cobra for spouse when employee goes on medicare

A covered employee becomes entitled to Medicare 8 months before they are terminated and they enroll in COBRA. Because the covered employee was entitled to Medicare before enrolling in COBRA, the spouse would be eligible for 36 months of COBRA coverage from the date the covered employee became eligible for Medicare.

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Should you pay for Cobra?

COBRA requires continuation coverage to be offered to covered employees, their spouses, former spouses, and dependent children when group health coverage would otherwise be lost due to certain specific events. COBRA continuation coverage is …

Can You get Cobra when retiring before eligible for Medicare?

Feb 02, 2014 · But if your spouse became eligible for Medicare and then left his or her employment (and thus lost access to employer-sponsored coverage) within 18 months of becoming eligible for Medicare, you can continue your spousal coverage with COBRA for up to 36 months from the date your spouse became eligible for COBRA.   So for example, if your …

Is COBRA primary over Medicare?

The Consolidated Omnibus Budget Reconciliation Act, or COBRA, is a federal law that requires employers to offer health care continuation to covered employees, their spouses and their dependents after a qualifying event. Enrollees can be required to pay 102 percent of premium costs, which includes the full premium and a 2 percent administrative fee.

Who is eligible for Cobra coverage?

Jun 29, 2021 · When an employee enrolls in Medicare and subsequently voluntarily drops the group health plan, their spouse does not become a qualified beneficiary eligible for COBRA coverage. Medicare entitlement (i.e. eligible & enrolled) is only a COBRA qualifying event (QE) if it causes an employee to lose group health coverage (i.e. under 20 lives, or retiree plan). …

What happens to my spouse when I go on Medicare?

Your Medicare insurance doesn't cover your spouse – no matter whether your spouse is 62, 65, or any age. But in some cases, a younger spouse can help you get Medicare Part A with no monthly premium. Traditional Medicare includes Part A (hospital insurance) and Part B (medical insurance).

Can you have Medicare and COBRA insurance at the same time?

If your Medicare benefits (Part A or Part B) become effective on or before the day you elect COBRA coverage, you can continue COBRA coverage as well as having Medicare. This is true even if your Part A benefits begin before you elect COBRA but you don't sign up for Part B until later.

How does COBRA and Medicare work together?

COBRA and Medicare will work together when a person already has Medicare and experiences a qualifying event. Medicare will become the primary insurer, and the COBRA continuation coverage will become the secondary insurer. However, if a person has COBRA first, the coverage will end on the first day of Medicare coverage.Jun 10, 2020

Does COBRA end when Medicare begins?

If you have COBRA continuation coverage before you enroll in Medicare, your COBRA coverage may end. This is because the employer has the option of canceling continuation coverage when Medicare entitlement begins. The length of time your spouse receives coverage under COBRA may change when you enroll in Medicare.

Can COBRA coverage spouse only?

Each qualified beneficiary has a separate right to elect COBRA continuation coverage. For example, the employee's spouse may elect continuation coverage even if the employee does not. COBRA continuation coverage may be elected for only one, several, or all dependent children who are qualified beneficiaries.

Is COBRA secondary to Medicare?

If you get COBRA Before Medicare Medicare will become primary, and if you can keep COBRA, it will become your secondary insurer.

Is COBRA primary or secondary to Medicare?

When you're eligible for or entitled to Medicare due to ESRD, COBRA pays first, and Medicare pays second during a coordination period that lasts up to 30 months after you're first eligible for Medicare.

Is COBRA considered creditable coverage for Medicare Part B?

Is COBRA creditable coverage for Medicare Part B? COBRA is NOT creditable coverage for Part B. If you delay enrollment, you'll face lifetime penalties.Jan 17, 2022

Do I have to enroll in Medicare Part B if I have COBRA?

If you have COBRA first and then become eligible for Medicare, your COBRA coverage may end. Since you will not be fully covered with COBRA you should enroll in Medicare Part A and Part B when you are first eligible to avoid a late enrollment penalty.

What happens to my dependents when I go on Medicare?

Summary: Medicare is individual insurance, not family insurance, and coverage usually does not include spouses and children. Unlike other types of insurance, Medicare is not offered to your family or dependents once you enroll. To get Medicare, each person must qualify on their own.

Can I get COBRA if my husband retires?

But if your spouse became eligible for Medicare and then left his or her employment (and thus lost access to employer-sponsored coverage) within 18 months of becoming eligible for Medicare, you can continue your spousal coverage with COBRA for up to 36 months from the date your spouse became eligible for COBRA.Sep 17, 2020

Is Medicare entitlement A COBRA qualifying event?

