will my cobra policy change when my covered spouse becomes eligible for medicare

If a COBRA beneficiary becomes entitled to Medicare during their COBRA continuation period, coverage is terminated unless otherwise stated by their policy details. If your coverage ends and your spouse or children are covered under the plan, their coverage will generally continue until the 18th month.

Full Answer

How long does Cobra coverage last for Medicare?

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.

Do spouses and dependents qualify for Cobra if they have Medicare?

Some people may decide to keep their COBRA coverage along with Medicare in order to retain additional benefits offered through the employer’s health plan. Do spouses and dependents qualify for COBRA if they lose coverage when an employee ages into Medicare? Yes. Employee enrollment in Medicare is considered a qualifying event under COBRA.

Should I enroll in Medicare Part B or cobra?

You should enroll in Part B immediately because you are not entitled to a Special Enrollment Period (SEP) when COBRA ends. Your spouse and dependents may keep COBRA for up to 36 months, regardless of whether you enroll in Medicare during that time. You may be able to keep COBRA coverage for services that Medicare does not cover.

What happens if an employee elects Cobra and then receives 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.

Can my spouse stay on COBRA If I go on Medicare?

Your spouse and dependents may keep COBRA for up to 36 months, regardless of whether you enroll in Medicare during that time. You may be able to keep COBRA coverage for services that Medicare does not cover.

Can I have both Medicare and COBRA?

If you have Medicare first and then become eligible for COBRA, you can have both Medicare and COBRA. It is important to remember that Medicare pays first and COBRA pays second.

Is going on Medicare a qualifying event for COBRA?

ANSWER: No, Medicare entitlement is not a COBRA qualifying event under these circumstances. If a COBRA triggering event, such as Medicare entitlement, does not cause loss of coverage under your plan, there is no qualifying event, and COBRA need not be offered.

How does COBRA insurance work for spouse?

Under COBRA, participants, covered spouses and dependent children may continue their plan coverage for a limited time when they would otherwise lose coverage due to a particular event, such as divorce (or legal separation).

What happens if I turn 65 while on COBRA?

The risks in electing COBRA at 65 or older include missing Medicare Part B enrollment deadlines and paying premium penalties, having a gap in medical coverage and being responsible for large medical bills you didn't anticipate.

How long can a spouse stay on COBRA?

36 monthsIf the qualifying event is the death of the covered employee, divorce or legal separation of the covered employee from the covered employee's spouse, or the covered employee becoming entitled to Medicare, COBRA for the spouse or dependent child lasts for 36 months.

Does COBRA count as creditable coverage for Medicare?

Does COBRA Count as Creditable Coverage for Medicare? To avoid penalties with Medicare, you must have creditable coverage. This means coverage that's at least equivalent to Medicare. COBRA does NOT meet these standards.

Is turning 65 a COBRA qualifying event?

After an employee turns 65 and loses eligibility for employer-sponsored health insurance by reducing hours or terminating employment, the plan sponsor should send the COBRA election notice because this is a COBRA-qualifying event.

What is a second qualifying event for COBRA?

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 does Medicare work with COBRA?

In this situation, Medicare is always primary to COBRA coverage. If you become entitled to Medicare after you've signed up for COBRA, your COBRA benefits cease. (But if COBRA covers your spouse and/or dependent children, their coverage may be extended for up to 36 months because you qualified for Medicare.)

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

Can I have Medicare and employer coverage at the same time? Yes, you can have both Medicare and employer-provided health insurance. In most cases, you will become eligible for Medicare coverage when you turn 65, even if you are still working and enrolled in your employer's health plan.

Can I drop my spouse from COBRA?

There is no qualifying event that triggers offering COBRA when an employee makes a voluntary choice to drop dependents from the health insurance plan during open enrollment. Generally, COBRA requires that an employee, spouse or dependent child be covered by the plan the day prior to the qualifying event.

How long can a spouse continue Cobra?

A covered employee's spouse who would lose coverage due to a divorce may elect continuation coverage under the plan for a maximum of 36 months. A qualified beneficiary must notify the plan administrator of a qualifying event within 60 days after divorce or legal separation. After being notified of a divorce, the plan administrator must give notice, generally within 14 days, to the qualified beneficiary of the right to elect COBRA continuation coverage.

