or parent had health insurance via a large group or an employer, and you were a dependent on that plan, then you can qualify for something called COBRA. With COBRA, you pay the full monthly costs of your employer health insurance plan. It can be expensive, but it’s one way to put off other changes in your life during this time.

This safety net policy was created to cover employees and their families who had involuntarily or voluntarily lost their job, had their hours reduced or were transitioning between jobs. COBRA also covers life-altering events like death of a spouse or divorce.

If your primary policyholder passed away in the last 60 days, and you want to continue to stay on their employer-based health insurance plan, COBRA rules allow you to do so. COBRA is not a permanent or long-term solution, though, as it only lasts for up to 18 months after you enroll.

You can qualify for COBRA if…

    1. Your spouse passed away in the last 60 days
    2. You were a named dependent on your spouse or parent’s health insurance plan
    3. You want to stay on your spouse or parent’s employer-based health insurance plan.

It’s also important to note here that you do not need to stay on your spouse’s employer-based insurance plan, COBRA simply allows you to do so if you want to. Oftentimes, families find it too expensive to keep these plans and will instead turn to the Affordable Care Act’s marketplace using an SEP. But no matter what you choose, it is important to know all of your options before you make a decision.

To continue existing coverage using COBRA, promptly call your current health insurance provider to work through the change in ownership.

How Can You Adjust Health Insurance if Your Dependent Passed Away?

If a dependent in your family dies – and they’re not your spouse – this may also qualify you for a Special Enrollment Period. Even if your dependent did not add to your annual income, like a child, their presence on your health insurance plan may have been contributing to the cost of your overall coverage.

The death of a dependent generally qualifies you for an SEP, although this is not guaranteed. No matter what though, you would only have 60 days to enroll or change your health insurance coverage after their passing. So, it is important to get an assessment of your coverage as soon as possible and see if you qualify for an SEP in this case.

You may qualify for this specific SEP if…

  1. Your dependent has passed away in the last 60 days
  2. Your dependent was named and insured on your plan.
  3. The health insurance coverage is in your name listed on application.

If A Dependent Not On Your Plan Passes Away

If a dependent of any age in your household passes away – whether or not they were covered by your health insurance plan – it could give you an opening to change your health insurance coverage or join a new plan.

Since loss of a loved one is a major change in anyone’s life, it can still affect your income and decisionmaking. Considerations include whether or not they were listed on your health insurance application (whether or not they were covered); if they are on your taxes (since income affects coverage). It’s best to call an expert for more information in these circumstances.

Taking the Next Insurance Steps After Your Spouse, Parent or Dependent Passes Away

If you are the person in your household who provides health insurance coverage for your family, you might not realize that the death of your spouse or dependent could even trigger a QLE.

Even though you might have the plan through your job or a pension, you may still be able to get an ACA plan with income-based subsidies now that they have passed.

Questions to Ask Your Health Insurance Provider During Your Bereavement Period

Tell your insurance expert that your dependent or spouse has passed away and get the conversation started with questions like this:

  • My spouse or dependent passed away within the last 60 days. Does your marketplace consider this a QLE and qualify me for a SEP?
  • My spouse passed away in the last 60 days and I was a dependent on their plan. What are my options now?
  • What paperwork do I need to provide you with?
  • Do I qualify now for an income-based subsidy?
  • Is there a different plan I need to sign up for now?
  • How is my current plan going to change?
  • If so, when would these changes take effect?

If your current, private healthcare provider can’t provide any subsidies you can explore other options. If you want to see if you can get a subsidy or less expensive plan, your SEP will guarantee enrollment in other Affordable Care Act plans for 60 days after your dependent’s passing.

If your spouse has passed away and you were a dependent on their plan, or your spouse or dependent has passed away and you want to reconsider your health insurance options, you only have 60 days to enroll or change your Affordable Care Act health insurance coverage. That’s why it’s important to get in contact with your current health insurance provider or an online marketplace to see what your options are before your Special Enrollment Period expires.

When to Begin Health Insurance Changes After a Loss

Because Qualifying Life Events are time sensitive, it is important to explore health insurance sooner rather than later. We know that during this time, health insurance is probably the last thing on your mind, and certainly not the first thing you want to deal with. But your health is as important as ever, so take the tips here and use them to ensure your coverage is still there for you going forward.

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