Medicare entitlement of the employee is listed as a COBRA qualifying event; however, it is rarely a qualifying event. In situations where it is a qualifying event, it is only a qualifying event for the spouse or children that are covered under the group health plan.Aug 1, 2019

How long can you keep cobra?

In most cases, COBRA allows you to continue coverage for 18 months. But if your spouse became eligible for Medicare and then left his or her employment (and thus lost access to employer-sponsored coverage) within 18 months of becoming eligible for Medicare, you can continue your spousal coverage with COBRA for up to 36 months from ...

How long do you have to pick a new insurance plan after losing your spouse's insurance?

Losing the coverage you had under your spouse's plan will make you eligible for a time-limited special enrollment period in the individual insurance market, on- or off-exchange (note that in this case, you have 60 days before the loss of coverage, and 60 days after the loss of coverage, during which you can pick a new plan).

Who is Elizabeth Davis?

Elizabeth Davis, RN, is a health insurance expert and patient liaison. She's held board certifications in emergency nursing and infusion nursing. If your health insurance coverage comes through your spouse’s job, you may lose that coverage when he or she retires and goes on Medicare. Not so long ago, this was a scary and expensive prospect, ...

Is Medicaid a separate program from Medicare?

It’s easy to confuse Medicaid and Medicare, but they're separate programs with different benefits and different eligibility criteria. In many states, low-income people making up to 138% of federal poverty level are eligible for Medicaid.

Can I get medicaid if my income is low?

If your income is low enough, you may be eligible for government-provided health insurance through Medicaid. In some states, the Medicaid program goes by another name like SoonerCare in Oklahoma or Medi-Cal in California. It’s easy to confuse Medicaid and Medicare, but they're separate programs with different benefits and different eligibility criteria.

What happens if you enroll in Cobra?

This means that if your employees enroll in COBRA instead of Medicare, once COBRA coverage ends, they will have to wait until the next annual enrollment period to enroll in Medicare, and they will have to pay late penalties. The late penalties are not minor, either. For Medicare Part B, for example, the monthly premium goes up 10 percent ...

What is the cobra law?

The Consolidated Omnibus Budget Reconciliation Act, or COBRA, is a federal law that requires employers to offer health care continuation to covered employees, their spouses and their dependents after a qualifying event. Enrollees can be required to pay 102 percent of premium costs, which includes the full premium and a 2 percent administrative fee.

How much does Medicare Part B premium go up?

For Medicare Part B, for example, the monthly premium goes up 10 percent for every 12-month period enrollment was delayed. Enrollees have to pay this penalty for the rest of their lives. If your employees are trying to decide between COBRA and Medicare, make sure they understand that they must enroll in Medicare if they want to avoid expensive ...

Is Medicare Part A free?

Some younger individuals with certain chronic health conditions may qualify as well. Some of your employees may be disappointed to learn that Medicare is not free, although most enrollees qualify for premium-free Medicare Part A.

Does Cobra end?

Their COBRA coverage may end at this time. If your employees have Medicare first and then become eligible for COBRA, they may decide to keep both coverage types. This can be expensive, since they will have to pay for both, but they may find it to be worthwhile. If someone is enrolled in both COBRA and Medicare, Medicare is the primary insurance.

Is Cobra the same as Medicare?

If someone is enrolled in both COBRA and Medicare, Medicare is the primary insurance. In other words, Medicare pays first, and COBRA may pay some of the costs not covered by Medicare. Certain benefits are not included in traditional Medicare. For example, dental, vision and hearing benefits are generally excluded from Medicare coverage, ...

Is Medicare a qualifying event?

Yes. Employee enrollment in Medicare is considered a qualifying event under COBRA. Imagine this scenario: One of your employees turns 65 and ages into Medicare, but he’s not ready to retire yet. He keeps working. Now he has two health plan options: his group health plan and Medicare.

What is Cobra coverage?

This section provides information about COBRA continuation coverage requirements that apply to state and local government employers that maintain group health plan coverage for their employees. Group health plan coverage for state and local government employees is sometimes referred to as “public sector” COBRA to distinguish it from the requirements that apply to private employers. The landmark COBRA continuation coverage provisions became law in 1986. The law amended the Employee Retirement Income Security Act of 1974 (ERISA), the Internal Revenue Code and the Public Health Service Act (PHS Act) to provide continuation of employer-sponsored group health plan coverage that is terminated for specified reasons. CMS has jurisdiction to interpret and administer the COBRA law as it applies to state and local government (public sector) employers and their group health plans. Individuals who believe their COBRA rights are being violated have a private right of action. The COBRA law only applies to group health plans maintained by employers with 20 or more employees in the prior year. In addition, the law does not apply to plans sponsored by the governments of the District of Columbia or any territory or possession of the United States, certain church-related organizations, or the federal government. (The Federal Employees Health Benefit Program is subject to generally similar requirements to provide temporary continuation of coverage (TCC) under the Federal Employees Health Benefits Amendments Act of 1988.)