What is the law for cobra?

The law generally applies to all group health plans maintained by private-sector employers with 20 or more employees, or by state or local governments. The law does not apply to plans sponsored by the Federal Government or by churches and certain church-related organizations. In addition, many states have laws similar to COBRA, including those that apply to health insurers of employers with less than 20 employees (sometimes called mini-COBRA). Check with your state insurance commissioner's office to see if such coverage is available to you.

What is FMLA coverage?

The Family and Medical Leave Act (FMLA) requires an employer to maintain coverage under any group health plan for an employee on FMLA leave under the same conditions coverage would have been provided if the employee had continued working. Coverage provided under the FMLA is not COBRA coverage, and taking FMLA leave is not a qualifying event under COBRA. A COBRA qualifying event may occur, however, when an employer's obligation to maintain health benefits under FMLA ceases, such as when an employee taking FMLA leave decides not to return to work and notifies an employer of his or her intent not to return to work. Further information on the FMLA is available on the Website of the U. S. Department of Labor's Wage and Hour Division at dol.gov/whd or by calling toll-free 1-866-487-9243.

What is continuation coverage?

If you elect continuation coverage, the coverage you are given must be identical to the coverage currently available under the plan to similarly situated active employees and their families (generally, this is the same coverage that you had immediately before the qualifying event). You will also be entitled, while receiving continuation coverage, to the same benefits, choices, and services that a similarly situated participant or beneficiary is currently receiving under the plan, such as the right during open enrollment season to choose among available coverage options. You will also be subject to the same rules and limits that would apply to a similarly situated participant or beneficiary, such as co-payment requirements, deductibles, and coverage limits. The plan's rules for filing benefit claims and appealing any claims denials also apply.

How long do you have to elect Cobra?

If you are entitled to elect COBRA coverage, you must be given an election period of at least 60 days (starting on the later of the date you are furnished the election notice or the date you would lose coverage) to choose whether or not to elect continuation coverage.

Can you use the Health Coverage Tax Credit for Cobra?

The Health Coverage Tax Credit (HCTC), while available, may be used to pay for specified types of health insurance coverage ( including COBRA continuation coverage).

Can you extend your 18 month coverage?

If you are entitled to an 18 month maximum period of continuation coverage, you may become eligible for an extension of the maximum time period in two circumstances. The first is when a qualified beneficiary is disabled; the second is when a second qualifying event occurs.

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.

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.

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.

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.

Do you have to tell Cobra if you are divorced?

You or the covered employee needs to tell the plan administrator if you qualify for COBRA because you got divorced or legally separated (court-issued separation decree) from the covered employee, or you were a dependent child or dependent adult child who's no longer a dependent.

Do you have to tell your employer if you qualify for Cobra?

Once the plan administrator is notified, the plan must let you know you have the right to choose COBRA coverage.

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.)

What happens after a COBRA election?

the employer ceases to maintain any group health plan. after the COBRA election, an individual obtains coverage with another employer group health plan. after the COBRA election, a beneficiary first becomes entitled to Medicare benefits.

How long does it take for a group health plan to notify the administrator of a second qualifying event?

If a second qualifying event is the death of the covered employee or the covered employee becoming entitled to Medicare benefits, a group health plan may require qualified beneficiaries to notify the plan administrator within 60 days of those events, as well.

How long do you have to notify Medicare plan administrators of a qualifying event?

Employers must notify plan administrators of a qualifying event within 30 days after an employee's death, termination, reduced hours of employment, or entitlement to Medicare (when an employee's Medicare entitlement results in loss of plan coverage for the employee's dependents).

How long do you have to notify a disability plan of a disability determination?

If the plan does not specify an alternative 60-day period with respect to a disability determination issued before the qualifying event, the qualified beneficiary is required to notify the plan of the disability determination only within the initial 18-month period of continuation coverage.

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.

Who pays first, Medicare or Cobra?

Who pays first; COBRA, or Medicare? Medicare pays first, except when you have End-Stage Renal Disease. If you have End-Stage Renal Disease, then COBRA pays first. Medicare pays second to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility.

When do you have to enroll in COBRA?