How long does Cobra last?

In most cases, COBRA coverage for the covered employee lasts a maximum of 18 months. However, the following exceptions apply: 29-Month Period (Disability Extension): Special rules apply for certain disabled individuals and family members.

What are the second qualifying events for Medicare?

Second qualifying events may include the death of the covered employee, divorce or legal separation from the covered employee, the covered employee becoming entitled to Medicare benefits (under Part A, Part B or both), or a dependent child ceasing to be eligible for coverage as a dependent under the group health plan.

How long is premium assistance?

Premium assistance was available for up to 15 months, calculated depending on the circumstances. Individuals still receiving 9 months of premium assistance could receive an additional six months of premium assistance (for a total of 15 months coverage).

When does continuation coverage end?

Continuation coverage generally begins on the date of the qualifying event and ends at the end of the maximum period. However, a period of coverage may end earlier if: an individual does not pay premiums on a timely basis. the employer ceases to maintain any group health plan.

What happens if you don't pay your insurance premiums?

If you do not make premium payments by the first day of the period of coverage, the plan has the option to cancel coverage until payment is received and then reinstate the coverage retroactively to the beginning of the period of coverage if payment is made within the grace period.

Does Cobra apply to life insurance?

Federal COBRA requirements only apply to employment-related group health plan coverage. They do not apply to individual or association health insurance policies, and they do not apply to any non-health benefits through the employer, such as life insurance.

What is Cobra insurance?

COBRA, or the Consolidated Omnibus Budget Reconciliation Act, is a law that gives workers and families that lose employer health coverage the right to maintain the coverage by paying the full premiums. If a company has more than 20 employees, it is required to offer COBRA benefits. COBRA allows coverage for 18 months, sometimes longer, ...

How long does Cobra last?

If a company has more than 20 employees, it is required to offer COBRA benefits. COBRA allows coverage for 18 months, sometimes longer, so if the working spouse can wait to retire until 18 months before the younger spouses 65th birthday, this would work out nicely. One caveat to this is that the premiums are going to be much higher than ...

How long do you have to work to qualify for Medicare?

First, it is important to know how eligibility for Medicare works. Most Medicare beneficiaries have worked and paid Medicare payroll taxes for at least 10 years to qualify for premium-free Medicare Part A as well as Part B coverage. If you have not worked for 10 years but your spouse has, you are allowed to claim benefits on their record. Medicare benefits cannot start earlier than when you turn 65, unless you are disabled, have ALS, or have end-stage renal disease. Medicare will only cover you, not your spouse or children if they are not eligible on their own.

Does Medicare cover spouse?

Medicare will only cover you, not your spouse or children if they are not eligible on their own. This is where problems begin, especially when a working spouse is older than a non-working spouse. Say the working spouse turns 65, retires, and claims Medicare. The other spouse is only 61.

How many employees can you have with Cobra?

In general, COBRA only applies to employers with 20 or more employees. However, some states require insurers covering employers with fewer than 20 employees to let you keep your coverage for a limited time.

What is Cobra insurance?

COBRA is a federal law that may let you keep your employer. group health plan. In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families. This is called "continuation coverage.". coverage for a limited time after your employment ends or you lose coverage as a dependent ...

How long do you have to sign up for Part B?

If you’re eligible for Medicare, you don’t qualify for COBRA coverage without having to pay a premium. You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA.

How long does Cobra last?

COBRA coverage generally is offered for 18 months (36 months in some cases). Ask the employer's benefits administrator or group health plan about your COBRA rights if you find out your coverage has ended and you don't get a notice, or if you get divorced.

What is the number to call for Medicare?

If your group health plan coverage was from a state or local government employer, call the Centers for Medicare & Medicaid Services (CMS) at 1-877-267-2323 extension 61565. If your coverage was with the federal government, visit the Office of Personnel Management.

How long is Cobra coverage?

In certain circumstances, if a disabled individual and non-disabled family members are qualified beneficiaries, they are eligible for up to an 11-month extension of COBRA continuation coverage, for a total of 29 months. The criteria for this 11-month disability extension is a complex area of COBRA law. We provide general information below, but if you have any questions regarding your disability and public sector COBRA, we encourage you to email us at [email protected].

How long does it take for Cobra to be paid?

A group health plan cannot require payment for any period of COBRA continuation coverage earlier than 45 days after the day on which the qualified beneficiary made the initial election for continuation coverage .

What is the cobra?

The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) amended the Public Health Service Act, the Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) to require employers with 20 or more employees to provide temporary continuation of group health coverage in certain situations where it would otherwise be terminated.

Who has jurisdiction over Cobra?

The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS) has jurisdiction with respect to the COBRA continuation coverage requirements of the PHS Act that apply to state and local government employers, including counties, municipalities and public school districts, and the group health plans that they sponsor.

What is the COBRA requirement?

Title XXII of the Public Health Service (PHS) Act, 42 U.S.C. §§ 300bb-1 through 300bb-8, applies COBRA requirements to group health plans that are sponsored by state or local government employers. It is sometimes referred to as “public sector” COBRA to distinguish it from the ERISA and Internal Revenue Code requirements ...

How long do you have to notify Cobra?

Qualified beneficiaries must be given an election period of at least 60 days during which each qualified beneficiary may choose whether to elect COBRA coverage.

How long does it take to get a Cobra election notice?

If the employer also is the plan administrator and issues COBRA notices directly, the employer has the entire 44-day period in which to issue a COBRA election notice.

How long does a spouse have to be on Cobra?

If the employee became entitled to Medicare less than 18 months before the qualifying event, COBRA coverage for the employee’s spouse and dependents is available for up to 36 months after the date the employee becomes entitled to Medicare.

What does it mean to be eligible for Medicare?

Being entitled for Medicare means you have already enrolled.

What age do you have to be to qualify for Medicare?

Age 65 and older and group health plan: 1 Employer with fewer than 20 employees: Medicare pays primary, group health plan pays secondary. 2 Employer with more than 20 employees: group health plan pays primary, Medicare pays secondary.

Is Cobra a group health plan?

COBRA coverage is not considered a group health plan based upon current employment. So, if an employee becomes eligible for Medicare but elects not to enroll at that time, believing he or she will enroll in COBRA instead, there are no future “special enrollment rights” for Medicare. The employee would have to wait until the Medicare enrollment period. This situation may also lead to a late enrollment penalty for Medicare Part B when COBRA coverage ends.

Can you terminate Cobra early?

Enrollment in COBRA, Then Medicare Eligibility: If you’re already enrolled in COBRA and subsequently become Medicare entitled, your COBRA coverage can be terminated early.

Does Cobra affect Medicare?

If an employee elects COBRA and then becomes entitled to Medicare, the employee’s Medicare entitlement terminates COBRA early but this does not affect the COBRA rights of dependents as long as they are not entitled to Medicare themselves.

Is Medicare a COBRA qualifying event?

Medicare entitlement is not a COBRA-qualifying event because it does not cause loss of employer plan coverage. Think of it this way: If someone turns 65, is still working and remains eligible for employer-sponsored health insurance but enrolls in Medicare, there is not a loss of coverage and, therefore, no COBRA-qualifying event.

How long does a spouse have to be on Cobra?

In this scenario, COBRA requires employers to offer the affected spouses and children to elect up to 36 months of COBRA coverage from the date of Medicare entitlement.

What is Cobra insurance?

0 comment (s) For private-sector employers who offer group health insurance plans and have 20 or more employees, the Consolidated Omnibus Budget Reconciliation Act (COBRA) requires that continuing medical care benefits be made available to former employees who lose their coverage due to a “qualifying event.”.

Is Medicare a triggering event?

If employers take such action and it leads to a loss of coverage for retirees’ spouses or dependents under the terms of the employer’s retiree coverage, then Medicare entitlement constitutes a triggering event for the qualifying beneficiaries.

How long is the grace period for COBRA?

COBRA Fines and Penalties. The IRS is authorized to assess an excise tax penalty for an employer’s failure to follow COBRA guidelines after a 30-day grace period to correct a negligent or accidental violation.

How much is excise tax?

The minimum excise tax is the greater of $2,500 for each beneficiary affected by the rule violation or $100 per day during the employer’s period of non-compliance. In certain circumstances, employers can be subject to a penalty of up to $15,000 instead of the minimum.

Can you be fired for gross misconduct?

While the termination can be involuntary (“for cause”) or voluntary (retirement, for example), being fired for gross misconduct disqualifies former employees. In most cases, employers who cover retirees under the same health plan and conditions as active employees need not offer COBRA coverage when an employee retires.

Table of Contents

See more on cms.gov

Background

Premium Assistance

Covered Benefits

Periods of Coverage

Shortened Periods of Coverage

Notices Required of Qualified Beneficiaries

Paying For Coverage

Other Coverage Considerations

Contact Information