If you’re on COBRA and under 65, you must enroll in Part A and Part B during your Initial Enrollment Period. Your Initial Enrollment Period will begin three months before your 65th birthday. If you don’t join during the seven-month window, you’ll incur penalties.

Can you terminate Cobra insurance?

It’s important to note that your COBRA coverage could be terminated before the maximum period if you become entitled to Medicare after electing to continue coverage.

Can you have cobra and Medicare at the same time?

It’s possible to have COBRA and Medicare coverage at the same time. However, they don’t coordinate the same way as employer coverage and Medicare. When you have COBRA, Medicare usually pays first, and COBRA pays second. However, it’s possible that your group insurance has special rules that will determine the primary payer.

Is Cobra a part of Medicare?

COBRA is NOT creditable coverage for Part B. If you delay enrollment you’ll face life-time penalties. You could choose to have Medicare Part A and B, alongside COBRA. But COBRA wasn’t made for Medicare.

Can you get a special enrollment period with Medicare?

Medicare allows you to qualify for a Special Enrollment Period if you lose your employer’s current health coverage, and you’re Medicare eligible . If you have COBRA when coverage ends, you won’t qualify for a Special Enrollment Period through Medicare.

Is Cobra a creditable insurance?

COBRA is NOT creditable coverage. If you’re Medicare-eligible and have COBRA, you should enroll in Part B. COBRA extends group benefits for a set period of time – up to 18 months. It’s rare for COBRA to be the best option for a Medicare-eligible person. You can usually get better coverage for less money than COBRA.

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 ...

How to contact CMS about Medicare?

Your employees can contact the CMS Benefits Coordination & Recovery Center at 1-855-798-2627 with questions about Medicare and COBRA. As always, do your best!

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.

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.

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, ...

When is COBRA primary?

Note: If you are eligible for Medicare due to End-Stage Renal Disease (ESRD), your COBRA coverage is primary during the 30-month coordination period. Be sure to learn about ESRD Medicare rules when making coverage decisions.

Is Medicare Part A or Part B?

If you have Medicare Part A or Part B when you become eligible for COBRA, you must be allowed to enroll in COBRA. Medicare is your primary insurance, and COBRA is secondary. You should keep Medicare because it is responsible for paying the majority of your health care costs.

How long does it take to get Medicare if you don't have Cobra?

If you’re not going to be eligible for Medicare yourself within 18 months (or up to 36 months, depending on the circumstances), you’ll have to come up with another plan for coverage when your COBRA continuation coverage runs out.

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).

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.

How long can a spouse stay on Cobra?

A spouse or dependent would be eligible to remain on COBRA coverage until the later of: 18 months from the loss of coverage due to the reduction in hours or termination. 36 months from the date the employee first became Medicare entitled.

How long does Cobra last?

When this occurs, COBRA can remain in place for up to 18 months. This is true provided an individual is enrolled in Medicare prior to electing to continue coverage under COBRA.

What happens if an employee cancels Medicare?

If an active employee cancels their employer sponsored coverage after enrolling in Medicare, that is considered a voluntary drop in coverage and the spouse and dependents would not be offered COBRA.

Does Cobra coverage end early?

If a COBRA qualified beneficiary (QB) become s Medicare entitled (eligible and enrolled), the COBRA coverage will terminate early for the individual who becomes Medicare entitled.

Is COBRA a secondary plan?

Medicare would be secondary to the coverage provided by the employer and can remain enrolled in both plans. The employee would need to stay on the employer sponsored health plan to keep your spouse covered, and if they voluntarily drop the plan there is no offer of COBRA.

Is Cobra a continuation of Medicare?

The relationship between COBRA continuation and Medicare can often cause confusion. At times Medicare entitlement (enrollment) can trigger a need to offer COBRA, but at other times it can trigger a termination of COBRA coverage.

Does Cobra pay first or second?

If an individual is enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if they are not enrolled in Medicare.

Table of Contents

Background

Premium Assistance

Covered Benefits

Periods of Coverage

• 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. If a qualified beneficiary is determined to be entitled to disability benefits under Titles II or XVI of the Soc...

See more on cms.gov

Shortened Periods of Coverage

Notices Required of Qualified Beneficiaries

Paying For Coverage

Other Coverage Considerations

Contact Information